Module 11 Flashcards
What are the predisposing factors for venous ulcers
Venous hypertension, valvular incompetence, impaired calf muscle pump function, obesity and history of DVT
Ulceration occurs when venous hypertension is
Greater than 90 mmHg
What are the reasons tissues become vulnerable to breakdown
Chronic stasis and edema
Distended veins in LE allow for
Pooling of blood
What is the most common cause of leg ulcers
Chronic venous insufficiency
Eczema or stasis dermatitis caused by _______ may result in _____
Edematous inflammatory agents, ulceration
Fluid that filters through the capillaries to the interstitial spaces contains
Dissolved proteins, electrolytes, salts, cells, and metabolic by products degrades and inactivated growth factors that come to the area during hemostasis
Location of venous ulcer
Medial aspect of distal third of lower extremity, posterior medial malleolus
The depth in a venous ulcer is
Shallow
The gaiter area for a venous ulcer is
Rich in perforated veins
Are venous ulcers typically painful
No
What is the most comfortable position for a venous ulcer
Elevating lower extremities
Venous ulcer wound bed will have ____ edema
Firm
Venous ulcer wound bed color
Beefy red, or reddish brown discoloration
What is the shape and margins of a venous ulcer
Large with irregular margin
Edges on a venous ulcer
Uneven
What is common on the wound base of a venous ulcer
Calcification
Exudate or drainage in a venous ulcer is frequently
Moderate to heavy
Post thrombotic syndrome may develop in _____ of all patients who experience lower extremity DVT
Half
What does CEAP stand for
Clinical signs, etiology can classification, anatomic distribution, physiologic dysfunction tool
C0 on the CEAP
No visible or palpable signs of venous disease
C1 on the CEAP
Reticular veins
C2 on the CEAP
Varicose veins
C3 on the CEAP
Edema
C4 CEAP
A) pigmentation and eczema b) atrophy Blanche
C5 CEAP
Healed venous ulcer
C6 CEAP
Skin changes with active ulceration
What are the goals in venous ulcer treatment
Increase venous return, decrease venous stasis and associated edema, provide compression, and address wound environment
Wound dressings are used to
Promote re epilthelialization and granulation when underlying pathophysiology has been treated
Occlusive compression dressings, bandages, wraps, and pneumatic sequential compression devices should not be used in the presence of
Sings of infection, cellulitis, or severe arterial disease
You should continue use of compression therapy after the wound has closed because
Venous ulcer can re occur
For treating a venous ulcer the legs should be elevated above the heart for
30 minutes 3-4 x per day
Calf muscle activity acts as a
Venous pump
Compression modalities are used to control
Stasis and edema
__ are not used when there is a wound present
Stockings
Elastic wraps are contraindicated with
Arterial disease, severe infection, weeping dermatitis, or friable tissue
Unna boot is a
Special gauze bandage made of cotton that contains zinc oxide paste and eases skin irritation and maintains moisture
Compression therapy requires ______ of pressure to counter act tissue capillary pressure
30-40 mmHg
Stockings should be replaced every
4-6 months
Intermittent pneumatic compression therapy lasts
One hour 5 days per week for up to 6 months
Intermittent pnematic compression pressure is __ at foot and ___ at thigh
45, 30
The degree of compression for these indications: prevent DVT, mild edema, tired, achy legs
20 mmHg
Pressure recommended for these recommendations Mild varicose veins, mild to moderate edema, long haul flights of greater than 4 hours, varicose veins during and after pregnancy
20-30mmHg
Pressure recommended for these indications : venous ulcer, DVT, superficial thrombophlebitis, following venous surgery, varicose veins with severe edema, post thrombotic syndrome, mild lymph edema
30-40 mmHg
Pressure recommended for these indications: severe lymph edema, severe chronic venous insufficiency
Greater than 40 mmHg
Compression stocking recommendations for spider veins, early varicose veins, aching feet and legs, and slight edema
8-15 mmHg
Compression stocking recommendations for varicose veins, mild edema and DVT prevention
Class one hosiery : 14-17 mmHg or 15-20 mmHg
Compression stocking recommendations for moderate varicose veins, mild edema and prevention of venous ulcer recurrence
Class two hosiery, 18-24 mmHg or 20-30 mmHg
Compression stocking recommendations for severe varicose veins, lymph edema, treatment after phlebitis, and to prevent and treat venous ulcers
Class 3 hosiery, 35-49 mmHg
Anti embolism stockings after surgery have what pressure
16-18 mmHg
Type 2 DM develops primarily due to progressive
B cell failure
An increase in insulin resistance causes a
Rise in blood glucose levels
Another name for type one and a half diabetes
Latent autoimmune diabetes in adults
Risk of cad and cvs increase ___ with diabetes
4 times
Older adults over the age of ___ have the greatest risk of developing diabetes
74
Charcot foot is a
Progressive destructive arthropathy present in an area of sensory loss due to peripheral neuropathy
Auto of neuropathy accompanies
Motor and sensation neuropathy
The Wagner wound classification system has a grading scale of
0-5
Grade 0 Wagner wound
No open lesion but may have deformity or cellulitis
Wagner wound grade 1
Superficial ulcer, partial or full thickness
Wagner wound grade 2
Ulcer extends to ligament, tendon, Joint capsule, or deep fascia without access, osteomyelitis, or joint sepsis
Wagner wound grade 3
Deep ulcer with abscess, osteomyelitis or joint sepsis, infection
Grade 4 Wagner wound
Gangrene localized to forefoot or heel
Wagner wound grade 5
Extensive gangrene
For a diabetic foot screen examine protective sensation
Use monofilaments 5.07 or 10 g semmes Weinstein
Testing arterial insufficiency for diabetic foot ulcers, what two tests
Ankle brachial index or toe brachial index
ABI and TBI values.
Normal is 1.0-1.2, mild is .8-1.0
Refer to a physician If there is
Less than .5 arterial insufficiency
ABI compares
Systolic BP in brachial artery with the dorsalis pedal or posterior tibial artery
Where is the systolic BP measured On the ankle
2.5 cm proximal to ankle malleolus
Calculate ABI by
Ankle SBP/ brachial SBP
Pressure of greater than ___ mmHg causes capillary closing
32
The pressure ulcer score for healing (push) tracks healing of stages _ to _
2 to 4
0 on PUSH means ulcer has
Closed
PUsH scores range from
0 to 17
Pressure sore status tool ranges from
13 to 65
Lower numbers on the pressure sore status tool means
Improvement
Scale that predicts not assesses healing
Sessing scale
Stage 1 pressure ulcer is
Non blanchanle erythema, initial development
Stage 2 pressure ulcer
Skin blisters or forms of an open sore, area around the sore may be red and irritated
Stage 3 pressure ulcer
Skin develops an open, sunken hole or crater, damage to tissue below the skin
Stage 4 pressure ulcer
Extends through deep fascia into underlying structures (muscle, bone, tendons and joints )
Pressure ulcers are unstageable when
Tissue at base of ulcer is covered by dead skin (yellow, tan, green or brown )
Most common cause of arteriosclerosis obliterans is
Arterial insufficiency ulcers
Fontaine classification of arterial insufficiency ulcers stage 1
Asymptomatic
Fontaine classification of arterial insufficiency ulcers stage 2
Intermittent Claudication
2a Fontaine classification
Pain free Claudication waking over 200 m
2b fontaine classification
Pain free, Claudication walking less than 200 m
Stage 3 Fontaine
Claudication with pain at rest
Stage 4 Fontaine
Necrosis, gangrene leading to possible amputation
Exercise prescription for PAD
Walking at intensity that elicits Claudication symptoms within 3-5 minutes pain score of 1
For PAD walking, continue walking until pain is a score of _ and stop until pain goes away
2
Repeated the rest walk cycle for PAD walking for ___ minutes
35
Increase PAD walking program by _ minutes up to __ minutes, _ to _ times per week for _ weeks
5, 50, 3, 5, 12
Criteria to progress walking to higher work rate in PAD
Patient can walk without having to stop for 8 minutes
Claudication pain rating scale
1: minimal discomfort, 2: moderate pain, 3: intense pain, 4: unbearable pain
Common locations of malignant melanomas
Trunk and LE
ABCDE for skin cancer
Asymmetrical border, brow or black, diameter greater than 6 mm and elevated or enlarged
Basal cell cancers are
More common and slow growing
Squamous cell cancers are
More invasive and malignant
