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WOCN program

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