EXAM 1: Wound Etiologies Pt 1

Question 1

Etiology of artificial insufficiency

Answer 1

• trauma
• acute embolism
• DM, RA
  Thromboangiitis Buerger’s disease

Question 2

Arteriosclerosis

Answer 2

1 cause of arterial insufficiency

• thickening / hardening of arteries

Question 3

Atherosclerosis

Answer 3

• systemic narrowing of arteries

Question 4

Explain how arterial insufficiency to becomes an ulcer

Answer 4

arterial insufficiency > intermittent claudication > ischemic rest pain > ulcer

Question 5

Gangrene & types

Answer 5

when oxygen supply does NOT equal demand, you have cell death
WET: surgery needed
DRY: stable “okay”

Question 6

Indications for performing an ABI

Answer 6

• decreased or absent pulse
• signs or symptoms of AI
• history of PVD

Question 7

ABI Result Interpretation (CHART)

• normal
• mild/mod AI
• vessel calcification
• severe AI

Answer 7

• Normal: .9-1.1 okay to debride
• Mild/Mod AI: .7-.9 (VI Ulcer apply compression!)
• Vessel calcification: 1.1-1.3
• Severe AI: <.5 (AI Ulcer NO compression)

Question 8

Trendelenburg test * not hip drop

Answer 8

• to identify vein incompetence and differentiate between which veins
• supine, leg elevation 45 degrees for 1 min
• note venous distension
• tourniquet to distal thigh
• stand upright and note time for superficial venous distension
• repeat process without tourniquet

tourneqet on : <20 sec = deep perforator vein incompetence
off: <10 sec= superficial vein incompetence

Question 9

Vein Surgery Terms:

• Ligation
• Stripping
• Sclerotherapy

Answer 9

• Ligation: tying off perforating veins to decrease venous hypertension in superficial veins
• Stripping: surgical resection of superficial varicosities
• Sclerotherapy: injecting agent to close dysfunctional veins

Question 10

Venous Ulcer Healing Time PROGNOSIS

Answer 10

• 8 weeks
• small ulcers 5-7
• large ulcers 10-16 weeks

(wounds w/o signs of healing in 4 wks should be referred)

Question 11

target muscle groups and exercises for VI?

Answer 11

ankle PF and DF
Gastroc & soleus stretching
- gait training = + influence on respiratory pumps

Question 12

Compression Methods
- paste bandage
- short stretch compression wrap
- long stretch compression wrap

Answer 12

• paste bandage : gauze impregnated with zinc oxide, calamine, glycerine and gelatin that hardens to a semi rigid support
• short stretch compression wrap : for up and moving pts
• long stretch compression wrap: for paralyzed patients

Question 13

Laplace’s Law

Answer 13

Bandage Compression = (tensionlayers appliedconstant) / (limb girth*bandage width)

Question 14

Explain the function of each layer of compression

Answer 14

inner layer: absorbs excess drainage & provides padding without tension

middle layer: absorbs drainage with tension

outer 1-2: increases pressure with tension

Question 15

Tubular Compression

Compression Garments

Answer 15

light compression off the shelf

knee highs

Question 16

LE Compression Standards (classes)

Answer 16

20-30mmHg Class 1 : mild venous insufficiency
30-40mmHg Class 2: mod venous insufficiency
>40mmHg Class 3-4: severe venous insufficiency

Question 17

Pressure Injury Definition

Answer 17

localized area of tissue necrosis that develops when soft tissue is compressed between a firm surface and underlying body prominence

Question 18

Classification for pressure injuries

Answer 18

NPUAP Injury Classification

National Pressure Ulcer Advisory Pannel Scale

Question 19

NPUAP SCALE

Answer 19

Stage 1
Stage 2
Stage 3
Stage 4
Unstageable

Question 20

Braden Risk Scale Interpretation

Answer 20

<18 at risk
15-18 mild risk
13-14 mod risk
<13 risk

Question 21

Pressure Ulcer Scale for Healing (PUSH)

Answer 21

score 8-24 (higher scores=more severe ulcer)

Healing score - PUSH initial score - reassessment score

(+ = improvements)

Question 22

at risk patients should be positioned at what angle on their side

Answer 22

30 degrees, not directly on side

Question 23

Pressure Injury Healing time PROGNOSIS

Answer 23

very slow!
stage 1: 1-3 wks
stage 2: avg 23 days
stage 3-4: 8-13 weeks

Question 24

Pressure injuries that do not decrease in size within ____ ________ should be reassessed for alternative interventions

Answer 24

2 weeks

Question 25

after hour of sitting, how long does it take to relieve pressure and reperfuse tissue ?

Answer 25

2 minutes - should move every 10-15 min seated - should move every 2 hours in bed

Question 26

Neuropathic Ulcer PROGNOSIS

Answer 26

- healing time 12-14 weeks - Wagner 1/2 have good prognosis

Question 27

When would you use a total contact cast? When should you not?

Answer 27

-neuropathic ulcers - for wagner ulcers grade 1 and 2 - not when the pt has osteomyelitis, gangrene, fluctuating edema, active infection, ABI < .45

Question 28

Lymphatic system is divided into superficial and deep lymphatics... what are their jobs

Answer 28

Superficial lymphatics: drains skin and superficial tissue (THIS IS WHAT WE ARE TREATING) Deep lymphatics: drains muscles, tendons, and joints

Question 29

Where is the immune system response activated?

Answer 29

in lymph fluid

Question 30

Flow of Lymph

Answer 30

Lymph capillaries > precollectors> lymph collectors> lymph nodes> thoracic duct/R lymphatic duct> venous system

Question 31

Lymphedema definition

Answer 31

- fluid stagnation and edema due to dynamic or mechanical insufficiency

Question 32

Dynamic Insufficiency of Lymphedema

Answer 32

- lymphatic load EXCEEDS transport capacity (too many cars on the road so back up and wear and tear on road)

Question 33

Mechanical Insufficiency of Lymphedema

Answer 33

- transport capacity decreases when axillary nodes removed (the road is under construction so cars cant get by)

Question 34

Fibrosis

Answer 34

caused by build up of collagen formation in later stages of lymphedema

Question 35

What stages of lymphedema are reversible?

Answer 35

stage 0 and stage 1

Question 36

Internal Society of Lymphology Lymphedema Staging

Answer 36

Stage 0: no edema, but impaired lymph transport Stage 1: fluid build up may subside with elevation, pitting edema present Stage 2: elevation no longer helps , fibrosis present; early and late (late has no pitting) Stage 3: skin thickening, hyperpigmentation, papillomas

Question 37

Unilateral Edema measurements: - mild - moderate - severe

Answer 37

- Mild: <3 cm difference - Moderate: 3-5 cm difference - Severe >5 cm difference

Question 38

Types of Burns

Answer 38

Thermal: severity based on contact time and temperature Chemical: takes 24-72 hrs to evolve; alkaline burns are more severe than acidic Electrical: charred entrance, explosive exit

Question 39

Pathophysiology of Burns (name the zones)

Answer 39

Zone of coagulation: central portion, ischemia, necrosis Zone of stasis: cellular injury and compromised perfusion Zone of hyperemia: outer edges, minimal cellular injury

Question 40

Degrees of burns & Example s

Answer 40

Superficial 1st Degree: bright red; blanches with pressure; SUNBURN Superficial Partial Thickness 2nd Degree: blistered; blanches with immediate capillary refill; resolves 10-14 days, CONTACT CHEM BURN Deep Partial Thickness Deep 2nd Degree: molted areas of red with white eschar, 3+ weeks to heal; SEVERE SUNBURN, CONTACT W DILUTE CHEMICALS Full Thickness 3rd Degree: leathery eschar; very painful; PROLONGED CONTACT W FLAME, IMMERSION SCALD INJURY Subdermal 4th Degree: charred, mummified appearance, possible ampu; ELECTRICAL BURN, STRONG CHEMICAL BURN

Question 41

How to estimate rule of 9s

Answer 41

head, chest, thorax, leg, leg 9% each arms 4.5% each side groin 1%

Question 42

Susceptible areas for contractures following a burn

Answer 42

anterior neck, axilla / shoulders, cubital fossa, ankle, posterior knee

Question 43

Debridement

Answer 43

early debridement often performed on patients with medium and large full thickness burns

Question 44

Escharotomy

Answer 44

Incision through eschar and subcutaneous tissue to release tissue constricting circulation

Question 45

Fasciotomy

Answer 45

Incision through fascia to release pressure/improve circulation