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SWM Module 15 part 2: Assessing the Wound — Lower Extremity Arterial Disease (LEAD)

front 1

Lower extremity arterial disease (___) is a progressive narrowing or blockage of arteries in the lower limbs, often due to atherosclerosis (McNichol et al., 2021). It is commonly associated with PAD and defined by an ABI < 0.9, leading to ischemia in the lower leg.

back 1

LEAD

front 2

____ leg ulcers are often triggered by trauma, such as blunt force or chronic pressure from improperly fitting footwear.

back 2

Arterial

front 3

PAD

back 3

front 4

Critical Limb Ischemia

back 4

Is the most severe form of LEAD, where blood flow is so poor that tissues cannot survive (DynaMed, 2022). Most individuals with CLI also have diabetes. Without appropriate revascularization, these patients often face amputation, with the risk increasing as their ABI decreases.

front 5

Risk Factor for Arterial Disease Modifialble:

back 5

  • Smoking
  • Diabetes
  • Dyslipidemia
  • Hypertension
  • Obesity
  • Inactivity
  • Stress

front 6

Risk Factor for Arterial Disease

back 6

  • Age
  • Male assigned at birth
  • Postmenopausal status
  • Family history of cardiovascular disease
  • Race, specifically Black

front 7

Is the VLU, or ALU?

back 7

ALU

Wound Edges

They have a well-defined, round, or "punched-out" appearance with sharply demarcated edges.

front 8

ALU characteristics

back 8

* well-defined, round, or "punched-out" appearance with sharply demarcated edges.

Wound bed pale, gray, or yellowish due to the lack of oxygen-rich blood reaching the area. The wound bed may also be dry and necrotic, with necrotic tissue ranging from thick black eschar to slough.

* Minimal exudate because of lack of blood supply

* Periwound Periwound -This is often thin, shiny, dry, and cool to the touch.

front 9

What does ABI stand for and mean?

back 9

An ankle-brachial index (ABI) is a painless test that measures blood pressure in your ankles and arms. It shows if you have peripheral artery disease (PAD), or plaque buildup in your leg arteries. Your ABI is the blood pressure in your ankle divided by that in your arm. * Can catch PAD before it gets severe!

front 10

When is an ABI test needed?

back 10

- if you have PAD symptoms, like leg pain when active. Your PCP may also suggest this test if you don’t have symptoms but are:

  • Age 65 or older
  • Age 50 to 64 and have certain risk factors for atherosclerosis (like diabetes, high blood pressure, high cholesterol, history of tobacco use) or a history of PAD in your biological family
  • Under age 50 and have diabetes along with another risk factor for atherosclerosis

front 11

Below are preparations for what kind of test/procedure?

  • Don’t eat or drink anything that contains caffeine on the day of your test.
  • Don’t use tobacco products or alcohol during the hour before your test.
  • Don’t exercise during the hour before your test.
  • Wear loose, comfortable clothes so your provider can easily access your upper arms and ankles.
  • Just before the test, go to the restroom and pee until your bladder is empty.

Be sure to tell your provider if you’ve had any procedures to improve circulation in your legs. This may affect how they do the test.

back 11

ABI test

front 12

What is this formula?

back 12

Ankel-Brachial Index

front 13

ABI: Ranges

_._-__._ is normal range

_._ or lower, you have PAD

back 13

1.0-1.3 is normal

0.9

front 14

What do these ABI results mean?

  • 1.0 to 1.3: Normal
  • 0.9 to 1.0: Borderline
  • 0.7 to 0.9: Mild PAD
  • 0.4 to 0.7: Moderate PAD
  • Lower than 0.4: Severe PAD

back 14

Normal

Borderline

Mild PAD

Moderate PAD

Severe PAD

front 15

ABI Range:

Lower that 0.4 means?

back 15

Severe PAD

front 16

ABI Range:

0.4 to 0.7 means?

back 16

Moderate PAD

front 17

ABI Range:

1.0 to 1.3 means?

back 17

Normal

front 18

ABI Range:

0.9 to 1.0 Borderline

back 18

Borderline PAD

front 19

When your arteries are calcified, an ___ test can't reliably diagnose PAD. Other options Toe- Brachial (big toe)

back 19

ABI

front 20

Researchers found that people with an ankle-brachial index higher than 1.4 have in increased risk of _____ ____

back 20

CARDIOVASCULAR DEATH

front 21

Ulcer Stages:

Supervicial Ulcer

back 21

Grade 1

Superficial ulcer w/out subcutaneous tissue involvement

front 22

Ulcer Stages:

DEEP ULCER

back 22

Grade 2

Involves ligament, tendon, joint capsule, or deep fascia but no abscess or osteomyelitis

front 23

Ulcer Stages:

Osteitis

back 23

Grade 3

Deep wound with abscess or osteomyelitis

front 24

Ulcer Stages:

Partial gangrene

back 24

Grade 4

Gangrene affects a portion of the foot

front 25

Ulcer Stages:

Gangrene

back 25

Grade 5

Gangrene affects entire foot

front 26

Wagner Scale (Meggitt-Wagner)

back 26

The Wagner Scale, also known as the Meggitt-Wagner classification, is a simple grading system used to evaluate the severity of DFUs (DynaMed, 2024b).

front 27

The Meggitt-Wagner classification, is a simple grading system used to evaluate the severity of DFUs (DynaMed, 2024b). It classifies ulcers based on:

back 27

  • Depth of the wound.
  • If the wound is infected.
  • The amount of tissue necrosis.

front 28

Which component of the blood is primarily involved in forming the initial phase of a blood clot during wound healing?

Red blood cells

Platelets

White blood cells

Plasma proteins

back 28

no data

front 29

Which type of white blood cell is most abundant and acts as the first responder to bacterial infection?

Lymphocytes

Neutrophils

Eosinophils

Monocytes

back 29

no data

front 30

What role does melanin play in protecting the skin from ultraviolet radiation?

Acts as a physical barrier by scattering and absorbing UV rays to decrease penetration

Increases transepidermal water loss to cool the skin

Produces antimicrobial peptides to defend against sun-induced pathogens

Stimulates the production of sweat to enhance evaporation cooling

back 30

no data

front 31

What is the average pH of the acid mantle of an adult’s skin?

5.5

0 to 4.5

7.1 to 14

7.0

back 31

no data

front 32

Which layer of the epidermis is responsible for producing new cells through mitosis?

Stratum Lucidum

Stratum Spinosum

Stratum Germinativum

Stratum Granulosum

back 32

no data

front 33

Which choice BEST describes the function of tendons?

Attaches bone to bone

Connects muscle to bone

Provides a surface for bones to glide over

Surround muscles to reduce friction

back 33

no data

front 34

What BEST describes the characteristics of healthy skeletal muscle?

White and shiny in appearance

Pearly white ribbon-like appearance

Pink to dark red in color with striation

Pale pink without striation

back 34

no data

front 35

What is the primary composition of fascia?

Adipose tissue

Collagen

Keratin

Muscle tissue

back 35

no data

front 36

What protein gives red blood cells the ability to transport oxygen?

Fibroblasts

Hemoglobin

Macrophage

Mast Cells

back 36

no data

front 37

What BEST describes the responsibilities of collagen and elastin in the skin?

Transporting nutrients and waste products through the dermis

Killing parasites and helping with allergic responses

Protecting skin integrity and preventing water loss

Providing tensile strength and recoil to the skin

back 37

no data

front 38

What best describes what “Skin of Color” refers to?

A specific skin type that is only found in tropical regions

Skin that tans easily and rarely burns under sun exposure

The broad range of skin types and complexions of individuals not of White descent

Skin that is overly sensitive to ultraviolet radiation and prone to sunburn

back 38

no data

front 39

Which of the following best describes a systematic head-to-toe skin assessment?

Examining only the areas around and under medical devices

Inspecting and palpating the skin, focusing on bony prominences and skin folds

Using only visual inspection to assess the skin

Checking the patient’s clothing for signs of moisture

back 39

no data