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LEAD
WOCN program
| Question | Answer |
|---|---|
| What is the cause of most ischemic ulcers | LEAD |
| What is the most common cause of LEAD in older adults | Atherosclerosis |
| Risk factors for LEAD include: | Smoking, DM, HL, HTN, obesity, inactivity, stress and social isolation, male gender, Black ethnicity, high homocysteine level, inflamm., infection, renal failure |
| list components of a comprehensive assessment for a pt with lower extremity ulcer | ulcer location & size, amt. of exudate, appearance of wound bed, shape and borders, periwound,pain, risk factors, appearance of extremity, pulses, ABI, H&H, INR, homocysteine level, sensation, ROM |
| Define intermittent claudication | reproducible cramping, aching, fatigue, weakness and/or frank pain in the buttock, thigh or calf occurring after exercise and relieved with 10min of rest |
| Define rest pain | Pain in absence of activity, legs dependent, signals advanced disease >90% occlusion |
| Rest pain indicates advanced occlusive disease of what % occlusion | 90%` |
| Describe characteristics of an arterial ulcer | punched out appearance, dry, pale or necrotic wound bed, minimal or absent granulation tissue, min. exudate, localized edema, usually small but may be deep |
| List 3 noninvasive tests for LEAD | ABI, TBI, TcPO2 |
| When is a TBI indicated? | pt has noncompressible arteries, ABI >1.3, unable to measure ABI due to wound |
| What should be included in management of a patient with an arterial ulcer | reduce risk for adverse events (max dose of statin should be used)prevent progression, improve perfusion, manage wound based on perfusion |
| What topical therapy is indicated for dry necrotic uninfected ischemic wound | Paint with povidone solution |
| Effective management of an infected ischemic wound is what? | Managing exudate, preventing desiccation , managing pain, preventing infection |
| how many patients with LEAD experience intermittent claudication | approx 33% (1/3rd) |
| what percent occlusion does intermittent claudication signal | 50% |
| what are the 6 P's and what do they indicate | pulselessness, pallor, polar (cold), pain, paresthesia, paralysis and can also include purple (cyanosis) They indicate acute ischemia |
| explain TCpO2 | Transcutaneous oxygen pressure- not pulse ox-measures oxygen in periwound tissue-indicated for nonhealing wound >or= 40mmHg is nl, <=40 is some degree of hypoxia, <=30 is CLI |
| What is normal ABI value | 1.0-1.3=normal |
| list TBI values and what they represent | <0.7=LEAD |
| what is ABI | arterial brachial index- compares brachial systolic to ankle systolic using doppler |
| meds for LEAD | ACE inhibitors ramipril(incr.s ABI, walking ability) alleviates intermittent claudication, plavix (anti-platelet) no anticoag. |
| what dressings are contraindicated in LEAD ulcers | hydrocolloids or any occlusive dsg- because they are contraindicated in infected wounds, and s&s of inf. are subtle in LEAD wounds, no wraps or constriction |
| what about debridement with LEAD wound | non-selective mechanical debridement is contraindicated, no debridement until perfusion has been established, best is surgical debridement |
| what is dressing of choice | no consensus on dressing, moisture retentive that allows for frequent visualization ok. Goal is management of exudate and prevention of desiccation |
| pt education includes | modifiable risk factors, pain management, nutrition (Mediterranean diet) incr Vit D, exercise |
| invasive tests for LEAD | reserved for presurgical planning- contrast catheter angiography, digital subtraction angiography |
| Fontaine stages of LEAD | I-asymptomatic IIa mild claudication IIb moderate to severe claudication III ischemic rest pain IV ulceration or gangrene |
| Rutherfor Categories of LEAD | 0 asymptomatic I mild claudication II moderate claudication III severe claudication IV ischemic rest pain V minor tissue loss VI ulceration or gangrene |
| ABI of 0.6-0.8 identifies___ | borderline perfusion |
| What ABI value indicates LEAD | ABI - 0.9 |
| What does ABI of 0.5 indicate | severe ischemia |
| What ABI value indicates critical ischemia | ABI - 0.4 |
| What ABI value would indicate non compressible vessels | ABI > or = 1.3 |
Created by:
Beth Perry
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