Ulcers - Sheet1

Question 1

What are the 4 stages of ulcers?

Answer 1

Stage I: non-blanchable erythema.
Stage II: like an unroofed blister, dermis exposed.
Stage III: exposed subdermal tissues; undermined edges.
Stage IV: exposed tendon or bone.
Unstageable: any wound with unobservable base due to eschar, exudate, etc.
Suspected deep tissue injury: a newer idea, that I think best applies to Stage I lesions.

Question 2

If there is heavy exudate or cannot see the base of the ulcer, what classification would you give it?

Answer 2

Unstageable or not stageable

Question 3

Three phases of healing

Answer 3

1. Inflammatory phase: extravisation (scabbing via monocytes; neutrophiles, macrophages,) 2. Reepithelialization and Neovascularization; fibroblasts 3. Remodeling

Question 4

Osteomyelitis

Answer 4

a sore over a bone. ESR, WBC, and X-ray (69% sensitivity if all three abnormal)

Question 5

Nutritional support for ulcer patients

Answer 5

some evidence for protein (1-1.5g/kg/day), healing requires extra calories (30-35 kcal/kg/day), mineral and vitamine not really helpful

Question 6

Local Ulcer care has 4 categories

Answer 6

1. Debridement 2. Cleansing (avoid antiseptics which may be cytotoxic) 3. Dressings (reproduce environment for fibroclot) 4. Be consistent and use familiar resources

Question 7

Local care for stage 1 ulcer

Answer 7

No Debridement, cleansing with nondrying soap and water, no dressings. Ask why did this happen?

Question 8

Local care for stage 2 ulcer

Answer 8

no debridement, saline cleaning, dress with polyurethane film and hydrocolloid wafer

Question 9

Local care for stage 3 and 4 ulcer

Answer 9

debridement if eschar or slough present for necrotizing tissue, saline cleansing, dressing (hydrocolloid, alginate, hydrogel),

Question 10

What is the most common lower extremity ulcer?

Answer 10

venous insufficiency (80 to 90%)

Question 11

Arterial Ulcer

Answer 11

looks like “punched out” and often well circumscribed; hairless skin, pulses absent, claudication (intermittent leg)

Question 12

Usual site of atherosclorosis

Answer 12

Superior femoral

Question 13

**Ankle-Brachial Index (ABI). What does it indicate?

Answer 13

Compares ankle and humoral arterial pressure. Normal is 1 or above. ABI of below 0.8 causes claudaication, ABI below 0.4 causes rest pain.

Question 14

A low ABI indicates what for life expectancy…

Answer 14

life expectancy primarily reduced by heart disease

Question 15

Buerger’s Disease

Answer 15

(aka Thrombangiitis obliterans) occurs in smokers, often young. Sores on feet or hands. Do Allen test for occlution of radial and ulner arteries. Treat: quite smoking

Question 16

Neurotrophic Ulcers

Answer 16

neuropathy causes one not to sense when to shift weight. paraipheral neuropathy most often caused by diabetes. Ulcer usually on feet. Treat with good diabetic management, good footwear.

Question 17

Pyoderma Gangrenosum

Answer 17

edges have blue or purple hue, pustule or blister procedes. Pyoderma gangrenosum usually occurs in association with an underlying inflammatory disease, such as Crohn’s or ulcerative colitis. It can also be seen with rheumatoid arthritis or leukemia.