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Acute Care Module 4 > LE Wounds > Flashcards

LE Wounds Flashcards

1
Q

define PVD and thus describe the vessels it impacts

A

diseases of blood vessels OUTSIDE the heart and brain

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2
Q

how are PVDs categorized (4)

A

inflammatory, arterial occlusive, venous, and vasomotor

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3
Q

what is a type of inflammatory PVD

A

vasculitis

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4
Q

what are two types of arterial occlusive PVD

A

arterial thrombosis or embolism

peripheral artery disease

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5
Q

what are four types of venous PVDs

A
  1. thrombophlebitis
  2. varicose veins
  3. chronic venous insufficiency
  4. DVT
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6
Q

what are two types of vasomotor disorders of PVD

A

raynaud and CRPS

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7
Q

what is LEAD

A

LE arterial disease: arterial narrowing as a result of atherosclerosis reducing blood flow to the limbs

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8
Q

what percentage of ischemic ulcers are caused by LEAD

A

10-25%

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9
Q

LEAD, LEVD, or LEND… which is most likely to lead to limb loss and death

A

LEAD

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10
Q

who are most at risk for LEAD

A

usual suspects:

<50 w DM or athero

50-70 DM or smoker

>70

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11
Q

what are the common clinical manifestations of LEAD

A
  1. INTERMITTANT CLAUDICATION
  2. 5 P’s
    1. pain
    2. pallor
    3. pulselessness
    4. paresthesia
    5. paralysis
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12
Q

what are the symptoms of intermittant claudication

A

reproducible painful cramping or aching with walking but subsides at rest

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13
Q

what are the five diagnositic tests we consider for patients with LEAD

A
  1. ABI
  2. TCPO2
  3. segmental and duplex doppler
  4. angiography
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14
Q

aside from walking, when should the LEAD patient experience pain?

A

with the leg elevated - relieved with return to the dependent position

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15
Q

what is the ABI

A

ankle brachial index: using a BP cuff to measure SBP at brachial/dorsalis pedis arteries

easy to remember ABI as ankle over brachial since A comes before B in the name

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16
Q

what is normal, mild/mod, and severe values for ABI?

A

normal: 1.19-0.95

mild/mod: 0.95-0.50

severe: <0.50

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17
Q

how do you perform a venous filling time

A

supine pt noting the veins, passively elevate the foot to 45 and hold for 1 min, return foot to dependent pos over EOB

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18
Q

how do you interpret a venous filling time test

A

normal takes 15 seconds to fill, but in the presence of arterial insufficiency >30s

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19
Q

how do you perform a rubor of dependency test

A

pt supine noting color of foot, elevate leg to 45 and hold for 1 min and then return to dependent position

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20
Q

how do you interpret a rubor of dependency test

A

in the presence of arterial insufficiency, the elevated foot will blanch, and when its return to dependent position it will take longer (>30s) to return the color and it will be a darker red

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21
Q

Describe how you would perform a claudication time test

A

as the client to walk on a treadmill before onset of IC

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22
Q

Describe a progressive walking program including the FITT recommendation

A

3-5 min bouts at a speed/grade that produces IC no higher than a 2 on the CPRS, rest until symptoms resolve, resume walking

30-60 min, 2-3x/wk, 6 months

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23
Q

what is the CPRS

A

claudication pain rating scale

  1. minimal discomfort
  2. mod pain (pt can still be distracted)
  3. intense pain
  4. unbearable pain
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24
Q

what indicates that conservative measures are failing and surgery/amputation may be recommended

A
  1. ABI < 0.5
  2. significant trophic changes
  3. non healing infected wound
    • rubor of dependency
  5. capillary refill time decreasing
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25
Q

describe the most common location(s) for arterial ulcerations

A

distal sites (toes) and the lateral malleolus

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26
Q

describe the wound bed and edges for arterial ulcerations

A

pale, dry punch outs with necrosis and gangrene likely

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27
Q

describe the pain in patients with arterial ulcers

A

intermittant claudication and pain with elevation

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28
Q

what does the limb look like in general for arterial ulcerations

A

atrophic, pale, decreased hair growth, thick nails, cool

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29
Q

what are 5 clinical results of arterial ulcerations

A
  1. distal pulses weak or absent
    • rubor of dependency
  3. capillary refill > 3s
  4. venous filling > 15
  5. ABI < 0.8
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30
Q

what are wound care considerations for arterial ulcers (3)

A
  1. warm moist environment
  2. hydrogels, hydrocolloids, impregnated gels
  3. avoid compression
31
Q

what does the limb look in LEVD (4)

A

swelling, brown/yellow, “brawny,” moist ulcers

32
Q

are bulging veins a sign of LEVD

A

no, they are cosmetic

33
Q

how does the consistency of the interstitial fluid change between venous and lymph edema

A

venous is protein poor and lymph is protein rich

34
Q

how would you differentiate generalized edema from LEVD

A

trunk swelling

35
Q

how would you differentiate heart failure from LVED

A

auscultation, JVD, >3lbs weight gain in 3 days, SOB/DOE

36
Q

how would you differentiate kidney failure from LEVD

A

low albumen, BUN, creatinine

37
Q

how would you differentiate liver failure from LEVD

A

low albumen, ascites, jaundice

38
Q

where are LEVD ulcers located

A

more proximal to medial malleolus

39
Q

describe the wound bed/edges of a LEVD ulcer

A

shallow, irregular, excessive exudate with yellow slough

40
Q

describe pain in LEVD ulcers

A

heavy ache mild to mod worse when standing and BETTER with elevation

41
Q

what does the limb look like in general in a LEVD wound

A

edema (hallmark sign), hemosiderin stain, dilated superficial veins

42
Q

what are two basic clinic results that implicate LEVD wounds

A
  1. distal pulses present
  2. girth measurement
43
Q

what are wound care considerations for LEVD ulcers (3)

A
  1. compression!
  2. clean with saline and debride slough
  3. use highly absorbant dressing (foam, alginate, hydrofiber)
44
Q

what are exercise, elevation, and compression recommendations for LEVD patients

A
  1. ankle pumps
  2. elevate 20-30 min x 3+/d
  3. 40mmHg compression at ankle to 12-17 at knee
45
Q

what are the classes of compression supports

A
  1. mild pressure (15-20 mmHg)
  2. mod pressure (20-30 mmHg)
  3. strong pressure (30-40 mmHg)
  4. very strong pressure (>40 mmHg)
46
Q

at what ABI is compression tx contraindicated

A

ABI < 0.6

47
Q

in what type of vein is a patient likely to experience a symptomatic DVT that can result in a PE

A

proximal superficial or deep vein

48
Q

what are the sxs of a DVT

A

swelling, warmth, prominent superficial veins, dull ache/tenderness, tight in DVT region

49
Q

what is the wells criteria and how do you interpret the score

A

point system to determine if a DVT exists: 2 or more points is a likely DVT

50
Q

what is a d-dimer and how does it help dx a DVT

A

blood test of fibrin degradation helpful to rule out a DVT

51
Q

what is the gold standard for dx a DVT and what is it being replaced by

A

MRI venography being replaced by doppler US

52
Q

what is a greenfield filter

A

vena cava filter useful in the prevention of PE

53
Q

T/F: a pt cannot wear compression stockings if DVT+

A

False: compression stockings may be worn if DVT is in popliteal vein with or w/o proximal migration into femoral veins

54
Q

how long after LMWH admin are you safe to mobilize

A

>5 hours or 3-5 with physician clearance

55
Q

how long after UFH administration are you safe to mobilize

A

>48 or 24-48 with physician clearance

56
Q

how long after administration of coumadin (warfarin) until you mobilize

A

INR 2-5

57
Q

What is an example of a primary LEND wound

A

Diabetic Foot Ulcer

58
Q

how can you further classify LEND

A

sensory, motor, or autonomic

59
Q

what is sensory neuropathy

A

damage to small nerve fibers resulting in unpercieved subcue damage, impaired joint proprioception, and sensation

60
Q

what is motor neuropathy

A

damage to large nerve fibers results in abnormal ankle jerk, atrophy, pes cavus/planus

61
Q

what is autonomic neuropathy

A

damage to large nerve fibers and sympathetic ganglia resulting in decreased sweat and oil (leads to dry/inelastic skin)

62
Q

what are the common locations of neuropathic ulcers

A

plantar surface, met heads, tips of toes

63
Q

describe the wound edges of a neuropathic ulcer

A

variable by definitely small, defined with periwound callous

64
Q

describe the pain in neuropathic ulcers

A

diminished/absent but sometime burning

65
Q

describe the limb in general of neuropathic ulcers

A

pale and dry with MSK deformities

66
Q

what are four clinic results in a limb with neuropathic ulcers

A
  1. pulses present
  2. monofilament abnormal
  3. ankle reflex diminished/absent
  4. vibration diminished/absent
67
Q

what are two wound assessment tools for diabetic feet

A

wagner scale and UT classification system

68
Q

what are the four grades and four stages of the UT classification system for diabetic foot wounds

A
  1. pre or post ulcerative lesion
  2. superficial wound
  3. wound penetrating to tendon/capsule
  4. wound penetrating to bone/joint

a. no infection or ischemia
b. infection
c. ischemia
d. infection and ischemic

69
Q

how do you clean and dress a neuropathic ulcer (3)

A
  1. sharp debridement of callus border and nec tissue
  2. thin hydrocolloid dressing
  3. off loading
70
Q

what are three options for offloading

A
  1. total contact cast
  2. other orthoses
  3. assistive devices
71
Q

when are total contact casts most appropriate

A

patients with noninfected, pure neuropathic ulcers

72
Q

how do you apply a TCC

A

wear for three days, then a week, then 2 weeks until wound closure, the keep for another 1-2 weeks to allow for maturation

73
Q

what are good education points for foot care especially in the neuropathic population

A
  1. check feet daily for redness, swelling, and calluses
  2. wear white seamless socks
  3. wear proper shoes

Acute Care Module 4 (10 decks)

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