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Advanced Wound Care > Lower Leg Shit > Flashcards

Lower Leg Shit Flashcards

1
Q

What are is the pathophysiology of a venous ulcer?

A
  • venous stasis
  • valvular insufficiency
  • increased venous pressure of capillaries
  • leakage of fluids and macromolecules
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2
Q

What is the pathophysiology of an arterial ulcer?

A
  • arterial insufficiency
  • arteriosclerosis
  • emboli
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3
Q

Define a neuropathic ulcer

A

Loss of protective sensation commonly on the foot in which trauma causes a wound

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4
Q

Define a neuro-ischaemic ulcer

A

Loss of protective sensation and arterial disease

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5
Q

What are the aetiological factors of an ulcer?

A

1) Vascular - arteriosclerosis, venous stasis, vasculitis
2) Lymphatic - lymphangitis, lymphoma, lymphoedema
3) Haematological - anaemia, sickle cell anaemia, polycythemia
4) Metabolic - diabetes
5) Immunological - rheumatoid arthritis, Raynaud’s disease, scleroderma
6) Infection
7) Trauma - mechanical, chemical, thermal
8) Allergy - contact dermatitis
9) Malignancy - BBC, SCC, Melanoma

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6
Q

What are the goals of ulcer care?

A

1) remove or treat precipitating cause
2) improve circulation
3) promote and sustain healing
4) preventative care

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7
Q

What aspects of assessment are required for ulcer care?

A
  • Clinical assessment
  • Medical & surgical history
  • Identify predisposing factors
  • Identify factors that inhibit healing
  • Ankle/brachial index
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8
Q

What are the predisposing factors for an arterial ulcer?

A 
Arteriosclerosis
Advanced age
Diabetes
Hypertension 
Smoking
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9
Q

What are predisposing factors for a venous ulcer?

A

History of DVT
Valvular incompetence in the perforating veins
Obesity
Chronic constipation

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10
Q

What changes occur in the lower leg in arterial ulcers?

A 
Thin, shiny dry skin
Absence of hair growth
Thickened nails
Pallor on elevation
Limb may be cool
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11
Q

What changes occur in the lower leg in venous ulcers?

A 
Firm brawny oedema 
Reddish/brown pigmentation (haemosiderin)
Evidence of healed ulcers 
Varicosities
Warm leg
Hair on lower limb
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12
Q

What are common locations for arterial ulcers?

A 
Phalangeal hands
Toes (between or tips)
Above lateral malleolus
Over metatarsal heads
On side or sole of foot
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13
Q

What are common locations for venous ulcers?

A

Anteriomedial malleolus
Pretibial area
Gaiter area

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14
Q

Describe the clinical appearance of an arterial ulcer

A

Demarcated, punched out edges
Deep, pale wound base
Necrotic or sloughy

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15
Q

Describe the clinical appearance of a venous ulcer

A

Ragged edges
Ruddy-red colour unless infected
Shallow ulcer

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16
Q

What type of ulcer is associated with pain?

A

Arterial, relieved by lowering legs or walking. Venous can be with severe oedema or if infected but is relieved by elevation

17
Q

Describe the surround skin of an arterial ulcer

A

Neuropathic, thin, shiny, hairless

18
Q

Describe the surround skin of an venous ulcer

A

Haemosiderin staining, leaking oedema may result in maceration, pruritus, scaly skin, oedema, hair

19
Q

Which type of ulcer has normal pedal pulses?

A

Venous, arterial ulcers are associated with diminished, or absent pulses.

20
Q

What are the 7 points for general management?

A

1) daily inspection
2) skin hygiene
3) moisturise skin
4) stop smoking
5) avoid trauma
6) nutritious diet
7) loose weight

21
Q

What is some advice specific to a venous ulcer?

A
  • regular ambulation
  • calf and foot muscle exercises
  • elevate feet when sitting (above the heart)
  • elevate foot of bed
  • avoid constipation
22
Q

What is some advice specific to a arterial ulcer?

A
  • avoiding constrictive leg wear
  • sit with legs down in a neutral position
  • elevate head of bed for night pain
  • increase exercise as tolerated
  • avoid trauma
  • regular podiatry
  • avoid sudden temperature changes
23
Q

What are treatment options for an Arterial ulcer?

A

Consult a vascular specialist
Chemical or surgical sympathectomy for small vessel disease
Angioplasty or by-pass surgery for large vessels
Amputation in severe cases

24
Q

What are three goals of care for an arterial ulcer?

A

1) pain management
2) prevent infection
3) healing if tissue perfusion adequate

25
Q

What dressings are appropriate for an arterial ulcer?

A
  • Hydrogel or Hydrocolloid for hydration and autolytic debridement
  • foams for protection and absorption
  • silicone dressing for fragile skin
  • topical antiseptic if needed
  • ABI
26
Q

What are treatment options for an Venous ulcer?

A
  • Graduate compression therapy

- 30-40 mmHg pressure at the ankle & reducing by 50% below the knee. Vessel closure 32mmHg for treat leakage

27
Q

What are the benefits of compression therapy?

A
  • improve calf pump function
  • improve venous return
  • reduce venous hypertension
  • control venous oedema
28
Q

What are the classes of compression stockings?

A

Class 1- 20-30mmHg
Class 2- 30-40mmHg
Class 3- 40-59mmHg

29
Q

Describe what an ankle brachial pressure index is

A
  • Handheld ultrasound that measures arterial blood flow in the legs to assist in determining the type of ulcer.
  • calculated by ANKLE BP/BRACHIAL BP
30
Q

What ABI indicates an arterial ulcer, mixed ulcer and a venous ulcer?

A 
Arterial -  0.5
Mixed venous/arterial - 0.5-0.7
Mixed arterial venous - 0.7-0.8
Venous - 0.8-1.2
Calcified vessels - >1.2
31
Q

What other diagnostic procedures are used to asses ulcers?

A 
Duplex ultrasound
Blood pathology
FBC, Hb, ESR, BSL
Rh factor
Angiography
Venography
Biopsy
32
Q

What other complications are associated with macro-vascular diseases?

A
  • peripheral vascular disease (diabetes)
  • gangrene
  • infection
  • sensory neuropathy
  • peripheral motor neuropathy
  • charcots osteoarthropathy
33
Q

What devices can be utilised for lower leg rehabilitation?

A
  • off load pressure with a back slab cast
  • removable walker
  • darco shoe
  • cotton socks
34
Q

What is foot care advice a nurse can provide?

A
  • daily inspection
  • regular podiatry visits
  • early report of problems
  • wash feet daily
  • avoid temperate extremes
  • wear shoes
  • moisturise
  • cotton socks
  • buy shoes in the afternoon
35
Q

Name the 5 different types of ulcers

A

1) venous ulcer
2) arterial ulcer
3) mixed ulcer
4) neuropathic
5) neuro-ischaemic

Advanced Wound Care (6 decks)

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