- dark, reddish brown color due to iron - doesn't go back to normal

1.21 Differentiating Ulcers Flashcards by Suzanne Maggioni

arterial ulcers: predisposing factors

diabetes
atherosclerosis
Raynaud’s
smoking
PVD
sedentary lifestyle

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venous ulcers: predisposing factors

PVD
chronic venous insufficiency
diabetes
lack of exercise
obesity
pregnancy

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diabetic ulcers: predisposing factors

diabetes

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What are diabetic ulcers also referred to as?

neuropathic

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arterial ulcers: anatomic locations

lateral malleolus
dorsum of foot
tips or between toes

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venous ulcers: anatomic locations

medial malleolus

- medial aspect of leg

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diabetic ulcers: anatomic locations

typically over WB surfaces
heel
first metatarsal head
dorsal metatarsal heads due to shoes

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arterial ulcers: other features of patients

pale
thin
shiny
lower leg missing hair
thick toenails
fat pads die on bottom of foot
no dorsalis pedis pulse
cold

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venous ulcers: other features of patients

dilated veins
swelling
weirdly warm
brawny edema
limb is heavy
activity tolerance low
fatigue

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diabetic ulcers: other features of patients

excessive callus formation
still have a warm foot
thick toenails
may have pulses
subcutaneous fat pads gone as well

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wound characteristics: margin/border

arterial ulcer

circular

- even

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wound characteristics: margin/border

venous ulcer

random, heaped, irregular edges

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wound characteristics: margin/border

diabetic ulcer

even, perfect ulcer (due to pressure)

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wound characteristics: color of wound bed

arterial ulcer

pale with necrotic tissue

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wound characteristics: color of wound bed

venous ulcer

granular
dark
brawny skin
red/ruby color
hemosiderin staining

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hemosiderin staining

dark, reddish brown color due to iron

- doesn’t go back to normal

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wound characteristics: color of wound bed

diabetic ulcer

pale

- clean base of wound

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wound characteristics: periwound skin

arterial ulcer

necrotic tissue, pale, eschar
typically no slough
gangrene

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wound characteristics: periwound skin

venous ulcer

yellow
mucousy
moist
slough

wound characteristics: periwound skin

diabetic ulcer

pale, not much necrotic tissue

wound characteristics: pain?

arterial ulcer

severe pain, even at rest

wound characteristics: pain?

venous ulcer

none

wound characteristics: pain?

diabetic ulcer

no pain

- slow onset cell death so they can’t feel it

wound characteristics: exudate?

arterial ulcer

not much (dead tissue)

- no fluid (blood)

wound characteristics: exudate? venous ulcer

- lots, heavy exudate | - waterfall, drippy

wound characteristics: exudate? diabetic ulcer

low

wound characteristics: depth arterial ulcer

- deep | - to where blood supply should be coming from

wound characteristics: depth venous ulcer

- very shallow | - epidermis gone, down to some of the dermis

wound characteristics: depth diabetic ulcer

deep

Which ulcer type has the highest chance of gangrene?

arterial ulcer

80% of LE ulcers are this type

venous

Which ulcer type carries with it a high risk for osteomyelitis?

diabetic

Which ulcer type is indicative of people who might have cellulitis?

arterial

What is osteomyelitis?

- bone infection | - can happen when a wound bed bottoms out at or close to the bone

What test is used to see how well blood sugar is maintained long term?

A1C

patient education: arterial ulcers

- no elevation (crossing legs, tight socks, recliner with legs up) - stop smoking - activity - water checks before bathing with a body part that has sensation

patient education: If they have PVD, they are at risk for arterial ulcers. What preventative measures would you educate them on?

- wear shoes - don't pick your nails - don't compress - keep feet in dependent positions

patient education: venous ulcers

- elevate the foot - compress (as long as there's no comorbidity), daily compression hose if skin is healthy without an active wound - intermittent compression device - any type of activity (develop more active lifestyle) - avoid dependent positions

patient education: diabetic ulcers

- water checks before bathing - daily foot inspection - prevention - proper footwear (specialty shoes) - controlling sugars - avoid pressure

What are arterial ulcers caused by overall?

anything that prevents blood flow to the tissue

What might be done for patients with PVD (surgery)?

- bypass (usu saphenous vein) - - may cause more pain after because suddenly they have blood flow - may have to do slice and dice amputation

chronic venous insufficiency produces

varicose veins

Why might hypertension cause venous ulcers?

blood pushing through, but pooling

Why does a diabetic lose motor and sensory function?

- lose circulation - cells die - function lost

Why do diabetics form such large calluses? Should you address these?

- lays down more skin to recreate the padding that gets lost | - don't want them to fall off or remove