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Integumentary > Practical #1 > Flashcards

Practical #1 Flashcards

1
Q

What are some causes of arterial insufficiency?

A 
Trauma
Acute embolism
Diabetes mellitus
Rheumatoid arthritis
Thromboangiitis (Buerger’s disease)
Arteriosclerosis
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2
Q

Most common places for arterial wounds:

A

Wounds between toes, on tips of toes, dorsal aspect of foot, over phalangeal heads, adjacent to lateral malleolous/ tibia or where subject to trauma , such as shin, distal calf

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3
Q

What arterial wounds look like:

A

Dry wounds with black/gray necrotic tissue and erythematous halo
Thin dry skin, absence of hair, shiny, smooth, cool

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4
Q

Borders of arterial wounds:

A

Well defined borders “punched out” smooth edges

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5
Q

Associated illnesses with arterial insufficiency ulcers

A 
Coronary disease 
CHF
COPD
Hypertension
Diabetes mellitus
End-stage renal disease
Hypercholesterolemia
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6
Q

Risk factors contributing to AI ulcers

A 
hyperlipidemia and elevated LDL
Systemic process
Smoking
Diabetes
Hypertension
Trauma
Advanced Age
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7
Q

Tests and Measures for AI

A 
Pulses
Capillary Refill
Rubor of Dependency
Venous Filling Time
Ankle-Brachial Index
Doppler Ultrasound
TBI- Toe pressures
TCPO2- Transcutaneous oxygen 
Plethysmography
Duplex scanning
Arteriography
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8
Q

Common causes of venous insufficiency

A

Common causes of venous insufficiency

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9
Q

Risk factors contributing to VI ulcers

A 
Vein dysfunction
Calf muscle pump failure
Trauma
Previous VI ulcer
Advanced Age
Diabetes
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10
Q

PT Tests and Measures for VI

A

Clinical Assessment for DVT
Ankle-Brachial Index
Trendelenburg Test
Venous Filling Time

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11
Q

C0

A

asyptomatic

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12
Q

C1

A

telangiactasias or spider veins <3mm

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13
Q

C2

A

varicose veins>/= 3mm

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14
Q

C3

A

leg edema

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15
Q

C4

A

skin and subcutaneou tissue change

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16
Q

C4A

A

hemosideran deposition

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17
Q

C4B

A

lipodermatosclerosis

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18
Q

C5

A

healed venous ulcer

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19
Q

C6

A

current venous ulcer

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20
Q

Venous signs:

A

Eschar or slough, wet, yellow fibrous
Moderate to heavy exudate
Tortuous veins
Edematous leg

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21
Q

Wound edges in VI:

A

Shallow wounds

Irregular wound edges

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22
Q

Location of VI insufficiency:

A

Superior to Malleoli, usually medial

Surrounding skin dry and scaly

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23
Q

ABI results >1 (.1.3)

A

Calcified vessels if diabetic- requires further evaluation. Do not exceed 250 mmHg, is non-compressible and may damage artery

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24
Q

ABI 1-.95:

A

No significant Arterial Disease

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25
ABI .95-.8:
Mild disease- Compression with caution
26
ABI: .8-.5:
claudication- compression contraindicated (usually symptomatic with claudication @.7)
27
ABI less than .6
debridement contraindicated by ANY means. Inadequate circulation, exposing debrided tissue to infection
28
ABI less than .5
compression contraindicated –resting pain .5-.4
29
ABI less than or equal to .3:
tissue loss
30
Risk Factors Contributing | to Pressure Ulcers
``` Shear Excessive moisture Impaired mobility Malnutrition Impaired sensation Advanced age History of pressure ulcer ```
31
Stage I PU:
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Area may be painful, warmer, cooler, firmer, softer than surrounding tissue
32
Tissues involved in stage I:
May be superficial | May be first sign of deeper tissue involvement
33
Stage II PU:
Superficial ulcer Shallow crater without slough or bruising May be ruptured or intact blister
34
Tissues Involved in Stage II:
Partial thickness (epidermis, dermis, or both)
35
Stage III PU:
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
36
Tissues involved in Stage III PU:
``` Full thickness (epidermis, dermis, subcutaneous tissue) Bone/tendon not visible ```
37
Stage IV PU:
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. Deep ulcer with extensive necrosis
38
Tissues involved in Stage IV PU:
Full thickness | Underlying deep tissue exposed
39
Unstageable PU:
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.
40
Tissues involved in unstageable PU:
Full thickness | Will be category III or IV
41
Superficial Burns
First-degree burns”/Integumentary Pattern B Dry, bright red, or pink skin that blanches upon pressure No dermal vessel damage
42
Types of superficial burns:
Sunburn, minor flash burn | Erythema, significant pain, lack of blisters, sunburn
43
Superficial Partial-Thickness Burns
Superficial second-degree burns”/Integumentary Pattern C Painful, moist, weeping, blistered skin with local erythema and edema Blanches to pressure with immediate capillary refill
44
Examples of Superficial Partial-Thickness Burns
Brief contact burns, flash burns, brief contact with dilute chemicals
45
Deep Partial-Thickness Burns
Deep second-degree burns”/Integumentary Pattern C Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity/reduced sensation Blanches to pressure with slow capillary refill Scarring, pigment changes, contractures possible
46
Examples of Deep Partial-Thickness Burns
Severe sunburn, scald, flash burn, brief contact with dilute chemicals
47
Full-Thickness Burns
Third-degree burns”/Integumentary Pattern D Initially look red then become mottled white/black, dry, leathery eschar, very painful Burned areas insensate to light touch Scarring and contractures likely Most require surgical debridement and grafting
48
What layers affected with full-thickness burn:
Epidermis, Dermis, and complete destruction to subcutaneous fat
49
Subdermal Burns
Fourth-degree burns”/Integumentary Pattern E Charred, mummified appearance Exposed deep tissues Burned areas insensate to light touch May have permanent nerve damage Require surgery (fasciotomy, escharotomy, grafting) and possible amputation
50
NU Wound edges:
even, well defined, with and without undermining
51
Diabetic Risk Factors Contributing Delayed Healing and Neuropathic Ulcers
``` Vascular disease Neuropathy Mechanical stress Abnormal foot function and inadequate footwear Impaired healing and immune response Poor vision ```
52
PT Tests and Measures | for Neuropathic Ulcers
Circulation | Sensory integrity
53
Grade 0 Wagner:
No open lesions | May have deformity or cellulitis
54
Grade 1 Wagner:
Superficial ulcer
55
Grade 2 Wagner:
Deep ulcer to tendon, capsule, bone
56
Grade 3 Wagner:
Deep ulcer with abcess, osteomyelitis, or joint sepsis
57
Grade 4 Wagner:
Localized gangrene
58
Grade 5 Wagner:
Gangrene of the entire foot
59
NU Position
Plantar foot Plantar aspect of metatarsal heads Plantar aspect of midfoot if Charcot deformity May occur under calluses May occur in areas of pressure/friction from inappropriate footwear
60
NU Presentation
Round, punched-out lesions Callused rim Minimal drainage unless infected Eschar or necrotic material uncommon unless infected

Integumentary (18 decks)

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