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PVD > Ulceations, Aneurysms and AV fistulae > Flashcards

Ulceations, Aneurysms and AV fistulae Flashcards

1
Q

What is an ulceration?

A 
clinical defects in soft tissue caused by
trauma 
ischemia
infection 
noninfectious inflammatory disorders
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2
Q

The common denominator in any wound healing is

A

The presence of tissue necrosis

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3
Q

What is wound healing?

A

A condition in previously injured tissue represented by
Removal of necrotic tissue
Resolution of infection and inflammation
Organized collagen and mature, stable epithelium overlying viable tissue

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4
Q

Phases of wound healing

A

Inflammatory phase
Fibroblastic (lag) phase or proliferative
Remodeling phase

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5
Q

Remodeling phase begins at about

A

4th week and can last for years

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6
Q

Factors affecting would healing

A 
Diabetes
Infection
Necrotic tissue
Neuropathy
Medication
Pressure
Abnormal metabolic processes
Hyperlipidemia
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7
Q

Ulceration risk factors in DM foot

A 
LOPS
PAD
limited joint mobility
Foot deformities
Abnormal foot pressure 
Minor trauma
History of ulcerations or amputation
Impaired visual acuity `
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8
Q

peripheral neuropathy is in category

A

1

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9
Q

check for peripheral neuropathy

A

semi-annualy

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10
Q

Neuropathy, deformity and PAD is in category

A

2

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11
Q

check for Neuropathy, deformity and PAD

A

quaterly

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12
Q

if you have previous ulcer or amputation evaluate

A

monthly or quarterly

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13
Q

what the the category for previous ulcer or amputation

A

3

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14
Q

Risk factors for amputation

A 
Neuropathy LOPS
PAD
Inection
history of prior foot ulcer or amupyation
structural foot deformity
Trauma
Charcot foot
Impaired vision
Poor glycemic control
older age 
male sex
Ethnicity
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15
Q

Causes of LE wounds

A 
Ischemia
Venous dz
Trauma
Pressure
Neuropathy
Infection
Dermatitis
Surgery
Thermal injury
Hypertension
Diabetes
Renal dz
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16
Q

Ischemic ulcer can happen in

A

Lateral lower leg bony prominences
>Malleolus
>5th met base
>5th met head

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17
Q

What are some non-invasive vascular tests

A

ABI/TBI
Segmental pressure
TcPO2

18
Q

Ischemic ulcer management

A

Referral for underlying dz
Stop smoking
Nutritional support
Wound care and dressing

19
Q

Pressure induced ischemic injury results within

A

1-2 hrs

20
Q

Pressure induced ischemic injuries are usually located at

A

Pressure points
>heel
>MPJ

21
Q

Appearance of Neuropathic ulcer?

A

HPK border
Possibly undermined border
Typically not painful

22
Q

Location of Neuropathic ulcer?

A

dorsal aspect of digits
Plantar aspect of met heads
heel

23
Q

Neuropathic ulcer evauation

A

Semmes-Weinstein Nylon monofilament test
Plain-film radiographs should be obtained to look for soft tissue gas and foreign bodies
Adequate debridement
Probe the ulcer with a sterile blunt instrument to determine the involvement of underlying structures such as tendon, joint capusle or bone
probe the bone to test for osteomylitis

24
Q

How much should you debride?

A

you should remove all necrotic tissue and surrounding hyperkeratosis until a healthy bleeding edge is revealed

25
Q

What is the gold standard for Neuropathic ulcer managament ?

A

total contact casting

26
Q

What does total contact cast do?

A

reduces pressure
immobilizes tissues
Reduces edema
Non- removable

27
Q

What are some indications for TCC?

A

chronic non healing ulceration associated with neuropathis d/o
well perfused
non infected
wagner 1 & 2

28
Q

What are some contraindications for TCC?

A 
Active infection
Poor perfusion
Ischemia
narrow and deep ulcerations
History of dermatitis
Wagner 3,4,5
Claustrophobia
29
Q

Classification/staging systems

A 
Wagner
UTHSC-SA
Gibbons
Forest
Ten-level seattle wound classification system
30
Q

Wagner classifications

A

most ulcers will be grade I or II
Doesnt differentiate well between ulcers
No predicative value for prognosis

31
Q

Wagner classification-0

A

foot at risk

32
Q

Wagner classification-1

A

Superficial ulcers

33
Q

Wagner classification-2

A

Deep ulcers

34
Q

Wagner classification-3

A

Abscessed deep ulcers

35
Q

Wagner classification-4

A

limited gangrene

36
Q

Wagner classification-5

A

Extensive gangrene

37
Q

UTSA

A

Grades pt medical condition and wound

38
Q

UTSA-0

A

Areas of pressure which are sometimes called pre-ulcerative lesion

39
Q

UTSA-I

A

Superficial ulcer not including tendon, capsulla or bone

40
Q

UTSA-II

A

Deep ulcer incuding tendon, capsula but not bone

41
Q

UTSA-III

A

deep ulcer including bone and articulation

PVD (5 decks)

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