Lesson 8: Lower Extremity Wounds Flashcards

Question

Lymphedema - causes

Answer 1

- Congenital - Radical surgery - Chronic venous disease - Filariasis

Answer 2

Stage 1: reversible - Fluid accumulation responds to elevation and compression Stage 2: spontaneously irreversible non-pitting edema, papillomatosis - Elevation is ineffective Stage 3: lymphostatic elephantiasis - Severe papillomatosis - Severe edema - Ulceration - Requires complex decongestive therapy

Answer 3

- Prevention and early treatment - Need lymphedema treatment center for advanced disease

Answer 4

Damage to sensory, motor, and autonomic nerves Results in - Compromised sensation - Neuropathic pain - Altered foot contours/deformity - Osteopenia/fractures/Charcot's foot - Reduced sweating

Answer 5

- Hyperglycenia - Ischemic damage to nerves due to microangiopathy - B12 deficiency - Spina bifida - Spinal cord injury

Answer 6

Damage to nerve controlling sensory input - Paresthesia: burning/tingling pain that occurs spontaneously - Progressive anesthesia: loss of protective sensation + increases risk of painless trauma Routine screening - Monofilament testing - Vibratory sense testing - Proprioceptive testing Clinical presentation - Loss of vibratory sense - Loss of protective sensation - Less of proprioceptive sense

Answer 7

Damage to nerves controlling muscles - Causes foot and toe deformities - Alters weight-bearing status Routine screening - Visual inspection - Assess for foot deformities

Answer 8

Damage to nerves controlling sweat glands and blood vessels - Reduced sweating - Persistent vasodilation - Demineralization of bones - Increased risk of fractures Screening - Skin hydration status - Assess foot contours and weight bearing pattern - Skin temperature checks

Answer 9

- Painless repetitive trauma - Usually focused on sites in contact with footwear - Heels, toe tips, or plantar surface - Breakdown between toes due to excess moisture - Corn and calluses indicate future ulcer

Answer 10

- Located on tips/tops of toes and sides of feet - Well defined edges - Wound base red - Moderate exudate - Callus formation is common Wagner Classification System - 0: pre-ulcerative lesions, healed lesions, presence of bony deformity - 1: partial thickness ulcer - 2: ulcer involving subcutaneous tissue - 3: osteitis, abscess or osteomyelitis - 4: gangrene of digit - 5: amputation +/- joint disarticulation

Answer 11

- Appropriate footwear - Daily foot inspection - Prevent pressure injuries in bed-bound patients - Avoid dry, cracked feet - Reduce/eliminate repetitive trauma - Pressure relief for heel ulcers - Deep + wide toe box for toe ulcers - Offloading - Tight glucose control

Answer 12

- Offloading - Glucose control - Wound management - Preventative care — daily foot inspection If wound fails to progress - Active wound therapy - Hyperbaric oxygen therapy - Refer to pedorthist +/- orthotist - Gradually increase walking time

Answer 13

Caused by inflammation and necrosis of blood vessels Usually associated with autoimmune disorders Pathology - Antigen-antibody complex deposits on vessel wall and becomes inflamed and occluded Clinical presentation - Depends on vessel involved and severity of inflammation - Usually full thickness, extremely painful - Wound bed is pale or necrotic with minimal exudate - Petechial or purpuric rash may precede ulcer Diagnosis - Systemic symptoms - Signs of vessel damage - Lab indicators — Sedimentation rate — ANA - Biopsy Management - Address underlying disorder - Anti-inflammatory drugs - Plasmapheresis - Pain management and moist wound healing

Answer 14

Inflammatory ulcers of the skin Clinical presentation - Ulcers or pustular lesions with purple borders - Acutely painful - Exudative and causes dermal destruction - 4 P’s — Purulent drainage — Painful — Pathergy — Purple edges Diagnosis - Diagnosis of exclusion - Biopsy confirms inflammation but nonspecific Treatment - Topical and systemic anti-inflammatory agents - Pain management - Moist wound management to manage exudate - Assure atraumatic removal

Answer 15

Sickle-shaped cells obstruct vessels and cause ulcer formation - Edema common due to loss of normal vasoconstrictive response Clinical presentation - Usually distal 1/3 of leg - Sharply demarcated edges - Scant exudate - Pale wound bed - Acutely painful - Ulcers are slow to heal and prone to reoccurrence Diagnosis - Relevant patient history of sickle cell disease Management - Systemic support — Hydration — Infection management — Nutritional support — Hydroxyurea - Pain management - Topical therapy +/- compression if edema

Answer 16

Pathology - Malignancy of basal cell layer of epidermis - May be primary lesion or develop into chronic wound Clinical presentation - Hypergranulation tissue with doesn’t respond to cauterization - Red/pink nodules - Ulcerative lesions with rolled borders Diagnosis - Biopsy Treatment - Surgery or radiation

Answer 17

Pathology - Malignancy involving keratinocytes - Usually associated with prolonged sun exposure Clinical presentation - Indurated papule, plaque, or nodule - Possible crusted areas - Shallow lesion with raised and indurated border Diagnosis - Biopsy Treatment - Surgery or radiation

Answer 18

Pathology - Rare but potentially fatal condition - Involves calcification of arterioles and soft tissue - Unknown true cause Clinical presentation - Painful, mottled lesions that progress to necrotic nodules - Common on fatty tissue areas - Mortality rate 50 – 80% Diagnosis - History and physical presentation - Lab values for calcium, phosphorus, and parathormone - Bone scan Treatment - Systemic measures to normalize extended lytes - Sodium thiosulfate infusion - Pain management - Topical therapy — Leave lesions open to air until systemic issues are corrected — Chemical or autolytic debridement — Possible NPWT vs grafting **all dependent on goals of care

Answer 19

Pathology - Rare condition usually associated with glucose intolerance - Etiology and pathology is unknown Clinical presentation - Well-demarcated “waxy” lesions on anterior and lateral surfaces of lower extremities - Lesions may be red, yellow, or brown - May be painful Diagnosis - Medical history - Clinical presentation Treatment - Systemic or intralesional steroids - Principles of moist wound healing

Lesson 8: Lower Extremity Wounds Flashcards

(43 cards)