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Questions and Answers
Which of the following is NOT considered a risk factor for arterial insufficiency ulcers?
Which of the following is NOT considered a risk factor for arterial insufficiency ulcers?
What indicates a better prognosis for healing arterial insufficiency ulcers?
What indicates a better prognosis for healing arterial insufficiency ulcers?
Which characteristic is true about the arterial system in relation to blood pressure?
Which characteristic is true about the arterial system in relation to blood pressure?
What should be done for all open wounds, regardless of type?
What should be done for all open wounds, regardless of type?
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What is a sign of poor prognosis in arterial insufficiency ulcers?
What is a sign of poor prognosis in arterial insufficiency ulcers?
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What is the acceptable time for capillary refill in a normal assessment?
What is the acceptable time for capillary refill in a normal assessment?
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In a Venous Filling Time assessment, what does a time greater than 30 seconds indicate?
In a Venous Filling Time assessment, what does a time greater than 30 seconds indicate?
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Which type of dressing is recommended for arterial ulcers?
Which type of dressing is recommended for arterial ulcers?
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What is the expected time for color to return in a normal Rubor of Dependency Test?
What is the expected time for color to return in a normal Rubor of Dependency Test?
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Which of the following conditions requires referral to a vascular surgeon?
Which of the following conditions requires referral to a vascular surgeon?
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When should 0.9% saline be used for wound cleansing?
When should 0.9% saline be used for wound cleansing?
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What type of topical treatment is recommended for ischemic wounds to prevent bacterial infection?
What type of topical treatment is recommended for ischemic wounds to prevent bacterial infection?
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Why should patients with low ABI avoid using sharp instruments for debris removal?
Why should patients with low ABI avoid using sharp instruments for debris removal?
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Study Notes
Wound Types
- Wounds secondary to pathology are different from traumatic wounds.
- Different types of wounds:
- Vascular wounds (arterial/venous insufficiency ulcers)
- Diabetic (neuropathic) wounds
- Pressure ulcers
Arterial Insufficiency Ulcers
- Arterial system has high pressure (120 mmHg).
- Arteries propel blood forward, pressure decreases as you move distally towards capillaries.
Risk Factors for Arterial Insufficiency Ulcers
- Atherosclerosis
- Obesity
- Diabetes
- Smoking
- Hypertension
- Age
- Cardiovascular disease
Prognosis of Arterial Insufficiency Ulcers
-
Good Prognosis:
- Ankle Brachial Index (ABI) > 0.5
- Toe pressure of 50 mmHg
- Transcutaneous oxygen levels > 30 mmHg
-
Poor Prognosis:
- Wound doesn't decrease in size or heal within 2 weeks
- Requires prompt referral to a vascular surgeon
Pulse Examination for Open Wounds
-
Capillary Refill Test:
- Patient position: Supine or sitting
- Normal: Blood returns in 3 seconds or less
- Abnormal/Impaired Vascular Status: Blood returns in more than 3 seconds
-
Venous Filling Time:
- Normal: 15-20 seconds
- Arterial Insufficiency: >15-30 seconds
-
Rubor of Dependency Test:
- Normal: Color returns to foot in 15 seconds
- Arterial Insufficiency: Color returns after 30 seconds and turns bright red
Infection Control
- Ischemic wounds are prone to bacterial infections.
- Bacterial swabs may be necessary if classical signs of infection are not present.
- Topical Treatment: Silver dressings, cadexomer iodide.
- Deep Tissue Infections: Systemic antibiotic therapy
Wound Cleansing
- Some wound cleaners are toxic, use only on superinfected wounds.
- Least harmful cleaner is 0.9% saline.
Dressing for Arterial Ulcers
- Arterial ulcers have minimal exudate and surrounding skin is fragile.
- Use moist, non-adherent dressings with antimicrobial properties.
Precautions for Patients with Arterial Insufficiency
-
High compression (30-40 mmHg):
- Avoid in patients with ABI > 0.80
-
Compression Dressings:
- Avoid in patients with ABI > 0.50, refer to a vascular surgeon.
-
Sharp Objects:
- Avoid using sharp objects to remove debris in patients with low ABI.
Pressure Ulcers
- Risk Factors:*
- Impaired sensation:
- Lack of pain as an early warning sign of tissue ischemia.
- Individuals may not shift their weight to alter pressure distribution.
- Examples: Spinal cord injury, spina bifida, stroke, full-thickness burns, peripheral neuropathy
- Impaired mobility:
- Due to hospitalization, diagnosis, spinal cord injury, infants/neonates.
- Usually develops within 3 weeks (adults) and 1 week (post-surgery).
- Other factors: Mental status, admission to a nursing home
- Previous pressure ulcers:
- Scar tissue recovers to 80% strength.
- Scar tissue + pressure injury = reduced tolerance and external load.
- Other risks: Individuals with low diastolic blood pressure.
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