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Advanced Wound Care 467 > Module 5 - Lower leg ulcers and neuro-ischaemic foot > Flashcards

Module 5 - Lower leg ulcers and neuro-ischaemic foot Flashcards

1
Q

Types of Ulcers?

A
  • Venous Ulcers
  • Arterial Ulcers
  • Mixed Venous / Arterial Ulcers
  • Neuropathic
  • Neuro-ischaemic
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2
Q

Define an ulcer?

A

An ulcer is a loss of skin or mucosa integrity. The most common causes of leg ulcers are associated with vascular or neuropathic disorders and are referred to as:

Arterial - involving arteries and arterioles
Venous - involving veins and venules
Mixed arterial/venous - involving arteries, arterioles, veins and venules
neuropathic - due to loss of protective sensation

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3
Q

Aetiology of venous ulcers

A
  • Increased venous pressure
  • increased permeability of capillaries
  • leakage of fluid and macromolecules

leads to –>

venous stasis
valvular insufficiency

causing venous ulcers

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4
Q

Aetiology of arterial leg ulcers

A
  • Arterial insufficiency
  • arteriolosclerosis
  • Emboli

leads to –>

Peripheral arterial disease
Lower-extremity arterial disease
Peripheral vascular disease
Peripheral arterial occlusive
disease
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5
Q

Explain neuropathic ulcers

A

loss of sensation - commonly on the foot

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6
Q

Explain neuroischaemic ulcers

A

loss of sensation

loss of circulation

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7
Q

Aims of treatment

A
  • identify and treat precipitating cause
  • promote circulation and improve venous return
  • promote healing
  • promote preventative care
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8
Q

Essential guidelines for assessment of ulcers (page 133)

A
  • Clinical History
  • clinical examination
    - palpation of pedal and leg pulses
  • hand held Doppler ultrasound
  • ankle/brachial pressure index (ABPI)
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9
Q

Predisposing factors of an arterial ulcer

A
  • arteriosclerosis
  • Advanced age
  • Diabetes
  • Hypertension
  • Smoking
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10
Q

Associated changes in the leg?

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

Arterial ulcer locations

A 
Over phalangeal heads
Between toes or at tip of toes
Above lateral malleolus
Over metatarsal heads
On side or sole of foot
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12
Q

Arterial ulcer characteristics?

A

Well demarcated edges

pain at rest, relieved by lowering leg to a dependent position

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13
Q

pain factor of arterial leg ulcer?

A

Exceedingly painful
Pain when legs elevated
Relieved by lowering legs
or walking

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14
Q

surrounding skin of arterial leg ulcer?

A

May have neuropathy

Thin, shiny, hairless legs

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15
Q

pedal pulse of an arterial ulcer?

A

Diminished or absent foot and leg pulses

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16
Q

Predisposing factor of a venous ulcer?

A
  • History of deep venous thrombosis
  • Valvular incompetence in the perforating veins
  • Obesity
  • deficits in calf muscle pump

*chronic constipation (Joys thing)

17
Q

Associated changes in venous leg ulcers?

A 
-Firm “brawny” oedema
haemosiderin (Reddish brown
pigmentation)
-Evidence of healed ulcers
-dilated and tortous superficial veins (Varicosities)
Warm leg
Hair on leg/toes
18
Q

Venous leg ulcers locations?

A

Anterior to medial malleolus
Pretibial area
Generally lower 1/3 leg
(gaiter area)

19
Q

Venous leg ulcer characteristics?

A
  • uneven edges
  • ruddy granulation tissue
  • no necrotic tissue
20
Q

Pain factor for venous leg ulcer?

A
  • moderate to no pain

- discomfort relieved by elevation of leg

21
Q

Venous ulcers surrounding skin?

A

Leaking oedema may result in maceration, pruritus and scale

22
Q

Venous ulcer pedal pulses

A

Normal foot and leg pulses

23
Q

General ulcer education/advice

A 
Daily inspection
Skin hygiene
Moisturise skin
Stop smoking
Avoid trauma
Nutritious diet
Lose weight
24
Q

venous ulcer education for patient

A
  • Regular ambulation
  • Calf and foot muscle exercises
  • Elevate feet when sitting(above heart level)
  • Elevate foot of bed
25
Q

arterial ulcer education for patient

A 
Avoid constrictive leg wear
 Sit with legs down in neutral
position
 Elevate head of bed if night pain
 Increase exercise as tolerated
 Avoid trauma
 Regular podiatry care
 Avoid sudden temperature changes in
feet
26
Q

Consultant investigation/interventions

A
  • management of underlying disease
  • review of medications
  • duplex ultrasound
  • angiography/angioplasty
  • chemical or surgical sympathectomy
  • by-pass surgery
  • amputation
27
Q

Goal of treatment for arterial leg ulcers

A

-Pain management
-Prevent infection
-Healing if tissue perfusion
adequate

28
Q

Goal of compression therapy

A

Improve calf muscle pump function
Improve venous return
Reduce venous hypertension
Control venous oedema

29
Q

Types of bandages?

A

Short stretch:
cotton without elastomers, extension 40-90%,
low resting pressure

Long stretch:
contain elastomers, extension 90-140%, higher resting pressure

Systems:
a combination of short & long stretch multi-layers

30
Q

ABI <0.5

A
  • arterial ulcer

- no compression

31
Q

ABI 0.5-0.7

A

Mixed arterial/venous ulcer

  • trial bandage according to tolerance
  • 20-30mm HG
  • light to moderate compression
32
Q

ABI 0.7-0.8

A

Mixed arterial/venous ulcer

  • trial bandage according to tolerance
  • 20-30mm HG
  • light to moderate compression
33
Q

ABI 0.8-1.2

A

venous ulcer
trial bandage according to tolerance
30-40 mm Hg
moderate to high compression

34
Q

ABI >1.2

A

possibly calcified vessels
trial bandage according to tolerance
30-20mm Hg
moderate to light compression’

***ARTERIAL CALCIFACTION CAN GIVE A FALSELY ELEVATED ABI (USUALLY >1.2) IN WHICH CASE COMPRESSION IS USED WITH EXTREME CAUTION – SEEK FURTHER ADVISE _ sorry about the caps :)

35
Q

What are the pedal pulses do you palpate in a leg ulcer assessment?

A

dorsalis pedis pulse (on central dorsal part of the foot)

  • posterior tibial pulse (behind the medial malleolus)
  • peroneal pulse (lateral dorsal part of foot
  • popliteal pulse (behind the knee)
  • femoral pulse (in the groin)
36
Q

how do you measure a Ankle brachial pressure index?

A

lie down for 20-30 minutes

  • palpate pedal pulse s
  • record systolic BP for ankle and brachial SBP’s

brachial SBP

=

ABI

37
Q

Assessments involved in Neuroischaemic exam

A 
Doppler pressures (pedal pulses)
Capillary refill test
peripheral neuropathy (10 gram filament)
ABI
patellar and achillies tendon reflexes
Duplex ultrasound
Blood pathology FBC, Hb, CRP, BSL
Rh factor.
Angiography
Venography
Biopsy
X ray
38
Q

Foot care and advise

A 
Daily inspection
Regular podiatry visits
Early report of problems
Wash feet daily
Avoid extremes of temperature
Wear shoes
Moisturise but not between toes
Cotton socks
Buy shoes in afternoon & wear in gradually

Advanced Wound Care 467 (6 decks)

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