Acute to Chronic Wounds

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Common complication that includes infection of marrow cavity of bones

Osteomyelitis

Venous ulcer drug therapy

Pentoxifylline 800 mg TID can accelerate healing

black and dry necrotic tissue

black eschar

venous skin ulcers develop when there is _________

venous insufficiency

the 3 big chronic wounds

venous ulcers diabetic ulcers pressure ulcers(decubious) dehisced wounds

Risk factors for venous ulcers

-Deep Vein Thrombosis -Leg surgery -obesity -blood-clotting -work that requires hours of surgery -CHF -smoking

usually DM pts present with ...

-Peripheral neuropathy(no feeling in the foot) -Ischemic Peripheral Vascular Disease -Charcot Osteoarthropathy(Sharko Foot)

Cofactors and Comorbidities

-insufficient oxygenation/perfusion -malnutrition -bioburden -excess pressure -concomitant conditions( PVD,DM) -adverse effects of Tx

- ABI of ____ or less suggests presence of PVD

0.9

venous ulcers account for _____% of all ulcers

80-90%

the ratio of systolic blood pressure in the ankle to that in the brachial artery

ABI(ankle-brachial index)

ultrasound method use to find foot pulse

Doppler examination

with wound bed score, the lower score means the better off you are...T/F

F... the lower score means yur worse off

in the Wagner Ulcer Classification System, at what grade does the bone get involved and what grade are you at highest risk

Grade 3 for osteo Grade 5 highest risk

what may be done in a nursing home to reduce the number fo pressure ulcers

Have elderly on turning schedules every 2 hours... Takes lots of manual labor and costs big $$$

imaging studies such as ___are useful in detecting bone infections

MRI

should compression be used with arterial ulcers?

NOPE

what if you had osteo in the spine and you couldnt cut it off??

Treat with IV anti-microbials for 6 to 8 weeks followed by weeks to months to maybe life of oral anti-microbials

Most venous ulcers develop on either side of the lower leg, above the ____ and below the _______.

above the ankle and below the calf

Venous ulcer 1st line Tx

compression bandaging (1st ) leg elevation biofilm based strategies

If a patient heals from a stage 3 pressure ucler and get another ulcer in the same spot... would it be classified as a stage 1 or stage 3

due to scar tissue would classify as a stage 3 and not revert back to stage 1

what is the first signs of venous ulcers

edema and varicose veins Dermatitis usually present

Historically, the standard procedure for treating osteomyelitis

excision of bone, toe amputation and major amputation

without venous ablation Sx, recurrence within 5 yrs is high or low

high

1st line for ulcer Tx

offloading using wheelchair/crutches

pressure ulcers risk factors

old age Immobilization Malnourishment incontinence DM

Pressure ulcers most commonly occur when??

over bony prominences

an area of skin that breaks down when you stay in one position for too long without shifting your weight.

pressure ulcer

1st line Tx for pressure ulcers

relief of pressure all biofilm based wound care nutritional support

are venous ulcers usually deep or shallow wounds??

shallow

difference between arterial and vasculitis ulcers in shape, margins and surrounding skin

shape: art...round vas...irregular margins: art... smooth vascular... irregular skin: art...pale vascular...hyperemic

wound assessment model

size surrounding skin(color, moisture, suppleness) wound bed (necrotic, exudate, odor, slough) wound edges(undermining, margins)

presentation of the skin in venous ulcers Pain??

skin often hyperpigmented only pain with infection

what stage in pressure ulcer staging involves the bone

stage 4


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