chronic wounds

predisoposing factors. tovenous leg ulcers

DVT and multiple pregnancies (due to risk for venous insufficiency)

typical area for. neuropathic ulcers

sole of foot or pressure points (places where pressure goes unrelieved)

venous ulcer presentation

irregular borders with slough/fibrin that requires debridement

diabetic foot ulcer triad

neuropathy, vascular insufficiency (ischemia) and infection

bacterial biofilms

a slime created by bacteria to protect against host defences. Biofilm can create a physical barrier that prevents cell mitigation and antibiotic penetration, it also produces low oxygen, low PH environment for the wound.

drainage may increase as an early sign of (not infection)

reperfusion, which triggers a redox reaction and inflamattion

obesity can contribute to what kind fo ulcers

venous stasis due to increased presure in the venous system

normal API (shows no arterial compromise)

0.9-1.3

tropic skin changes associated with venous disease

edema, dry thick scaling skin

primary intention

edges come together

secondary intention

healing from the bottom up (open) - chronic wounds

diabetic nephropathy

microvascular complication of blood vessels that suppli the glomeruli of the kidneys

how to detect diabetic nephropathy

macroalbuminuria

neuropathy two types

1. sensory

   1. autonomic

cause of neuropathy

persistent hyperglycemia causes damage to nerves = decreased nerve conduction speed due to demyelination.

primary disease falling under sensory neuropathy

distal symmetrical enuropathy

hallmark signs of sensory neuropathy

paraesthesia which can become hyperesthesia, worsening at night

atrophy of the musles in the hands and feet = deformity

treatmetn of sensory neuropathy

control of blood glucose levels

autonomic neuropathy signs

hypoglycemia unawareness, incontincence of bowels, urinary rentention, delayed gastric emptying (which can cause N/V, reflux, anorexia, or trigger hypoglycemia)

cardiac effects of autonomic neuropahty

hypotension, tachy, silent MI

primary risk factor for diabetic complications of the lower extremity

loss of protective sensation (LOPS)

another name for charcot foot

neuropathic arthropathy

another name for pressure ulcer

ischemic ulcer

hemasitus staining

aka iron staining in venous legs due to RC breakdown

predisposing factors for venous ulcers

DVT

multiple pregnancies

trauma

obesity

varicose veins

predisposing factors for arterial ulcers

arterial disease (high lipids)

diabetes

hypertension

vasospastic diseases

smoking

common location for venous ulcers

medial or lateral malleoli

common location for arterial ulcers

toes or shin or over pressure points

edges of arterial ulcer

hypertrophic

what type of ulcers have no pain

neuropathic

dressing to control bacterial colonization

silver and iodine paste/dressings

reperfusion injury

area will reperfuse when you take pressure away and newly found O2 will trigger a redox reaction causing increased inflammation and drainage, this is why you want to reperfuse slowly

venous ulcer treatment

compression

ambulation

exercise

elevation

anticoagulant (aspirin)

treatment arterial wound

prevent infection

promote collateral circulation (creation of new blood vessels)

avoid cold

do not elevate

vasodilators

platelet inhibitors

statins

treatment of diabetic foot ulcers

offloading

foorwear

glucose control

daily foot inspection

compression if accompynied by vascular disease

hypoglycemics

statins