Module 2 NDNQI Wounds
Venous Ulcer Location - ✔️✔️Lower calf and ankle (the gaiter area)
Pretibial and medial supra-malleolar area of the ankle near perforator veins.
Lower Extremity Venous Disease Risks - ✔️✔️Family history
Older age
Obesity
History of venous disease or thromboembolism
Trauma to the legs
Female
Pregnancy
Occupation that involves standing for a long period
Wound/Skin Injury etiology - ✔️✔️disease, moisture and trauma
Arterial Ulcers - ✔️✔️A wound caused by impaired arterial blood flow to the lower leg
and foot esp. Toes, dorsum of the foot, lateral malleolus, distal lower leg
The impairment in blood flow results in tissue ischemia, necrosis, and loss.
Arterial Ulcer causes - ✔️✔️Atherosclerosis
Arteriosclerosis
History of arterial insufficiency to lower extremities:
Peripheral Arterial Disease (PAD)
Lower Extremity Arterial Disease (LEAD)(1)
Risks:
Age
Smoking
Diabetes Mellitus
Hypertension
Dyslipidemia
Obesity
Family history of cardiovascular disease(2)
Arterial Ulcer Associated Skin Assessment - ✔️✔️Cooler skin temperature
Thin, shiny skin
Decreased or absent skin hair
Decreased pulse strength in affected extremity
Skin pallor on foot elevation; dusky rubor on dependency
Dystrophic toenails
Low Ankle-Brachial Index (ABI)
, Arterial Ulcer Characteristics - ✔️✔️Round and regular in shape
Pale wound bed
Can be shallow in depth or relatively deep
Smooth wound edges
Gangrenous/necrotic tissue may cover the wound
Minimal drainage
Severe pain
Venous Ulcer - ✔️✔️An open skin lesion of the leg or foot that occurs in an area
affected by venous hypertension.
Prolonged venous hypertension results in vein wall damage. This increases capillary
permeability and allows the extravasation of micromolecules and macromolecules into
the surrounding tissue. Damage to these tissues leads to venous ulcer development.
Venous Ulcer Associated Skin Assessment - ✔️✔️Hyperpigmentation of lower calf and
ankle skin from hemosiderin staining (leakage of red blood cells into the tissue)
Lipodermatosclerosis - thickening and fibrosis of skin and subcutaneous tissue from
chronic inflammation
Edema that may worsen with prolonged standing
Dry scaly skin that may be itchy
Weepy skin
Evidence of healed venous ulcers
Venous Ulcer Wound Characteristics - ✔️✔️Typically shallow in depth
Irregular in shape
Defined wound edge
Moderate to large amount of drainage is common
Often has a yellow fibrous film covering the surface
Variable pain (mild to severe)
Location Diabetic Foot Ulceration - ✔️✔️Common sites - toe interphalangeal joint,
metatarsal head, plantar surface of the foot, under heel
Diabetic Foot Ulcer Causes - ✔️✔️Lower Extremity Neuropathic Disease (LEND)
(peripheral neuropathy)
- Sensory neuropathy leads to loss of protective sensation
Motor neuropathy causes an imbalance between flexor and extensor muscles leading to
foot deformities that create abnormal bony prominences and pressure points
- Autonomic neuropathy alters blood flow in the foot and sweat and oil gland function
leaving skin dry
Peripheral vascular disease with poor microvascular circulation
Leads to tissue ischemia
Venous Ulcer Location - ✔️✔️Lower calf and ankle (the gaiter area)
Pretibial and medial supra-malleolar area of the ankle near perforator veins.
Lower Extremity Venous Disease Risks - ✔️✔️Family history
Older age
Obesity
History of venous disease or thromboembolism
Trauma to the legs
Female
Pregnancy
Occupation that involves standing for a long period
Wound/Skin Injury etiology - ✔️✔️disease, moisture and trauma
Arterial Ulcers - ✔️✔️A wound caused by impaired arterial blood flow to the lower leg
and foot esp. Toes, dorsum of the foot, lateral malleolus, distal lower leg
The impairment in blood flow results in tissue ischemia, necrosis, and loss.
Arterial Ulcer causes - ✔️✔️Atherosclerosis
Arteriosclerosis
History of arterial insufficiency to lower extremities:
Peripheral Arterial Disease (PAD)
Lower Extremity Arterial Disease (LEAD)(1)
Risks:
Age
Smoking
Diabetes Mellitus
Hypertension
Dyslipidemia
Obesity
Family history of cardiovascular disease(2)
Arterial Ulcer Associated Skin Assessment - ✔️✔️Cooler skin temperature
Thin, shiny skin
Decreased or absent skin hair
Decreased pulse strength in affected extremity
Skin pallor on foot elevation; dusky rubor on dependency
Dystrophic toenails
Low Ankle-Brachial Index (ABI)
, Arterial Ulcer Characteristics - ✔️✔️Round and regular in shape
Pale wound bed
Can be shallow in depth or relatively deep
Smooth wound edges
Gangrenous/necrotic tissue may cover the wound
Minimal drainage
Severe pain
Venous Ulcer - ✔️✔️An open skin lesion of the leg or foot that occurs in an area
affected by venous hypertension.
Prolonged venous hypertension results in vein wall damage. This increases capillary
permeability and allows the extravasation of micromolecules and macromolecules into
the surrounding tissue. Damage to these tissues leads to venous ulcer development.
Venous Ulcer Associated Skin Assessment - ✔️✔️Hyperpigmentation of lower calf and
ankle skin from hemosiderin staining (leakage of red blood cells into the tissue)
Lipodermatosclerosis - thickening and fibrosis of skin and subcutaneous tissue from
chronic inflammation
Edema that may worsen with prolonged standing
Dry scaly skin that may be itchy
Weepy skin
Evidence of healed venous ulcers
Venous Ulcer Wound Characteristics - ✔️✔️Typically shallow in depth
Irregular in shape
Defined wound edge
Moderate to large amount of drainage is common
Often has a yellow fibrous film covering the surface
Variable pain (mild to severe)
Location Diabetic Foot Ulceration - ✔️✔️Common sites - toe interphalangeal joint,
metatarsal head, plantar surface of the foot, under heel
Diabetic Foot Ulcer Causes - ✔️✔️Lower Extremity Neuropathic Disease (LEND)
(peripheral neuropathy)
- Sensory neuropathy leads to loss of protective sensation
Motor neuropathy causes an imbalance between flexor and extensor muscles leading to
foot deformities that create abnormal bony prominences and pressure points
- Autonomic neuropathy alters blood flow in the foot and sweat and oil gland function
leaving skin dry
Peripheral vascular disease with poor microvascular circulation
Leads to tissue ischemia
