Etiology of wounds

Question 1

What do you need for adequate healing

Answer 1

adequate oxygenation

Question 2

why is it important to differentially diagnose wounds

Answer 2

so we can properly perform our interventions

Question 3

what is the most common form of peripheral

vascular disease

Answer 3

Venous insufficiency

Question 4

cause of Venous insufficiency

Answer 4

• valvular incompetence

- obstruction of the deep venous system

Question 5

risk factors of venous insufficiency

Answer 5

-Smoking
• DVT
• Trauma
• Ortho surgery
• Immobility
• Family history
• CHF
-age
-frequent flyers

Question 6

diagnostic tests for venous insufficiency

Answer 6

Venous doppler
ultrasound
– ABI Arterial
brachial index –
arterial
insufficiency
– Duplex scanning

Question 7

characteristsics of venous insufficiency

Answer 7

-Edema
– Trophic changes- brown discoloration
– Weeping dermatitis
– Irregular margins
Depth is shallow
– Exudate moderate to heavy (wet)
– Minimal pain
– Peripheral pulses palpable
– Normal skin temperature (may be warm
if chronically inflamed)

Question 8

what is the typical location of venous insufficiency

Answer 8

medial aspect of the lower leg

 superior to medial malleolus

Question 9

what is Hemosiderin

staining

Answer 9

red blood
cells leak into the
tissue and leaves a
“stain” on the skin

Question 10

Treatment of venous ulcers

Answer 10

Control edema
 Improve mobility
 Dressings
 Education
 Debridement

Question 11

ways to control edema

Answer 11

Compression garments, ace wraps, tubigrip, pumps

Question 12

cause of ARTERIAL insufficiency

Answer 12

– insufficient arterial perfusion

– arteriosclerosis

Question 13

risk factors of arterial insufficiency

Answer 13

– Diabetes
– Smoking
– Hyperlipidemia
– HTN

Question 14

characteristics of arterial insuffieciency

Answer 14

Significant pain
• with exercise
• change in position
• nocturnal
– Cool skin temperature
– shiny taunt skin
– hair loss
Regular wound margins- often circular
- Lack of peripheral pulses
 - Pallor on elevation
– Rubor when dependent
– Pale or necrotic ulcer base
– Minimal exudate
– Gangrene is common
– Typically on tips of toes, lateral
malleolus, between toes

Question 15

what causes hair loss

Answer 15

poor circulation

Question 16

how would you asses if a patient has poor circulation

Answer 16

check pulses

feel temperature of skin

Question 17

location of arterial insufficiency

Answer 17

typically on tips of toes, lateral malleolus or between the toes

Question 18

diagnostic tests for arterial insufficiency

Answer 18

–ABI (Ankle Brachial Index)
– Plethysmography
– Duplex scanning

Question 19

what is the gold standard of diagnostic tests for arterial insufficiency

Answer 19

ABI
Compares brachial systolic pressure to
radial
– Ankle pressure is divided by arm
pressure
– Normal is 1.0-1.4

Question 20

significance of ABI < 0.5

Answer 20

Significant peripheral arterial disease
• Refer to vascular specialist
• Compression therapy contraindicated

Question 21

significance of ABI < 0.51-0.8

Answer 21

Moderate peripheral arterial disease
• Refer to vascular specialist
• Light compression maybe allowed

Question 22

significance of ABI 0.81-0.99

Answer 22

Mild peripheral arterial disease

• Compression therapy allowed

Question 23

significance of ABI 1.0-1.4

Answer 23

Normal

• Compression for maintenance if needed

Question 24

significance of ABI >1.4

Answer 24

May have calcification of arterial walls

• Assess with toe/brachial index

Question 25

what is plethysmography

Answer 25

Expansion of ABI – 3-4 cuffs used on LE – Better able to identify where arterial disease is

Question 26

where is the cuff placed for individuals with dM to measure with plethysmography

Answer 26

the great toe because calcification doesn't occur there

Question 27

what is claudication

Answer 27

pain caused by too | little blood flow, often during exercise

Question 28

how to determine claudication time

Answer 28

``` Use a treadmill or just walk on level grade at 1-2 MPH – Measure time elapsed until claudication pain occurs ```

Question 29

Claudication Scale

Answer 29

1= Definite discomfort or pain but only of initial or modest levels 2= Moderate pain but the patients attn can be diverted by conversation 3= Intense pain from which the person’s attention can’t be diverted 4= Excruciating and unbearable pain

Question 30

what is the best intervention for intermittant claudication

Answer 30

EXERCISE

Question 31

ACSM guidelines for intermittant claudication

Answer 31

Warm-up and cool down- mostly UE – Mode-Track walking or treadmill – Intensity-Workload set to elicit claudication within 3-5 min.; continue until moderately severe claudication Rest and repeat Duration- 35 min intermittent walking, ↑ 5 min each session until 50 min with goal of 35-50 min continuous walking – Frequency- 3-5x/wk

Question 32

symptoms of chronic arterial insufficiency

Answer 32

``` Skin temperature is cooler – Color is typically pale – Intermittent claudication – Rest pain -LE elevation worsens pain -Ulcers result from vessel occlusion ```

Question 33

treatment of arterial ulcers

Answer 33

``` Exercise • Keep clean • Dressings • Stop smoking • Avoid the cold • Debridement • Protect surrounding skin • Dangle feet when in pain ```

Question 34

which type of wound is most likely to heal

Answer 34

venous insufficiency

Question 35

which type of wound is least likely to heal and why

Answer 35

arterial insufficiency because the blood supply is significantly compromised

Question 36

what can you do to restore integrity to the venous wall

Answer 36

provide an outside counter pressure

Question 37

what would be the focus of PT for patients with venous insufficiency

Answer 37

control edema

Question 38

interventions for venous insufficiency

Answer 38

- muscle pumps for calves in supine - walking (at least 30min/day) - elevation - compression via stockings or tubigrip - aerobic exercise via stair climbing - diaphragmatic breathing because every breath in drops the pressure and brings fluid up - education on diet and fluuid intake and smoking cessation