Term
| An ulcer is an open wound that results from loss of the __ and part or all of the __. |
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Definition
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Term
| Etiologies of ulcers (7): |
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Definition
1. Arterial occlusion- usually due to an embolus or thrombus that causes sudden severe pain in an extremity
2. Arteriosclerosis- plaque formation causing gradual onset of pain with exertion and relieved by rest
3. Venous stasis- lower leg heaviness, aching and swelling typically after long periods of standing or sitting
4. Neoplastic: often have history of growth preceeding ulceration
5. Factitial: suspected in patients with history of emotional disorders
6. Infective: suspected in patients with recent travel history, sexual history, or wildlife exposure
7. Drug side effect: allopurinol, barbituates, anticonvulsants, and certain antibiotics may cause drug induced epidermal necrolysis or vasculitis |
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Term
| If only epidermis is lost, the lesion is considered to be an __. |
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Definition
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Term
| If the etiology of an ulcer is arterial occlusion, pain in legs will be worse when __ __ and better when __ __. Use compression stockings. |
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Definition
- worse when laying down
- better when sitting up |
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Term
| HPI for ulcers should include: |
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Definition
Onset- acute vs. chronic
Symptoms
Neoplasm
Family History
Social History
Travel
Medications |
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Term
| Fibrotic tissue in an ulcer can appear yellow, so don't assume it is a bacterial infection. Must debride the fibrotic material so healthy tissue can grow. Rotate bed-ridden patients every __ hours. |
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Definition
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Term
| Vascular studies are ordered with ulcers to rule out __ __ _. The __ __ __ is the best screening tool to rule out PVD. |
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Definition
- peripheral vascular disease
- Ankle:brachial index |
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Term
| What vascular study is the best to rule out PVD? |
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Definition
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Term
| What 2 vascular studies can be used to define extent of arterial obstruction? |
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Definition
- Selective Arteriography
- Arterial Duplex Ultrasonography |
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Term
| What vascular study is used to rule out venous insufficiency, DVT, and superficial thrombophlebitis? |
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Definition
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Term
| What study is used to distinguish between venous and arterial abnormalities and also can be used to determine cutaneous blood perfusion at margins of an ulcer to predict potential for healing? |
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Definition
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Term
| When figuring out etiology of an ulcer, what 5 blood tests are used to rule out connective tissue disease? |
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Definition
- ANA
- RF
- anti-DNA antibody
- anti-phospholipid antibody
- lupus anticoagulant
(side note: would not normally do a blood test for an ulcer, unless you suspect an underlying disease) |
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Term
| Hematologic disorders including sickle cell anemia, spherocytosis, thalassemia and dysglobulinemia can be ruled out by various blood tests |
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Definition
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Term
| Cultures can also be done to discover etiology of an ulcer. Cultures are necessary for diagnosing __ or __ infection. Routine cultures are polymicrobial. Antibiotics for ulcers that have become secondarily infected, will not work unless underlying cause of ulcer is corrected. If osteomyelitis is suspected, diagnosis by __ is required. |
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Definition
- topical or unusual
- radiography |
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Term
| A biopsy is indicated for all __ ulcers of __ origin. This helps to rule out __. Biopsy at the __. |
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Definition
- chronic ulcers
- unknown origin
- neoplasm
- edge |
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Term
| Venous insufficiency typical findings: |
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Definition
- LOWER LEG EDEMA
- BRAWNY INDURATION
- brownish discoloration
- petechiae
- dermatitis
- rarely occurs below the level of the malleolus
- varicose veins may or may not be prominent |
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Term
| Treatment of Venous Insufficiency: |
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Definition
- external compression is the most effective treatment
- treat initially with a compression boot that is changed weekly
- after healing, high knee medium pressure elastic compression stockings are used to prevent recurrence |
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Term
| PUNCHED OUT ULCERS USUALLY ON ANTERIOR OF LOWER LEG, Multiple small ulcers predominant on the lower extremities. Purpuric, hemorrhagic, and necrotic ulcer borders. |
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Definition
Vasculitis
(PUNCHED OUT ULCERS= VASCULITIS ON TEST) |
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Term
| Vasculitis kind of looks like pyodermic gangrenosum, but vasculitis is not an infective process. |
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Definition
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Term
| Individual or multiple cutaneous nodules that become ulcerated. Tend to bleed on their own without scratching. |
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Definition
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Term
| Treatment of neoplastic ulcers: |
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Definition
- surgery
- chemotherapy
- radiation |
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Term
| __ __ is a type of cancer that can result in ulcerated plaques and tumors on the back. |
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Definition
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Term
| Ulceration of the lower third of the leg above the ankle can be a major manifestation in an African American adult of __ __ __ __. |
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Definition
| homozygous sickle cell disease |
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Term
| Ulcers found on areas of pressure and trauma, particularly on an insensate foot. This is commonly seen in patients with diabetes or leprosy. Frequently has significant softened macerated cells. |
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Definition
Neuropathic ulcer aka malperforans
(always check sensation of feet in diabetics and make sure have good fitting shoes) |
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Term
| Neuropathic ulcer treatment: |
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Definition
- prevention is key
- relieve pressure with mechanical devices (orthotic shoes for diabetics) |
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Term
| Geometric, bizarrely shaped, angular ulcer: |
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Definition
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Term
| Genital ulcers are highly suggestive of veneral diseases like __ __, __, __, or __ __. |
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Definition
- herpes simplex
- syphilis
- chancroid
- granuloma inguinale |
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Term
| Herpes simplex ulcers will occur at the __ place every time, __ will precede ulcer appearance. |
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Definition
- same place every time
- burning will precede ulcer appearance |
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Term
| Syphilis ulcers are painful/non-painful? |
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Definition
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Term
| Chancroid ulcer is painful/non-painful? |
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Definition
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Term
| __ __ occur in usually elderly and incontinent patients. Those at the greatest risk are usually bed-ridden or wheel chair bound. |
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Definition
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Term
| Most common sites for decubitis ulcers include: |
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Definition
- sacral, coccygeal, and ischial tuberosities
- greater trochanter |
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Term
| __ ulcers begin as irregular, ill-defined, reddish, indurated areas that resemble abrasions. Then, full thickness skin defects develop with extensions into the subcutaneous tissue and ultimate penetration into the deep fascia and muscle. |
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Definition
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Term
Do very thorough exam of skin upon hospital admittance. Insurance doesn’t pay for hospital-acquired ulcer care, so need to know if ulcers were there before admittance to hospital.
If have reddish, purplish tissue overlying bony prominence in bed-ridden patient-- considered stage one wound, and is before skin breaks down and ulcerates. Watch out for this. |
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Definition
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Term
| Pyoderma Gangreosum is a __ developing __ ulcer with __ edge and __ border. These usually occur on __ __ and are frequently associated with __ __, __ __, and __ __. |
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Definition
- rapidly
- painful ulcer
- undermined edge
- gangrenous border
- lower legs
- granulomatous colitis
- RHEUMATOID ARTHRITIS
- myeloproliferative diseases |
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Term
Rapidly developing, painful ulcer with undermined edge and gangrenous border
Usually occur on lower legs
Frequently associated with ulcerative and granulomatous colitis, RA, and myeloproliferative diseases |
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Definition
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Term
| Pyoderma Gangreosum is NOT an __ __. You will culture it over and over and it will come back with no organisms. Treat with ___ to slow down over-inflammatory process and allow for wound healing. |
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Definition
- NOT an infectious process
- steroids |
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Term
| Treatment for ulcers due venous insufficiency: |
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Definition
| compression/boot stockings |
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Term
| Treatment of ulcers due to arterial insufficiency: |
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Definition
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Term
| Treatment of vasculitis ulcers and Pyoderma gangrenosum (inflammatory process): |
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Definition
- prednisone
- dapsone
- treatment of associated disease |
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Term
| Pyoderma gangrenosum is an __ process, NOT an infectious process. |
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Definition
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Term
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Definition
- debridement: surgical, enzymes (remove fibrotic tissue)
- dressings- nonadherent, occlusive, or moist to dry
- infection control- antibiotics
- skin grafting |
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Term
| Occlusive dressings are made from many polymers. They work to keep the ulcer __ which promotes epidermal repair through migration of epithelial cells over the ulcer. Large amounts of exudate form under the dressing, which remove the crust and necrotic debris through autolytic digestion. Change the dressing every _to _ days. Provide pain relief. |
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Definition
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Term
| Treatment of ulcers with antibiotics is often ineffective due to development of resistant bacteria. Thus antibiotic treatment of ulcers is reserved for those complicated by __, __, or __. |
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Definition
- cellulitis
- lymphangitis
- septicemia
(culture is important to see if you're dealing with resistant bacteria) |
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Term
| For a venous ulcer that has failed to respond to conservative therapy, a __ __ may be done. Skin usually taken from __. |
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Definition
- skin graft
- thigh
DO NOT DO THIS IF THERE IS AN INFECTIOUS PROCESS OCCURING |
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Term
| Possible complications of ulcers: |
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Definition
- cellulitis
- lymphangitis
- septicemia
- osteomyelitis |
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Term
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Definition
Cell Death:
Infection, toxic chemicals, physical injury, and loss of nutrition all cause cell death, tissue loss, and ulceration.
As long as cell death continues, the ulcer will persist |
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Term
| Ulcer healing requires intact __ _, __, proliferation of __, __ __, and __. |
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Definition
- vascular supply
- inflammation
- proliferation of fibroblasts, endothelial cells, and keratinocytes |
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Term
| Dermal integrity depends on fibroblasts synthesis of(3): |
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Definition
- collagen
- elastin
- proteoglycans |
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Term
| Epidermal repairs require proliferation and migration of __ over a __ __ support matrix. |
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Definition
| keratinocytes over a fibrin-fibrinonectin support matrix |
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Term
| Inflammation is always an important part to healing an ulcer b/c the ___ is the essential and most important cell. |
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Definition
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Term
| Growth Factors (epidermal, platelet-derived, fibroblast, TGF-B) have a role in wound healing by enhancing reepithelialization and granulation tissue |
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Definition
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Term
For ulcers: Healing process is very slow, especially with vascular disease patients or diabetic patients.
Never put topical steroid directly on the wound, as this will slow down the healing process. |
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Definition
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