Ulcer Types

Question 1

Define peripheral vascular disease (PVD)

Answer 1

• general term of disrupted arterial or venous blood flow to the extremities

Question 2

Cause of peripheral vascular disease (PVD)

Answer 2

• smoking
• cardiac disease
• diabetes
• hypertension
• increased cholesterol & triglycerides
• obesity
• sedentary lifestyle

Question 3

Define arterial insufficiency

Answer 3

• lack of blood flow to a region

Question 4

Define venous insufficiency

Answer 4

• inadequate drainage of venous blood

Question 5

Clinical presentation of an arterial ulcer

Answer 5

• wound base is necrotic & pale, no granulation tissue
• drainage is minimal
• painful
• trophic changes
• skin is cool to touch
• periwound is black or mummified

Question 6

Rumor of Dependency Testing

Answer 6

• 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

Question 7

What does it mean if Rubor test takes 25-40 secs

Answer 7

• severe ischemia

Question 8

What does it mean if Rubor disappears quickly with elevation & returns in <25 secs

Answer 8

• may be venous reflux

Question 9

Define ankle brachial index

Answer 9

• systolic blood pressure in the ankle divided by the systolic blood pressure of in the arm on the same side

Question 10

Grading of ankle brachial index readings

Answer 10

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

Question 11

Interventions for arterial ulcers

Answer 11

• stop smoking
• start some exercise
• education

Question 12

At risk population for venous ulcers

Answer 12

• inactive people
• diabetic people
• people with congestive heart failure
• obesity
• pregnancy
• aging

Question 13

Clinical presentation of venous ulcers

Answer 13

• 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

Question 14

Define lipodermatosclerosis

Answer 14

• inflamed fat underneath the skin

Question 15

Risk factors for pitting edema

Answer 15

• venous insufficiency
• obesity
• medications
• prolonged sitting/standing
• pregnancy
• congestive heart failure

Question 16

When can compression therapy not be used to treat pitting edema

Answer 16

• when the patient has congestive heart failure

Question 17

Define diabetic neuropathy

Answer 17

• generic term for any diabetic related disorder of the nerves

Question 18

Clinical presentation of neuropathic ulcers

Answer 18

• 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

Question 19

Define sensory neuropathy

Answer 19

• unable to sense pain or pressure

Question 20

Risk of skin breakdown for people with sensory neuropathy

Answer 20

• decreased awareness
• mechanical stress
• repeated stress

Question 21

Characteristics of motor neuropathy

Answer 21

• loss of intrinsic muscles of the foot
• poor weight distribution
• increased friction in shoes
• foot drop

Question 22

Describe autonomic neuropathy

Answer 22

• decreased or absent sweat & oil production
• dry & inelastic skin
• increased susceptibility to skin breakdown & injury
• heavy callus formation

Question 23

Interventions for neuropathic ulcers

Answer 23

• monitor & manage blood glucose, protection, & weight distribution
• antibiotics
• proper skin & wound care
• debridement & dressing selection
• prevention & education