Week 5 | Arterial Wounds (16180-SP)
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Topics
Normal arterial perfusion and terms
Etiology
- Atherosclerosis
- Arterial trauma
- Acute embolic syndrome
- Entrapment syndromes
- Buerger’s Disease (thromboangitis obliterans)
- Sickle cell
- Associated with autoimmune diseases, collagen abnormalities, vasculitic disorders, clotting abnormalities such as protein C deficiencies and vasospastic diseases such as Raynaud’s disease.
Pathology of atherosclerosis
Risk Factors
- Modifiable:
- Tobacco use
- Hypertension
- Dyslipemia
- Diabetes
- Predisposing:
- Advanced Age
- Male gender
- Family history
- African American ethnicity
- Emerging:
- Hyperhomocysteinemia
- Increased C-Reactive Protein
- Chronic renal disease
- Chlamydia pneumoniae
- Peridontal disease
Arterial disease and diabetes
Structured assessment approach
- Patient assessment
- Pain history and assessment
- Common locations, characteristics, alleviating and aggravating factors
- Intermittent Claudication
- Nocturnal
- Rest
- Lower extremity exam
- General appearance of limb
- Ischemic Skin Changes
- Epidermal thinning
- Atrophy of subcutaneous tissue
- Shiny, taut, dry skin
- Purpura
- Loss of hair
- Thick toenails
- Color changes
- Elevational pallor
- Dependent rubor
- Assess pulses
- Doppler signal quality
- Ankle-Brachial Index
- Skin temperature
- Capillary refill
- Non-invasive assessment
- TBI
- Transcutaneous oxygen
- Focused wound assessment
Ulcer characteristics and pathology
- Location: Distal aspect of extremity, phalangeal heads, lateral malleolus, areas of repetitive trauma
- Punched out appearance, well defined borders
- Pale or necrotic wound bed
- Minimal exudate
- Faint halo of erythema, infection common
- Extremely painful
Treatment
- WOCN guidelines: Relate treatment to adequacy of perfusion (ABI).
- Referral to vascular surgeon: surgical/endovascular options
- Limb salvage/preservation
- Bypass grafts
- Angioplasty
- Thrombolysis
- Amputation
- Pharmacologic options
- Analgesics
- Risk factor modification
- Statins
- Antiplatelet agents
- Cilostazol
- Referral indications
- Adjunctive therapies
- Hyperbaric oxygen therapy
- Arterial flow augmentation
- Measures to improve perfusion
- Smoking cessation
- Maintenance of hydration
- Avoidance of cold
- Avoid caffeine
- Avoid constrictive garments
- Graduated walking program
- Nutritional supplements
Topical Management Issues
- Identify and treat infection
- Maintain dry non-infected necrotic wound
- Cleansing.
- Cautious use of occlusive dressings
- Manage edema in mixed disease
- Principles
- Appropriate use antiseptics and topical antibiotics
- Pain management
- Indicators of wound infection in the ischemia limb.
Patient education
Summary
Objectives for Learning Outcomes
After completing this session, you will be able to:
- Describe the etiology and risk factors for lower extremity arterial disease (LEAD).
- Discuss the assessment, clinical presentation, and management of lower extremity arterial ulcers.
Renee Anderson, MSN, RN, CWON
Certified Wound Ostomy Nurse; Co-Director, Wound Management Education Program (WMEP) and Wound Management Fundamentals Course (WMFC), Continuing Nursing Education, University of Washington School of Nursing, Seattle; President, Rainier Clinical Consultants, Inc, Seattle, WA
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