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Special Topics 1 > Foot Wound Exam And Tx > Flashcards

Foot Wound Exam And Tx Flashcards

1
Q

Basic neuro test

A

Wagner and Semmes weinstein monofilament 5.07/10g

Intact means 7/10

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2
Q

If monofilament shows intact

A

Proceed w/ 128 hz tuning fork

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3
Q

If monofilament not intact

A

Precede w/ cotton ball

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4
Q

Foot vascular testing - ABI TBI and pulses w/ handheld Doppler

A

Dorsalis pedis
Posterior tibial
Lateral calcaneal

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5
Q

Foot- further arterial tests

A

Segmental perfume pressure (useful for falsely elevated ABI in some person w/ DM
Lower extremity arterial duplex ultrasound

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6
Q

Foot deformities

A 
Charcot foot
Hammer toe (pip)
claw toe (pip plus dip)
mallet toe (dip)
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7
Q

Wound severity

A

Wagner ulcer classification system
University of Texas diabetic wound classification
Pressure ulcer staging

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8
Q

Venous ulcer locations

A

Above medial malleolus

Above lateral malleolus

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9
Q

Arterial ulcer location

A

Over toe joints
Anterior shin
Under heel
Over malleoli

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10
Q

Neuropathic ulcer location

A 
Over toe joints
Under met head
Under heel
Over malleoli
Inner side of first met head
Planar surface of foot
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11
Q

Predisposition to neuropathic ulcers

A

Diabetes
SCI
AIDS
Peripheral neuropathy

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12
Q

Would characteristics of neuropathic ulcer

A 
Well defined margins
Calloused periwound
Deep wound bed
Cellulitis and/or osteomyelitis
Granulation tissue
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13
Q

3 types of neuropathy changes

A

Diminished or absent sensation in foot
Xerox is and anhydrous is
Musculoskeletal changes leading to foot deformities

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14
Q

Neuropathic ulcer - presentation

A

3 types of neuropathy changes
Subcutaneous fat atrophy
Arterial findings if pt has PVD

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15
Q

Wagner ulcer classification system

A

Used as a predictor of outcome: increased amputation risk or prolonged ulcer healing time

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16
Q

Wagner ulcer classification grade 0

A

No open lesions

May have deformity or cellulitis

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17
Q

Wagner ulcer classification grade 1

A

Superficial diabetic ulcer

Partial or full thickness

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18
Q

Wagner ulcer classification grade 2

A

Ulcer extension to ligament, tendon, joint capsule, or deep fascia w/out abscess or osteomyelitis

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19
Q

Wagner ulcer classification grade 3

A

Deep ulcer w/ abscess, osteomyelitis, or joint sepsis

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20
Q

Wagner ulcer classification grade 4

A

Gangrene localized to portion of forefoot or heel

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21
Q

Wagner ulcer classification grade 5

A

Extensive gangrenous involvement of the entire foot

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22
Q

University of Texas diabetic wound classification

A

Graded by depth then staged

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23
Q

UT grades

A

0 - epithelialized wound
1 - superficial wound
2- wound penetrates to tendon or capsule
3 - wound penetrates to bone or joint

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24
Q

UT stages

A

A - no infection or ischemia
B - infection present
C- ischemia present
D - infection and ischemia present

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25
Q

TX foot ulcer

A

Offloading!!!
Properly fitting footwear
Protection from trauma and pressure
If diabetic, management of blood glucose, A1c level every 6 mo

26
Q

total contact cast

A

Gold standard for offloading neuropathic foot ulcers

27
Q

Irremovable cast walker

A

Removeable cast walker w/ foam insole rendered irremovable by circumferential fiberglass casting strip

Similar results to TCC, forced adherence, lower material and application cost, faster to apply

28
Q

Removeable cast walker

A

Cast walker, foam insole w/ removeable pegs
Mean peak pressure similar to TCC
Pt able to remove device
65% healed at 12 weeks compared to 89.5% w/ TCC

29
Q

Half shoe

A

Available w/ forefoot or heel relief
May be unstable for pts w/ balance or strength impairments
Optional: add padding
Higher mean peak plantar pressures than TCC and RCW
Lower mean peak plantar pressures than felted foam w/ post op shoe
58.3% healed

30
Q

Football dressing

A

Layered padding applied to foot to reduce forefoot pressure and sheer
Difficult for pts to remove
Small retrospective study

31
Q

Felted foam

A

Felt/foam combo to entire plantar surface, cutout for wound, open to side of foot, beveled edges
Reduced pressure at planted wound 297–>90 kPA
No longer effective at day 4

32
Q

Offloading/healing shoe

A

Protective shoe w/ foam insole
Rigid sole limits MP ext, dispersing pressure over plantar surface during gait
Removeable insole pegs may reduce pressure at wound

33
Q

Offloading continuum

A
  • Start w/ TCC, offloading boot, custom multilayer orthosis
  • when wound closes, progress to lesser offloading device for 2-3 was
  • wean off and into diabetic shoe w/ custom mold insert
34
Q

Types of traumatic wounds

A 
Contusion
Abrasion
Laceration
Bite
Puncture
Impalement
Avulsion/degloving
Crush injury
Burn
Post surgical
35
Q

Treat foot trauma

A

Protect area from further trauma
Protect area from water, dirt; keep covered in shower/bath
Evaluate footwear and correct as needed
Remind pt to wear shoes ALL THE TIME w/ open wound

36
Q

Surgical side infection - treat the cause

A
  • Communicate w/ physician if infection is not controlled
  • check for remaining sutures causing irritation or stitch abscess. Get clearance from surgeon to remove
  • check for factors causing trauma
  • control edema
37
Q

Pressure injury - treat cause

A
  • help neurons educate and position at risk pts
  • turn every 2 hours or less
  • keep pts off of existing pressure injuries
  • increase mobility and independence of patients asap
  • monitor skin closely during tx
  • help w/ preventative measure and support surface adherence
38
Q

Arterial ulcers - tx the cause

A
  • ABI
  • arterial ultrasound if ABO <0.8. Ask for vascular surgery consult
  • gangrene in outpatient or non-acute—> referral to vascular surgeon, be in communication w/ primary MD and document!! May need to be seen in ER if moist/worsening
  • protect area
  • apply non-occlusive dressing
  • cautious debridement, only after basic vascular testing.
39
Q

No debridement for

A

Stable, dry eschar unless ordered by vascular surgeon

40
Q

Infection tx

A 
Call MD to report status of wound if
-pt not on PO or IV antibiotics
-has been on PO or IV abx 3-4+ days and not improving
Consider having pt evaled by MD
Document your comm w/ MD
41
Q

ABI screens for

A

Arterial insufficiency
Safe level of compression
Wound healability

42
Q

Ab 0.8-1.2

A

30-40 mmHG

Compression

43
Q

ABI 0.6-0.8

A

20-30 mmHG

Compression w/ caution

44
Q

ABI <0.6

A

No compression

45
Q

Venous ulcer- predisposition

A
  • venous valve incompetence
  • varicose veins
  • hx of ulcers
  • DVT
  • leg trauma
  • hx of LE surgeries
  • LE weak
  • impaired ankle motion or limited mobility
  • advanced age
  • medication
  • smoking
  • obesity
  • mult pregnancies
46
Q

3 common components of venous disease

A

Valve incompetence causing reflux
Venous obstruction
Calf muscle weakness causing insufficient venous return

47
Q

Typical VLU presentation

A
  • Located in gaiter area
  • Wound w/ red granulation tissue and/or cellular -debris or crust
  • Irregular wound margins
  • Periwound skin color changes
48
Q

Venous - leg appearance

A
  • firm edema
  • dilated superficial veins
  • Dry, thin scaly skin
  • evidence of healed ulcers
  • leg hyperpigmentation
49
Q

Venous - periwound appearance

A 
Leg edema 
-Dermatitis 
-Maceration v  Hyperkeratotic tissue 
-Atrophie blanche (white, thin w/red vessels) 
-Lipodermatosclerosis (bound down,
hyperpigmented or hypopigmented)
50
Q

Venous wound appearance

A
  • granulation tissue
  • fibrin
  • slough
  • crusted areas
  • non granular tissue
  • irregular wound margins
  • superficial wound
  • min to mod pain
  • mod to heavy exudate
51
Q

Venous - to cause

A 
Compression wrapping or garments
Exercise
Elevation
Education
Pt buy in and participation 
Request venous US and referral to vascular surgeon inf slow healing, hx of recurrent venous leg ulcers
52
Q

Slow healing

A

<40% area decrease in 1 month

53
Q

Arterial - predisposing factors

A 
PVD
Smoking
DM
Advanced age
Male gender
Hypertension
54
Q

Arterial - leg appearance

A 
Thin, Shiny, dry skin 
Hair loss on ankle and foot
Dystrophic (thick) toenails
Elevation pallor 
Dependent rubor
Decreased temperature 
Absent or diminished pulses 
Cyanosis 
Ischemic pain
55
Q

Arterial location

A 
B/n toes
Tip of toes
Pressure points
Sites of trauma/footwear rubbing
Typically distal to ankle
56
Q

Arterial wound characteristics

A 
Well - defined wound margins
Pale or necrotic wound bed
Gangrene may be present
Minimal exudate
Painful 
Infection common 
Planched or purpuric periwound
57
Q

Tx cause of arterial

A

ABI

If <0/8, arterial US and ask for vascular sx consult

58
Q

**gangrene in outpt/non acute:

A

obtain urgent referral to vascular surgeon, be in comm / primary physician and document this. May need to be seen in ER if gangrene moist or worsening

59
Q

Arterial tx

A

Protect area
Apply non occlusive dressing if needed
Cautious debridement only after basic vascular testing done w/ results eval

60
Q

Types of traumatic wounds

A 
Contusion
Abrasion
Laceration
Bite
Puncture
Impalement
Avulsion/degloving
Crush injury
Burn 
Post-sx

Special Topics 1 (12 decks)

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