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PM2 > Week 5 - Foot Disease I > Flashcards

Week 5 - Foot Disease I Flashcards

1
Q

Ulceration Definition

A

An ulcer is a lesion through the skin or a mucous membrane resulting from loss of tissue, usually with inflammation

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2
Q

Ulceration - considerations (3)

A
  1. Causes of ulceration
  2. Wound healing process
  3. Assessment of ulceration
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3
Q

Ulceration causes

A
  • local or systemic
  • 3 main causes
    1. venous - usually in gaiter region, shallow, irregular margins, local tissue inflammation
    2. arterial/ischaemic - usually present on distal margins of the foot e.g. apex of toes, posterior heel, punctate, painful, dry, black, necrotic
    3. neuropathic - usually in plantar aspect/WB areas of the foot, surrounded by callus painless
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4
Q

Factors impairing healing

A
  • Psychosocial
  • age
  • socioeconomic
  • conditions
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5
Q

Processes of wound healing (4)

A
  1. Immediate: Haemostasis - bodies attempt to quickly stop bleeding
  2. Inflammation - increased blood flow (WBC) + debridement
  3. Proliferation - granulation + epithelialisation
  4. Maturation
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6
Q

Inflammation phase - dilated vessels

A
  • Breakdown of softened necrosis is accelerated by enzymes - removal of cellular debris tissue and cleaning the wound
  • WBC - macrophages and neutrophils are dominating cells
  • Normal duration: 2-3 days
  • Moist environment facilitates hydration of the wound
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7
Q

Proliferation phase - granulation

A

Macrophages arrive in large numbers at the relatively warm and moist envrionment and produces substances that stimulate formation of capillaries and fibroblasts
- macrophages attract endothelial cells
- granulation tissue will soon appear, degrading the existing blood clot
- fibroblast amount increases and collagen is produced

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8
Q

Proliferation phase - epithelialisation

A
  • Epithelial cells multiply and migrate across the surface from the wound edges
  • this migration proceeds much faster in a moist envrionment than in a dry wound
  • moist wound healing is pain relieving, due to prevention of drying out the nerve endings
  • when complete - wound is healed
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9
Q

Maturation phase

A
  • transformation of the produced collagen will increase the strenght of the connective tissue
  • capillaries that formed during granulation phases will disappear normalising blood supply
  • duration - longer than a year depending on site, depth, health and person
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10
Q

Initial assessment of the wound (6)

A
  1. thorough patient history and physical examination
  2. thorough wound history
  3. record wound observations
  4. look for signs of infection
  5. identify the status of the ulcer
  6. use classification system
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11
Q

Assessment - wound history

A
  1. DURATION of the wound
  2. changes in SIZE or APPEARANCE
  3. change in NUMBER of lesions/wounds
  4. Any PREVIOUS INCIDENTS of similar lesions
  5. Any PAIN or ALTERED SENSATION associated with the lesion
  6. Other SIGNS or SYMPTOMS related to the wound e.g. ischaemic changes
  7. Does the patient know the CAUSE of the wound
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12
Q

Assessment - wound observations

A
  • precise ANATOMICAL site of the wound
  • SIZE - measured accurately
  • GENERAL APPEARANCE of wound and surrounding tissue
  • SIDE/EDGES of wound - undermining walls, sinus tracts
  • BASE/FLOOR - colour red (granulation), yellow (slough), black (necrosis), deeper structures infiltrated
  • EXUDATE - light, thick, copious, odour
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13
Q

Wound appearance: Black

A
  • dehydrated necrotic tissue
  • retards healing
  • remove if possible
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14
Q

Wound appearance: Yellow

A
  • loose
  • cellular debris
  • yellow to grey-green necrotic
  • creamy yellow if large number of WBC
  • yellow (fibrous)
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15
Q

Wound appearance: Red

A
  • red (granulation):
    bright red + moist - healthy granulation
    palar with spontaneous bleeding - ischaemia, infection, anaemia
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16
Q

Wound appearance: Pink

A
  • pink (epithelialisation)
    final stages of healing
    pink, white or transclucent area may overly healthy granulation tissue
    migrates from the wound margin or hair
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17
Q

Wound observations - edges (5)

A

ulcer shape, edge and surrounding skin may indicate would aetiology

Saucer shaped - infiling and healing
vertical edge - static ulcer
rolled - ?malignacy
maceration - white, waxy, soft and wet looking
induration (hard) - firm swelling or without redness, infecton or inflammation

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18
Q

Wound observation - wound base

A

colour - considerable variation, black, white, red, pink and white
texture

19
Q

wound observations - exudate (4)

A

quantity
quality
odour
evaluate the dressing after removal - moisture, colour, tissue debris

20
Q

Signs of infection (6)

A

heat and redness
oedema
pain
exudate/pus
pyrexia
haematological effects

21
Q

Assessment - status (4)

A

extending - active
chronic - static
healing - decreasing
infected - spreading

22
Q

Wounds classification systems

A

SINBAD - provides necessary info for communication about the characteristics of an ulcer between healthcare professionals, allows for triage by specialist team

WLfl - system for communication about the characteristics of an ulcer between healthcare professionals, providing holistic wound overview in revascularisation decison-making

23
Q

University of Texas Wound Classification (UTWC)

A

grading system for depth of the wound and staging co-morbidities
- requires equipment and clinical expertise
- does not assess neuropathy

24
Q

Wound assessment -summary

A
  • History
  • Observation
  • clinical sings of infection
  • status
  • classification/grading
25
Q

Venous Leg Ulcers (VLCs)

A
  • most severe clinical presentation of chronic venous disease
  • high rate of reoccurance
  • reduces patients quality of life
  • occurs predominately in older adults
26
Q

Chronic venous disease

A

Collective term describing chronic conditions that are caused by disease or abnormal veins - creating hypertension
- 5 times greater prevalence than PAD
- most common circulatory diorder

27
Q

CVD - etiology (3)

A
  • Primary - valve or wall weakness and dilation due to: degenerative changes, genetic predisposition
  • Secondary - Intravous (post DVT, hormone (preg)
  • Congenital - valve absence or malfucntion
28
Q

Venous hypertension

A

when there is increased venous pressure, impairing return of blood to the heart

29
Q

Causes of venous hypertension (4)

A
  1. valve incompentence - creates reflux
  2. venous obstruction/occlusion - result in repaid progression of disease - immobility, DVT
  3. Dyfunction of calf muscle pump - immobility, joint disease, paralysis, obesity
  4. congestive cardiac failure (CCF) - fluid and water retention - swollen anles, legs, abdomen
30
Q

CVD - pathophysiology

A

reflux
obstruction
reflux and obstruction

31
Q

CVD - anatomical site affected

A

superficial veins - lack muscular support, leads to ‘superficial venous hypertension’

deep veins - drain by calf muscle contraction, -ve pressure pulls blood from superficaial system
- Deep plantar venous arch (foot)
- tibial veins (leg)
- popliteeal and femoral veins (thigh)
- iliac veins (groin)

perforating veins - bridging channels between superficial and deep systems
- important role to equilibrating blood-flow between superficial and deep systems

32
Q

Symptoms of CVD

A

none
aching/heaviness
swelling/itching
cramps
venous claudification
bleeding
pain, induration, inflammation
superficial thrombophelbitis
ulceration

33
Q

CVD - clinical signs: C0

A

no visable or palpable signs of VD

34
Q

CVD - clinical signs: C1

A

telangictasia - purpuric colouration, areas of blood deposition

35
Q

CVD - clinical signs: C2

A

varicose veins - aching swollen legs that feel relieved with elevation

36
Q

CVD - clinical signs: C3

A

oedema

37
Q

CVD - clinical signs: C4a

A

excema/stasis dermatitis
haemosiderin deposits

38
Q

CVD - clinical signs: C4b

A

induration (long term)
atrophy blanche

39
Q

CVD - clinical signs: C5

A

healed ulcer

40
Q

CVD - clinical signs: C6

A

active venous ulcer

41
Q

CVD - clinical signs: C6r

A

recurrent active venous ulcer

42
Q

CVD treatment - manage venous hypertension

A

regular walking - calf muscle pump activation
- weight reduction
- avoid immobility - prolonged standing and sitting
- frequent leg elevation
- management of underlying condition
- referral to vascular service for investigation and interventional treatments
- compression

43
Q

Compression therapy

A

aims to provide venous return, reduce venous pressure by:
- supporting venous leg pump
- preventing venous dilation during walking and standing
- increasing velocity of venous blood flow
- reducing valve insufficiency
- increasing tissue pressures
- improving blood flow

PM2 (8 decks)

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