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Complex Pt Management > AI/VI characteristics > Flashcards

AI/VI characteristics Flashcards

1
Q

Location of AI wounds

A

Commonly below the ankle

  • foot, heel, met heads, tips of toes, bunion areas
  • possible superior lateral malleolus or anterior lower leg
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2
Q

AI Presentation

A
  • Starts shallow then deepens
  • Punched out appearance
  • Usually round
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3
Q

AI Drainage

A

Minimal to none

Usually dry and hard

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4
Q

AI Tissue

A
  • Black and brown eschar
  • Pale granulation
  • Mixed
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5
Q

Dry Gangrene

A
  • Mummification
  • no drainage, hard
  • Little/no odor
  • Clear demarcation
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6
Q

Dry Gangrene treatment

A

Protect/off load
Monitor for conversion
-Auto Amp

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7
Q

Wet Gangrene

A
  • Drainage
  • Odor
  • Fluctuance /edema
  • Erythema
  • Less clear demarcation
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8
Q

Wet Gangrene Treatment

A
  • Urgent referral

to Vascular surgeon

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9
Q

Should you place a moist dressing on dry eshcar?

A
  • NEVER

- careful at other times, depends on surgical candidacy

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10
Q

Moist dressing on unhealable AI ulcer?

A

Keep dry until proven healable

- AVOID ADHESIVES

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11
Q

What is the healable conditions for AI ulcers?

A

Vascular status ABI > .5 and consultant with MD

  • slow progression
  • AVOID ADHESIVES
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12
Q

What is the PT role in AI wounds?

A

ID, Refer, protect, monitor, educate

  • wound care exercise
  • Treatment after re-vascularization/AMP. team effort
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13
Q

Debridement precautions for AI

A
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14
Q

ABI and Compression

A
  • ABI > .08 35-40mmHg OK
  • ABI < .8 but >.6 caution but light compression 17-25mmHg
  • ABI
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15
Q

After Re-Vascularization/AMP

A

GO AFTER IT - moist wound environment, debridement

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16
Q

VI location

A
  • Above the malleoli in distal 3rd of lower leg (medial and lateral)
  • If outside the area, may not have VI etiology
17
Q

Surrounding Skin VI

A

-Hyperpigmentation - hemosiderin staining
- Lipodermatosclerosis
(scarring of skin/fat, results in hard thickening, immobile skin, can cause “champagne bottle leg, scarring can restrict fluid)
- Thick and scaley epidermis
-Irritation from chronic
-exposure to large amounts of drainage
- Varicose veins

18
Q

VI would characteristics

A
  • Uneven edges (can be diffused or rolled)
  • Highly exudative (esp at initiation of tx)
  • Pain not bad, if severe consider AI/vasculitis
19
Q

VI periwound

A
  • Maceration common (intially or w/inadequate dressings or change schedule
  • Diffuse edges
  • irritation
20
Q

VI compression

A
  • Comfrt, cosmesis, tolerance (some compression is better than none)
  • Ok to compress over most wound dressings
  • Ambulation?
  • Vascular status?
21
Q

Tube-like (Tubigrip)

A
  • least compression, inexpensive, east to apply
  • light compression but can be doubled
  • Conservative trial to determine tolerance
  • Utilized with UE and LE issues or with at risk sprains, wounds
  • Variation in compression
    (different sizes, can pair different stizes, depends on limp contour, 10-12mmHG)
22
Q

Long Stretch

A
  • Stretches a long way
  • ACE wrap
  • delivers constant compression, can feel tight at rest
  • Applied with figure 8 or spiral technique
  • CAUTION with AI
23
Q

Short Stretch

A
  • Short distances
  • Applied with consistent tension/spiral layering
  • can telescope
  • Use ABI levels to determine safe
  • HIGH compression during contraction
  • LOW during rest
24
Q

In Elastic

A
  • Unna Boot
  • enough tension to hold in place
  • 2-3 layers over entire LE or UE
  • Secondary wrap
  • Longer wear time (1 week)
  • Telescopes
  • Can rub against bend at ankle
25
Q

Multi Layer

A
  • 2-4 layers
  • More layers = higher levels of compression 30-40mmHg
  • On during work or rest
  • Specific layering techniques and sequence
  • More expensive, More time for application
  • Long wear - 1 week
  • Both ambulation and non
26
Q

Stockinga

A

Not just for VI, can be support/Vein health
- replace 6 months
Custom vs OTC
- Lowest effective level for maintenance - comfort, application, heat

27
Q

Compression levels

A
  • 15-20 mmHG SUPPORT - w/o ulcer, lite prophylaxis for high risk pt’s (tired legs)
  • 20-30mmHG THERAPEUTIC Mild VI w/wo uler, prophylaxis, inability to tolerate high compression
28
Q

La Place’s Law

A
  • Adjustments to overal amount of compression graded or graduated
  • increase/decrease tension
  • # layers
  • based on girth
29
Q

Exercises for VI ulcers

A
  • Gastoc stretches ROM (muscle pump)
  • ankle pumps, circumduction, ABCs
  • Heel toe raises in sitting
  • Step overs - Step over 3-4 inch obstacle using heel strike in foot, toe push off
  • Exaggerated heel toe sequence during walking
  • biking, Aquatics
30
Q

Education VI

A

Compression (chronic situation)

  • Extend standing, sitting crossing legs, ankle pumps
  • Elevation above heart level
  • Care and replacement of compression stocking
  • Lifestyle
31
Q

Spiral / Figure of 8

A

50% overlap, 50% tension
Base of toes over gastroc 2 fingers
Leg shape and padding

32
Q

Want Graduated/Graded Compression

A

Ankle -30-40mmHG, proximal calf ~18mmHG

  • Ankle circumference w/ multilayer systems due to higher levels of compression
  • Leg shape & padding

Complex Pt Management (12 decks)

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