Ulcers

Question 1

Describe arterial ulcers

Answer 1

Arterial ulcers are generally in the foot and ankle, are painful, cold with no palpable pulses, low ABPI measurements and are punched out

Question 2

Describe venous ulcers and their causes

Answer 2

Venous causes are usually found in the foot and mid lower leg region and are flat and wet. Caused by venous hypertension secondary to venous insufficiency, associated oedema

Question 3

What are the risk factors for venous ulcers?

Answer 3

Varicose veins 
DVT
Venous insufficiency
Poor calf function 
Arterio-venous fistulae
Obesity
Leg fracture

Question 4

How should venous ulcers be investigated?

Answer 4

Dopplers and ABPI to assess for arterial disease
If no healing after 3 months, then biopsy for cancer – Marjolin’s ulcer a type of squamous cell carcinoma usually seen on the lower leg

Question 5

How are venous ulcers managed?

Answer 5

Graded compression bandaging promotes healing
Healing is better with bandages that are occlusive and absorb exudate improving comfort
Treat any infection with systemic antibiotics until sensitivities are available
Avoid topical antibiotics
Analgesia

Question 6

What are pressure ulcers?

Answer 6

These occur due to uninterrupted pressure on the skin and shearing and friction forces from being pulled or pushed over beds. Moisture from incontinence contribute too
Common locations are sacrum, heel and greater trochanter.

Question 7

What are the risk factors for pressure ulcers?

Answer 7

Extremes of age 
Reduced mobility and sensation
Vascular disease 
Chronic or terminal illness 
Malnourishment 
Incontinence

Question 8

How can patients be screened for pressure ulcer risk?

Answer 8

Screening for those at risk of pressure ulcers is done using the waterloo score.

Question 9

How are pressure ulcers managed?

Answer 9

Pressure relieving mattress and cushions
Referral to tissue viability nurse
Frequent repositioning
Optimise nutrition
Treat any infection with systemic antibiotics
Modern moist dressings to aid wound healing e.g. hydrocolloid or hydrogels
Debride dead or necrotic tissue

Question 10

How are pressure ulcers staged?

Answer 10

Staging – European Pressure Ulcer Advisory Panel

I Non-blanching erythema over intact skin

II Partial thickness skin loss e.g. shallow crater

III Full thickness skin loss extending into fat

IV Destruction of muscle, bone or tendons
Can lead to osteomyelitis if not treated