Wk5- Foot Disease

Question 1

Define foot disease disorders

Answer 1

severe disorders that are the end result of chronic diseases (diabetes, Cvd, cancer, kidney disease)

Question 2

What 3 things determine foot disease

Answer 2

1. Ulceration
2. Infection
3. Ischemia

Question 3

What are the main risk factors for foot disease

Answer 3

PAD, PN, deformity, trauma or history of FD

Question 4

Define ulceration

Answer 4

lesion through skin or mucous membrane resulting in loss of tissue (no loss of tissue = wound

Question 5

Ulcer classifications and signs for each

Answer 5

1. Venous- medial ankle, shallow, inflammation, irregular margins
2. Arterial- distal foot, dry, puncture, painful
3. Neuropathic- plantar/weight bearing, surrounding callous, painless
4. Combined (neuroischamic)

Question 6

Stages of wound healing

Answer 6

1. Immediate- Haemostasis (constriction of blood vessels, strengthening of fibrin strands to stop bleeding)
2. Inflammation- (2-3 days) increased blood flow (WBC- macrophages+ neurtophils), phagocytosis for debridement
3. Proliferation - granulation tissue (new capillaries for tissue reconstruction) and epithelialisation
4. Maturation - (1+ year) transformation of collagen

Question 7

What does a wound assessment involve? 6

Answer 7

1. Patient history and examination
2. Wound history
3. Would observations
4. Signs of infection
5. Identify status of ulcer (active, etc)
6. Grading system (UTWC

Question 8

What should be included in a wound history

Answer 8

• duration of wound
• Changes in size or appearance
• Change in number of wounds
• Previous history
• Pain or altered sensation with wound
• Signs and symptoms related
• Does pt know the cause of wound

Question 9

What should be included in observations of a wound

Answer 9

• anatomical site
• Size (measured)
• General appearance of wound and surrounding tissue
• Edges of wound
• Colour of Base of wound
• Exudate

Question 10

Potential Colours of wounds and what each mean (black, yellow, bright red, pale red, pink)

Answer 10

Black - necrotic tissue (retards healing, remove)

Yellow - fibrous tissue, appears before granulation tissue develops (creamy if large number of WBC and greeny if necrotic)

Bright Red - granulation tissue

Pale red with spontaneous bleeding- infection, ischemia, anaemia

Pink- final stages of healing (epithelialisation) migrating from wound margin

Question 11

Potential wound edges and what they mean (saucer, vertical, rolled, firm, maceration, undermining)

Answer 11

Saucer shaped- infilling and healing

Vertical edge - ischemic ulcer

Rolled- malignant ?

Firm swelling- infection/inflammation

Maceration- uncontrolled exudate

Undermining- internal wound

Question 12

Wound base colour and what it is (red, yellow, black, white)

Answer 12

Red- granulation
Yellow- slough
Black- necrosis
White- deeper structures

Question 13

Changes in Wound exudate and what it means (increase, decrease, clear, cloudy, odour)

Answer 13

Increases - bacteria, infection, foreign matter
Decreases- as it heals
Clear/thin/watery- healthy
Bloody/thick/purulent/cloudy- infection
Odour- foul odour is occluded wound

Question 14

What are the signs of infection 6

Answer 14

Red
Hot
Oedema
Pain
Exudate
Loss of function

Question 15

Ulcer status and what it means

Answer 15

Active- extending
Static - chronic
Decreasing- healing
Spreading - infection

Question 16

UTWC would classification

Answer 16

A- absence of infection and ischamia
B- infection
C- ischemia
D- both

0- healed
1- superficial wound, no penetration
2- wound penetrating to tendon or capsule
3- wound penetrating to bone or joint

Question 17

CEAP classification

Answer 17

C0- no signs
C1-telangiectasia or reticular veins (purple/ areas of blood deposition)- permanent dilation of capillaries, venules and arterioles
C2- varicose veins - superficial veins dilated
C3- oedema
C4- changes in skin and subcutaneous tissue
C4a- stasis dermatitis - pigmentation (haemosiderin deposits) or eczema
C4b- lipodermatosclerosis - induration (inverted wine bottle)- subcutaneous fibrosis and hardening of skin or atrophy blanche (scar patches without pigmentation)
C5- healed ulcer
C6- active venous ulcer (medial malleolus)
C6r- recurrent active venous ulcer (25-30% recurrence rate

Question 18

CEAP stands for

Answer 18

C- clinical signs
E- cause
A- anatomical site
P- pathophysiology

Question 19

What are the causes of venous leg ulcers

Answer 19

• valve incompetence (primary)
  -venous obstruction/occlusion ( secondary)
  -dysfunction of calf muscle pump (secondary)
  -Congestive cardiac failure

Question 20

Chronic venous insufficiency is diagnoses by what CEAP classification?

Answer 20

C3-C6