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Wound Management Adult Med


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What causes a pressure (decubitus) ulcer
impaired blood supply resulting from porlonged pressure over bony or cartilaginous prominences
What are some differential diagnoses for pressure ulcers
herpes, skin cancers, pyoderma gangrenosum and ecthymagangrenosum (ulcerating lesion due to pseudomonas)
What methods are used fro prevention
clean dry skin and linens, turned at least once hour, examine pressure points frequently, special mattresses and pads
What does a stage 1 ulcer look like:
Ill-defined area of intact skin with fixed erythema after pressure is relieved. may have a change in skin temp, tissue consistency firm or boggy, pain or itching. In light pigmented skin may appear red, in darker skin tones may appear red, blue, or purple.
What does a stage 2 ucler look like:
Partial thickness loss of epidermis or dermis. Ulcer is superficial and resembles blister, abrasion or shallow crater. Necrotic tissue may overlie ulcer.
What does a stage 3 ulcer look like:
Full thickness loss of epidermis and dermis with damage to underlying subQ fat. May extend to but not thru fascia.
What does a stage 4 ulcer look like:
Full thickness skin loss with extensive destruction, or tissue necrosis to bone, muscle, tendon or joint.
What is a grade / stage 5 ulcer
Closed cavity communicating thru a small sinus.
What other staging systems are used to assess decubitus ulcers
Yarkony-kirk has 6 stages. Pressure sore status tool 1-4 scale. Sessing scale 1-6. Wound healing scale uses letters, Nortonand Braden A&B scales predict.
Describe chages in a wound that indicate infection
warm or hot, red and swollen, possible fever, increased WBC. Infection is common among pt's with pressure ulcers which occationally lead to bacteremia, sepsis and death
What mechanical forces can lead to pressure ulcers
pressure, friction or shearing
What does the Norton scale assess
hysical condition, mental status, activity, mobility, and incontinent
What does Braden scale assess
sensory perception, skin moisture, physical activity, nutritional intake, friction and shear, and ability to change and control body position
How would you treat a pressure ulcer
decrease pressure, wound care and testing for osteomyelitis
what are some symptoms specific to arterial ulcers
diminished pulses, edema not generally present, skin t4emp decreased or cool, surroungding skin shiny taut thin dry, no hair on lower extremity, thick brittle toe nails. Painful and more severe
What are some treatment considerations for arterial ulcers
laser doppler to measure capillary refill, tcPO2, duplex scan, vascular consult, no smoking
What does a venous ulcer look like
color is yellow and sloughy, wound base fibrinous or granular, irregular margins, frequent edema, skin temp normal, surrounding skin may be brown with haemosiderosis staining.
What are some treatments for venous ulcers
improve venous return, multi-layer compression wraps, compression hose, leg elevation, compression devices
What might a hx be for someone with a venous ulcer
previous DVT or varicosities, decreased mobility, obesity, traumatic injury, fam hx, previous venous ulcer, pain when extremity is dependent, decreased pain with elevation
What might a hx be for someone with an arterial ulcer
smoking, DM, HTN, age, hx of arterial disease, intermittent claudication, px with elevation, improves with dependence

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