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Acute Care Module 4 > LE Wounds > Flashcards

LE Wounds Flashcards

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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
describe the most common location(s) for arterial ulcerations
distal sites (toes) and the lateral malleolus
26
describe the wound bed and edges for arterial ulcerations
pale, dry punch outs with necrosis and gangrene likely
27
describe the pain in patients with arterial ulcers
intermittant claudication and pain with elevation
28
what does the limb look like in general for arterial ulcerations
atrophic, pale, decreased hair growth, thick nails, cool
29
what are 5 clinical results of arterial ulcerations
1. distal pulses weak or absent 2. + rubor of dependency 3. capillary refill \> 3s 4. venous filling \> 15 5. ABI \< 0.8
30
what are wound care considerations for arterial ulcers (3)
1. warm moist environment 2. hydrogels, hydrocolloids, impregnated gels 3. avoid compression
31
what does the limb look in LEVD (4)
swelling, brown/yellow, "brawny," moist ulcers
32
are bulging veins a sign of LEVD
no, they are cosmetic
33
how does the consistency of the interstitial fluid change between venous and lymph edema
venous is protein poor and lymph is protein rich
34
how would you differentiate generalized edema from LEVD
trunk swelling
35
how would you differentiate heart failure from LVED
auscultation, JVD, \>3lbs weight gain in 3 days, SOB/DOE
36
how would you differentiate kidney failure from LEVD
low albumen, BUN, creatinine
37
how would you differentiate liver failure from LEVD
low albumen, ascites, jaundice
38
where are LEVD ulcers located
more proximal to medial malleolus
39
describe the wound bed/edges of a LEVD ulcer
shallow, irregular, excessive exudate with yellow slough
40
describe pain in LEVD ulcers
heavy ache mild to mod worse when standing and BETTER with elevation
41
what does the limb look like in general in a LEVD wound
edema (hallmark sign), hemosiderin stain, dilated superficial veins
42
what are two basic clinic results that implicate LEVD wounds
1. distal pulses present 2. girth measurement
43
what are wound care considerations for LEVD ulcers (3)
1. compression! 2. clean with saline and debride slough 3. use highly absorbant dressing (foam, alginate, hydrofiber)
44
what are exercise, elevation, and compression recommendations for LEVD patients
1. ankle pumps 2. elevate 20-30 min x 3+/d 3. 40mmHg compression at ankle to 12-17 at knee
45
what are the classes of compression supports
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
at what ABI is compression tx contraindicated
ABI \< 0.6
47
in what type of vein is a patient likely to experience a symptomatic DVT that can result in a PE
proximal superficial or deep vein
48
what are the sxs of a DVT
swelling, warmth, prominent superficial veins, dull ache/tenderness, tight in DVT region
49
what is the wells criteria and how do you interpret the score
point system to determine if a DVT exists: 2 or more points is a likely DVT
50
what is a d-dimer and how does it help dx a DVT
blood test of fibrin degradation helpful to rule out a DVT
51
what is the gold standard for dx a DVT and what is it being replaced by
MRI venography being replaced by doppler US
52
what is a greenfield filter
vena cava filter useful in the prevention of PE
53
T/F: a pt cannot wear compression stockings if DVT+
False: compression stockings may be worn if DVT is in popliteal vein with or w/o proximal migration into femoral veins
54
how long after LMWH admin are you safe to mobilize
\>5 hours or 3-5 with physician clearance
55
how long after UFH administration are you safe to mobilize
\>48 or 24-48 with physician clearance
56
how long after administration of coumadin (warfarin) until you mobilize
INR 2-5
57
What is an example of a primary LEND wound
Diabetic Foot Ulcer
58
how can you further classify LEND
sensory, motor, or autonomic
59
what is sensory neuropathy
damage to small nerve fibers resulting in unpercieved subcue damage, impaired joint proprioception, and sensation
60
what is motor neuropathy
damage to large nerve fibers results in abnormal ankle jerk, atrophy, pes cavus/planus
61
what is autonomic neuropathy
damage to large nerve fibers and sympathetic ganglia resulting in decreased sweat and oil (leads to dry/inelastic skin)
62
what are the common locations of neuropathic ulcers
plantar surface, met heads, tips of toes
63
describe the wound edges of a neuropathic ulcer
variable by definitely small, defined with periwound callous
64
describe the pain in neuropathic ulcers
diminished/absent but sometime burning
65
describe the limb in general of neuropathic ulcers
pale and dry with MSK deformities
66
what are four clinic results in a limb with neuropathic ulcers
1. pulses present 2. monofilament abnormal 3. ankle reflex diminished/absent 4. vibration diminished/absent
67
what are two wound assessment tools for diabetic feet
wagner scale and UT classification system
68
what are the four grades and four stages of the UT classification system for diabetic foot wounds
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
how do you clean and dress a neuropathic ulcer (3)
1. sharp debridement of callus border and nec tissue 2. thin hydrocolloid dressing 3. off loading
70
what are three options for offloading
1. total contact cast 2. other orthoses 3. assistive devices
71
when are total contact casts most appropriate
patients with noninfected, pure neuropathic ulcers
72
how do you apply a TCC
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
what are good education points for foot care especially in the neuropathic population
1. check feet daily for redness, swelling, and calluses 2. wear white seamless socks 3. wear proper shoes

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