Non healing wounds Flashcards
Q: What is a non-healing wound?
A: A non-healing wound is a chronic skin and soft tissue wound that fails to heal within 4 to 6 weeks.
Q: What are the two main categories of non-healing wounds?
A: The two main categories are ulcers (pressure, neuropathic, venous, and arterial) and non-ulcer related chronic wounds (postoperative wound complications, neoplastic or radiation-induced skin lesions, and infectious or inflammatory wounds).
Q: What is the first step in assessing a patient with a non-healing wound?
A: Obtain a focused history and physical exam.
Q: What are common underlying conditions that prevent proper wound healing?
A: Common underlying conditions include diabetes, peripheral arterial disease, and poor nutritional status.
Q: What type of imaging is often obtained for pressure ulcers to evaluate for osteomyelitis?
A: Common underlying conditions include diabetes, peripheral arterial disease, and poor nutritional status.
Q: What type of imaging is often obtained for pressure ulcers to evaluate for osteomyelitis?
A: An MRI is often obtained to evaluate for osteomyelitis if there is exposed bone in the wound bed.
Q: What is the significance of checking HbA1c in patients with neuropathic ulcers?
A: Checking HbA1c helps ensure that the patient’s diabetes is under control to prevent further progression of the neuropathic ulcer.
Q: What is the common location of venous ulcers?
A: Venous ulcers are typically located at the medial malleolus.
Q: What is the diagnostic test for arterial ulcers?
A: An ankle-brachial index (ABI) is used to diagnose arterial ulcers, with an ABI of less than 0.9 confirming peripheral arterial disease.
Q: What should be considered if a patient has exposed bone in the wound bed of a pressure ulcer?
A: Consider obtaining an MRI to evaluate for osteomyelitis.
Q: What are the key features of neoplastic lesions in chronic wounds?
A: Neoplastic lesions can appear as hypo or hyperpigmented nodules, ulcers resembling a crater, or hard fixed raised nodules known as cauliflower lesions.
Q: What is a pressure ulcer?
A: A pressure ulcer is a wound caused by prolonged pressure that decreases blood flow to an area of skin and underlying soft tissue.
Q: What are the clinical features of a pressure ulcer?
A: Partial or complete skin loss with dark ischemic discoloration or necrosis over bony prominences, potentially exposing underlying fat, muscle, or bone.
Q: What is the typical onset of pressure ulcers?
A: Pressure ulcers typically develop in patients with a history of immobility and poor nutrition, often seen in those who are hospitalized or reside in nursing homes.
Q: How is a pressure ulcer diagnosed?
A: Diagnosis is based on clinical examination; MRI may be used to evaluate for osteomyelitis if there is exposed bone.
Q: How is a pressure ulcer managed and treated?
A: Management includes relieving pressure on the affected area, improving nutrition, and treating any underlying infections.
Q: What is a neuropathic ulcer?
A: A neuropathic ulcer is a wound occurring in patients with peripheral neuropathy, often from diabetes.
Q: What are the symptoms/clinical features of a neuropathic ulcer?
A: Deep painless “punched out” ulcer with surrounding callus, typically around pressure points such as the plantar metatarsal heads of the feet.
Q: What is the typical onset of neuropathic ulcers?
A: Neuropathic ulcers develop in patients with chronic conditions like diabetes that cause peripheral neuropathy.
Q: How is a neuropathic ulcer diagnosed?
A: Diagnosis involves clinical examination, checking HbA1c, and obtaining an ankle-brachial index to rule out peripheral arterial disease.
Q: How is a neuropathic ulcer managed and treated?
A: Management includes controlling diabetes, wound care, and reducing pressure around the wound with appropriate footwear and orthotics.
Q: What is a venous ulcer?
A: A venous ulcer is a wound caused by venous insufficiency, often seen in patients with a history of prolonged standing, smoking, or deep vein thrombosis.
Q: What are the symptoms/clinical features of a venous ulcer?
A: Shallow ulcers with irregular borders, surrounded by edematous, firm skin with reddish-brown hyperpigmentation, typically located at the medial malleolus.
Q: What is the typical onset of venous ulcers?
A: Venous ulcers develop in patients with chronic venous insufficiency and other risk factors like smoking or prolonged standing.
Q: How is a venous ulcer diagnosed?
A: Diagnosis involves clinical examination and a venous duplex ultrasound to check for venous reflux.
Q: How is a venous ulcer managed and treated?
A: Management includes compression therapy, elevation of the affected leg, and treating any underlying venous insufficiency.
Q: What is an arterial ulcer?
A: An arterial ulcer is a wound caused by peripheral arterial disease, often seen in patients with a history of atherosclerosis or smoking.
Q: What are the symptoms/clinical features of an arterial ulcer?
A: Punched-out, pale, gray, or yellow ulcer with a dry base, often located at the distal ends of digits like the toes, with reduced or absent peripheral pulses.
Q: What is the typical onset of arterial ulcers?
A: Arterial ulcers develop in patients with chronic conditions like peripheral arterial disease or atherosclerosis.
Q: How is an arterial ulcer diagnosed?
A: Diagnosis involves clinical examination and an ankle-brachial index (ABI) to evaluate for arterial insufficiency.
Q: How is an arterial ulcer managed and treated?
A: Management includes improving arterial blood flow, possibly through surgical interventions, and managing underlying conditions like atherosclerosis.
Q: What are postoperative wound complications?
A: Postoperative wound complications include wound disruption, dehiscence, evisceration, infection, or drainage following a surgical procedure.
Q: What are the symptoms/clinical features of postoperative wound complications?
A: Fever, tachycardia, partial or complete incisional disruption, drainage (serosanguinous, pus, or GI contents), and foul smell.
Q: What is the typical onset of postoperative wound complications?
A: These complications typically develop soon after a surgical procedure.
Q: How are postoperative wound complications diagnosed?
A: Diagnosis involves clinical examination, lab tests (CBC, ESR, CRP, albumin), and imaging (ultrasound or CT scan).
Q: How are postoperative wound complications managed and treated?
A: Management includes treating any infections, ensuring proper wound care, and addressing nutritional deficiencies.
Q: What are neoplastic lesions and radiation-induced skin changes?
A: Neoplastic lesions are malignant growths that can appear in chronic wounds, and radiation-induced skin changes result from radiation treatment.
Q: What are the symptoms/clinical features of neoplastic lesions and radiation-induced skin changes?
A: Neoplastic lesions can appear as nodules, ulcers, or raised nodules; radiation-induced changes can look like a rash that turns into shiny taut skin.
Q: What is the typical onset of neoplastic lesions and radiation-induced skin changes?
A: These conditions typically develop in patients with a history of malignancy or radiation treatment.
Q: How are neoplastic lesions and radiation-induced skin changes diagnosed?
A: Diagnosis involves obtaining a wound biopsy to check for malignant cells or epidermal necrosis with dermal inflammatory changes.
Q: How are neoplastic lesions and radiation-induced skin changes managed and treated?
A: Management depends on the specific condition and may involve treating the underlying malignancy or managing radiation-induced changes.
Q: What are infectious and inflammatory wounds?
A: These wounds result from inflammatory destruction of the skin and soft tissue, often triggered by infection or inflammatory conditions.
Q: What are the symptoms/clinical features of infectious and inflammatory wounds?
A: Open sores with necrotic debris, purulent discharge, and possible abscess; inflammatory wounds can resemble a dry rash with erythema.
Q: How are infectious and inflammatory wounds diagnosed?
A: Diagnosis involves clinical examination, wound swab cultures for infectious wounds, and biopsy for inflammatory wounds.
Q: How are infectious and inflammatory wounds managed and treated?
A: Management includes treating the underlying infection or inflammatory condition and providing appropriate wound care.
