Ulcer Types Flashcards
Define peripheral vascular disease (PVD)
- general term of disrupted arterial or venous blood flow to the extremities
Cause of peripheral vascular disease (PVD)
- smoking
- cardiac disease
- diabetes
- hypertension
- increased cholesterol & triglycerides
- obesity
- sedentary lifestyle
Define arterial insufficiency
- lack of blood flow to a region
Define venous insufficiency
- inadequate drainage of venous blood
Clinical presentation of an arterial ulcer
- wound base is necrotic & pale, no granulation tissue
- drainage is minimal
- painful
- trophic changes
- skin is cool to touch
- periwound is black or mummified
Rumor of Dependency Testing
- place patient supine
- elevate legs 60 degrees and hold for 60 secs
- if loss of color occurs, arterial involvement is suspected
- normal circulation will quickly flush pink
- impaired circulation will take >15 secs and can progress from pink, to purple-red, to bright red
What does it mean if Rubor test takes 25-40 secs
- severe ischemia
What does it mean if Rubor disappears quickly with elevation & returns in <25 secs
- may be venous reflux
Define ankle brachial index
- systolic blood pressure in the ankle divided by the systolic blood pressure of in the arm on the same side
Grading of ankle brachial index readings
Normal: >1.0<1.3
Mild peripheral arterial occlusive disease: 0.8-1.0
Intermittent claudication: <0.6
Moderate peripheral arterial occlusive disease: 0.5-0.8
Severe occlusive disease: <0.5
Resting ischemic pain: <0.26
Gangrenous extremity: <0.02
Interventions for arterial ulcers
- stop smoking
- start some exercise
- education
At risk population for venous ulcers
- inactive people
- diabetic people
- people with congestive heart failure
- obesity
- pregnancy
- aging
Clinical presentation of venous ulcers
- typically small, shallow, irregular margins, & flat border
- wound bed is red, granulation tissue is present
- moderate to large drainage
- pain varies but general painless
- skin temperature may be elevated
- edema, complaints of itching, fatigue, aching, & heaviness in involved limb
Define lipodermatosclerosis
- inflamed fat underneath the skin
Risk factors for pitting edema
- venous insufficiency
- obesity
- medications
- prolonged sitting/standing
- pregnancy
- congestive heart failure
When can compression therapy not be used to treat pitting edema
- when the patient has congestive heart failure
Define diabetic neuropathy
- generic term for any diabetic related disorder of the nerves
Clinical presentation of neuropathic ulcers
- located on the weight bearing surface of the foot
- anesthetic, round, & over bony prominences
- wound bed is discolored, granulation is central with less necrotic tissue
- minimal drainage unless infected
- rimmed by callous
- painless
- may be present for years
Define sensory neuropathy
- unable to sense pain or pressure
Risk of skin breakdown for people with sensory neuropathy
- decreased awareness
- mechanical stress
- repeated stress
Characteristics of motor neuropathy
- loss of intrinsic muscles of the foot
- poor weight distribution
- increased friction in shoes
- foot drop
Describe autonomic neuropathy
- decreased or absent sweat & oil production
- dry & inelastic skin
- increased susceptibility to skin breakdown & injury
- heavy callus formation
Interventions for neuropathic ulcers
- monitor & manage blood glucose, protection, & weight distribution
- antibiotics
- proper skin & wound care
- debridement & dressing selection
- prevention & education
