Leg ulcers Flashcards
describe the presenting history and physical of social risks of venous disease
previous history of DVT varicose veins reduced mobility traumatic injury to the lower leg obesity pregnancy previous vein surgery
presents as non healing ulceration
recurrent phlebitis
describe the presenting history and physical of social risks of arterial disease
diabetes hypertension smoking previous history of vascular disease inability to elevate limb
what is the typical position of a venous ulcer
gaiter area of leg
medial aspect of the leg
what is the typical position of a arterial ulcer
lateral malleolus and tibial area
toes and feet
over pressure points
what is the pain like in venous disease
throbbing, aching, heavy feeling in the legs
what is the pain like in arterial disease
intermittent claudication
worse at night/rest
improves with dependency
what are the characteristics of a venous ulcer
shallow with flat margins
often presents with slough at the base with granulation tissue
moderate to heavy exudate
what are the characteristics of an arterial ulcer
punched out, occasionally deep
irregular in shape
unhealthy appearance of wound bed
presence of necrotic tissue or fixed slough
low exudate unless infected
what is the usual condition of the leg in venous disease (9)
haemosiderin staining
thickening and fibrosis
dilated veins at the ankle
crusty dry hyperkeratotic skin
eczematous, itchy skin
pedal pulses present
normal cap refil
limb oedema common
what is the usual condition of the leg in arterial disease
thin, shiny, dry skin
reduced/no hair
skin cool to touch
pallor on leg elevation
absence or weak pedal pulses
delayed cap refil time
development of gangrene
what are the perimeters of ABPI
1-1.2 normal 0.9-0.99 acceptable 0.8-0.89 mild arterial disease 0.5-0.79 moderate <0.5 severe
what are the 5 P’s of critical limb ischemia
pain pallor pulseless paralysis perishingly cold
what is a chronic leg ulcer
an open lesion between the knee and ankle joint that remains unhealed for 4 weeks
why can PWIDs get drugs
inject into thigh- get clot in femoral vein that blocks venous drainage
where are the majority of leg ulcers treated
in the community
what type are the majority of ulcers
venous
why do diabetics get ulcers
neuropathy
what are the distressing symptoms of leg ulcers
pain, leakage, smell, infection, social isolation
what are the different diagnosis of a chronic leg ulcer (7)
venous arterial mixed vasculitic malignant inflammatory hydrostatic- (dependant limb- dangling)
what do you need to asses in a venous ulcer
what is causing it
why isn’t it healing
SIGN tool- asses first patient then leg then ulcer
what extras are important to inclide in leg ulcer history
social circumstances
mobility
pain
sleep disturbance (sleeping in chair will create dependant limb)
what is lipodermatosclerosis
sclerotic skin (thickened, very hard) in response to venous hypertension
very likely to develop in to an ulcer
how do you treat venous dermatitis
regular emollients, topical steroids and compression stockings
what is important to record when visually assessing ulcer
position
surface area
depth
slough
