WOCN program
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| What is the cause of most ischemic ulcers | LEAD
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| What is the most common cause of LEAD in older adults | Atherosclerosis
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| 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
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| 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
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| 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
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| Define rest pain | Pain in absence of activity, legs dependent, signals advanced disease >90% occlusion
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| Rest pain indicates advanced occlusive disease of what % occlusion | 90%`
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| 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
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| List 3 noninvasive tests for LEAD | ABI, TBI, TcPO2
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| When is a TBI indicated? | pt has noncompressible arteries, ABI >1.3, unable to measure ABI due to wound
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| 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
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| What topical therapy is indicated for dry necrotic uninfected ischemic wound | Paint with povidone solution
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| Effective management of an infected ischemic wound is what? | Managing exudate, preventing desiccation , managing pain, preventing infection
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| how many patients with LEAD experience intermittent claudication | approx 33% (1/3rd)
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| what percent occlusion does intermittent claudication signal | 50%
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| 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
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| 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
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| What is normal ABI value | 1.0-1.3=normal
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| list TBI values and what they represent | <0.7=LEAD
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| what is ABI | arterial brachial index- compares brachial systolic to ankle systolic using doppler
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| meds for LEAD | ACE inhibitors ramipril(incr.s ABI, walking ability) alleviates intermittent claudication, plavix (anti-platelet) no anticoag.
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| 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
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| what about debridement with LEAD wound | non-selective mechanical debridement is contraindicated, no debridement until perfusion has been established, best is surgical debridement
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| 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
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| pt education includes | modifiable risk factors, pain management, nutrition (Mediterranean diet) incr Vit D, exercise
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| invasive tests for LEAD | reserved for presurgical planning- contrast catheter angiography, digital subtraction angiography
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| Fontaine stages of LEAD | I-asymptomatic IIa mild claudication IIb moderate to severe claudication III ischemic rest pain IV ulceration or gangrene
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| 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
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| ABI of 0.6-0.8 identifies___ | borderline perfusion
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| What ABI value indicates LEAD | ABI - 0.9
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| What does ABI of 0.5 indicate | severe ischemia
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| What ABI value indicates critical ischemia | ABI - 0.4
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| What ABI value would indicate non compressible vessels | ABI > or = 1.3
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Created by:
Beth Perry
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