10/9/2015. Differential Assessment of Lower Extremity Wounds. Disclosure Statement. Program Objectives
|
|
- Elvin Simmons
- 5 years ago
- Views:
Transcription
1 3M All Rights Reserved 3M All Rights Reserved 2 3M All Rights Reserved 3 Differential Assessment of Lower Extremity Wounds Presented by: Lynn Peterson RN, BSN, CWOCN 3M Health Care November 3, 2015 Disclosure Statement Lynn Peterson is employed by 3M Health Care, Critical & Chronic Care Solutions Division as a Product Service Specialist Program Objectives Differentiate between arterial, neuropathic and venous leg ulcerations Identify key risk factors for lower extremity ulcerations List five key wound assessment parameters Describe appropriate methods of treating lower extremity ulcerations 1
2 3M All Rights Reserved 4 3M All Rights Reserved 5 3M All Rights Reserved 6 treated Etiology leg ulcers 72% 8% 14% 6% venous arterial combined other Do you know the difference? Comprehensive bilateral lower-extremity assessment General appearance Trophic changes Thin & shiny epidermis, loss of hair growth, thickened nails (LEAD) Edema, hyperpigmentation, scaly, eczematous skin (LEVD) Dryness, fissures, cracks, foot deformities (LEND) Hair, nail, skin patterns Veins Skin color, shape, texture, integrity Edema Ermer-Seltun J. Lower Extremity Assessment. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4 th ED. St. Louis, MO: Elsevier Mosby; 2012:
3 3M All Rights Reserved 7 3M All Rights Reserved 3M All Rights Reserved 9 Comprehensive bilateral lower-extremity assessment Functional-sensory status Gait and mobility Range of motion of ankle joint Pain Perfusion Elevational pallor or dependent rubor Skin temperature Blood flow (bruit/thrill) Capillary refill Pulses Ankle-brachial index Ermer-Seltun J. Lower Extremity Assessment. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4 th ED. St. Louis, MO: Elsevier Mosby; 2012: Lower Extremity Arterial Insufficiency (LEAD) & Arterial Ulcers Lower Extremity Arterial Disease (LEAD) Insufficient arterial perfusion from arteriosclerotic changes Peripheral vascular disease (PVD) Peripheral arterial occlusive disease (PAOD) Lower-extremity peripheral arterial disease (PAD) When arterial flow is diminished: Minor injuries can become non-healing wounds Ulcers occur often at distal locations May progress to gangrene or tissue necrosis amputation 3
4 3M All Rights Reserved 10 3M All Rights Reserved 11 3M All Rights Reserved 12 LEAD prevalence & significance 8-12 million adults 40yrs. of age 40% in individuals 80 yrs. of age 50-80% individuals undiagnosed, untreated or undertreated secondary to atypical symptoms $21 billion US cost of treatment $4.37 billion - US hospitalization costs Medicare eligible patients Risk Factors Atherosclerosis Diabetes Smoking Age Hyperlipidemia Genetics Hypertension Characteristics of arterial insufficiency Dependent rubor/pallor with elevation Peripheral pulses absent or diminished ABI < 0.9 Ischemic pain Skin cool or cold, thin, dry, shiny epidermis 4
5 3M All Rights Reserved 13 3M All Rights Reserved 14 3M All Rights Reserved 15 Characteristics of arterial insufficiency (continued) Atrophy of skin Shiny, thin, taut, dry Hair loss on lower extremity Localized edema Dystrophic nails Ischemic pain Intermittent claudication cramping, aching, fatigue, weakness or calf pain Pain with moderate to heavy exercise Relieved by 10 minutes of rest Vessel ~ 50% occluded Nocturnal pain Pain at rest in bed, feet elevated Relieved by lowering legs Rest Pain Pain at rest Legs dependent Advanced occlusive disease Doughty D. Arterial Ulcers. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4 th ED. St. Louis, MO: Elsevier Mosby; 2012:p.182. Arterial Ulcer: Clinical presentation Base: pale, minimal granulation tissue, necrosis, eschar Exudate: minimal exudate Size: Variable, often small Margins: Punched out appearance, rolled edges, smooth, undermined Ischemic toes Pain: common Infection: frequent, may be subtle 5
6 3M All Rights Reserved 16 3M All Rights Reserved 17 3M All Rights Reserved 18 Common locations for Arterial Ulcer Tips of toes and web spaces Phalangeal heads Over lateral malleolus Areas exposed to repetitive pressure or repetitive trauma Mid-tibia (shin) Interventions Vascular consult Re-establish perfusion Diagnostic evaluations Ankle-brachial pressure (ABI) Toe Pressure (TP) measurements patients with diabetes and suspected LEAD (indicated for ABI >1.3) Transcutaneous Oxygen (TcPO2) Angiography or Arteriography may be ordered Interventions (continued) Surgical intervention bypass/ angioplasty, skin grafts, amputation Reduce risk factors Smoking cessation Increased activity Prevent infection Pain management: Walking, specialist referral Aspirin, Cilostazol, Prostaglandins?, Pentoxifylline? 6
7 3M All Rights Reserved 19 3M All Rights Reserved 20 3M All Rights Reserved 21 ABPI (ankle-brachial pressure index) A method for comparing blood pressure in the arm to blood pressure in the leg Reflects the degree of perfusion loss in the leg Should be a resting pressure obtained with the patient in a supine position Interpretation Normal range < 0.9 LEAD < 0.6 to 0.8 Borderline perfusion < 0.5 Severe Ischemia, wound healing unlikely unless revascularized Nursing management Avoid debridement until perfusion is determined Do NOT debride dry, stable eschar Determine proper use of antiseptics to assist with maintenance of stable eschar Infected, necrotic wounds Refer for surgical debridement and antibiotic therapy Do not rely on topical antibiotics to treat infected, ischemic wounds Choose appropriate dressings. May need frequent visualization and inspection of wound Nursing management Edema - patients with mixed venous and arterial disease, use reduced compression under close supervision ABI >0.5 to <0.8: modified compression, mm / Hg at the ankle, may promote healing ABI <0.5: compression should not be used Pain management Nutritional consult Patient/family education 7
8 3M All Rights Reserved 3M All Rights Reserved 23 3M All Rights Reserved 24 Lower Extremity Neuropathic Disease (LEND) & Diabetic Foot Ulcers Lower Extremity Neuropathic Disease (LEND) LEND Autonomic dysfunction & loss of sensation Lowerextremity ulcer LEND significance Diabetes global epidemic 370 million people globally 23.6 million people in U.S. 25% lifetime risk of diabetic foot ulcer development Patients with diabetic neuropathy & wounds: 66% rate of relapse over 5 years, 12% progress to amputation US cost of care - $174 billion/yr. 8
9 3M All Rights Reserved 25 3M All Rights Reserved 26 3M All Rights Reserved 27 Risk factors Diabetes Advanced age Impaired glucose tolerance Family history Smoking Hypertension, obesity, Raynaud s disease Spinal cord injury Trauma to lower extremity Lower Extremity Neuropathic Disease (LEND) Wounds Mechanism of damage: Peripheral Neuropathy (loss of protective sensation) Peripheral Vascular Disease (decreased blood perfusion) Vascular changes (occlusion & calcification) Tissue injury Neuropathic damage Progressive due to uncontrolled hyperglycemia Sensory neuropathy Loss of protective sensation Numbness, burning, tingling pain/sensation Loss of vibration and positional sensation, sensory ataxia Motor neuropathy Gait, muscle weakness Orthopedic deformities Hammer toes, claw-toes Muscle atrophy Autonomic neuropathy Decrease sweat and oil production dry skin Loss of skin temperature regulation Abnormal blood flow in soles of feet Fissures, cracks, callus Rigid arteries ischemia, edema 9
10 3M All Rights Reserved 28 3M All Rights Reserved 29 3M All Rights Reserved 30 Assessment parameters Wound status Perfusion ABI (Ankle brachial index) TBI (Toe brachial index) Transcutaneous oxygen (TCP02) Screening for loss of protective sensation Pain May be superficial, deep, aching, stabbing, dull, sharp, burning, or cool May be worse at night Clinical presentation Location Plantar surface or areas of exposed to trauma Metatarsal heads Dorsal and distal aspects of toes Heels Base: pale, pink, necrosis/eschar Size: Varies Clinical presentation Depth: Varies; partial thickness to full thickness with exposed bone Shape: Round or oblong Exudate: small to moderate Foul odor and purulence indicate infection Periwound Callus common Erythema, induration May have dry, cracked skin or maceration Pain May be superficial, deep, aching, stabbing, dull, sharp, burning, or cool May be worse at night 10
11 3M All Rights Reserved 31 3M All Rights Reserved 32 3M All Rights Reserved 33 Diabetes Common presentation NOTE: Neuropathic ulcers Are NOT pressure ulcers! Think of their etiology NEUROPATHY! Diabetic Ulcers Nursing management Wound care Offloading, referral, education & support Provide moist environment for healing Dressing selection periodic reevaluation Maintain dry stable eschar on noninfected, ischemic wounds Observe clinical manifestations of infection may be subtle due to reduced blood flow Optimize healing process through management of blood glucose levels Pain management Monitor patients receiving compression therapy due to decreased sensation of pain Nutritional support, control of blood glucose Patient & family education Offloading Wound care Routine foot surveillance/daily foot inspection Appropriate footwear Pain management Nutrition/glycemic control Smoking cessation 11
12 3M All Rights Reserved 3M All Rights Reserved 35 3M All Rights Reserved 36 Lower Extremity Venous Disease (LEVD) & Venous Leg Ulcers Lower Extremity Venous Disease (LEVD) Prevalence 7 million individuals worldwide, 2-5% of Americans 3 million progressing to ulceration (VLU) Account for 80-90% of all leg ulcers 600,000 new VLU each year Common in women More common in aging $ 1.9 to 3.5 billion/year in US 26-28% VLU reoccur within 12 months When damage occurs to the venous system Incompetent valves Damaged or dysfunctional veins Impaired calf muscle pump Chronic ambulatory venous hypertension occurs which is the underlying cause of venous ulcers 12
13 3M All Rights Reserved 37 3M All Rights Reserved 38 3M All Rights Reserved 39 Impact on Quality of Life Decreased self esteem Decreased mobility Decreased functionality of affected limb Difficulty finding appropriate clothing/shoes Inability to manage ADL s Inability to work, job loss Adverse effect on finances Housebound Depression Cost to health care system and personal life disruption for repeat admissions for cellulitis Sen Chandan, Gordillo Gayle, Roy Sashwat, Kirsner R, et al; Human skin wounds: A major and snowballing threat to public health and the economy Wound Rep Reg (2009) Clinical conditions present with LEVD Edema Wound drainage Pain Periwound margins Skin changes Maceration Common characteristics of the venous ulcer Warm, palpable pulses Edema: usually hard, non-pitting Characteristic location Above medial malleolus Calf to malleolus Irregular shape, margins Dark red ( ruddy ) base Hemosiderin staining 13
14 3M All Rights Reserved 40 3M All Rights Reserved 41 3M All Rights Reserved 42 Effect of Chronic Edema in Lower Extremities Clinical Presentation Maceration Dermatitis Inflammation of the epidermis and dermis Inside-out problem. Only way to heal it is to remove the edema * Characteristic: Scaling Crusting Weeping Erythema Erosions Intense itching * Dr. David Keast, Enhancing Wound Healing with Compression Therapy Presentation at Wounds International 2011, Cape Town Africa Dermatitis vs. Cellulitits Dermatitis Inflammation of epidermis and dermis Cellulitis Diffuse acute inflammation and infection of the skin and subcutaneous tissues that signifies a spreading infectious process 14
15 3M All Rights Reserved 43 3M All Rights Reserved 44 3M All Rights Reserved 45 ABPI (ankle-brachial pressure index) A method for comparing blood pressure in the arm to blood pressure in the leg Reflects the degree of perfusion loss in the leg Should be a resting pressure obtained with the patient in a supine position Interpretation > 1.0 Normal > 0.8 LEVD < 0.6 to 0.8 Borderline < 0.5 Severe Ischemia Topical therapy goals Control edema Absorb exudate Prevent trauma/injury Identify/treat infection Promote wound healing/maintain moist wound bed Protect periwound skin Minimize pain Optimal wound bed preparation Complete debridement of devitalized and poorly functioning tissue Restoration of bacterial balance Maintenance of optimal moisture balance Control of edema/lymphedema Protect surrounding skin Alcohol free barrier film, ointment Topical corticosteroids to reduce inflammation Bland emollients for moisturization Avoid fragrances, dyes Promote comfort 15
16 3M All Rights Reserved 46 3M All Rights Reserved 47 3M All Rights Reserved 48 Topical therapy Choose dressings to manage ulcer characteristics Protect surrounding skin Non alcohol barrier film, ointment Topical corticosteroids to reduce inflammation Bland emollients for moisturization Avoid fragrances, dyes Promote comfort Provide Compression Most essential component of venous leg ulcer treatment. Reduce edema/lymphedema by providing resistance against the calf muscle Improves speed of blood flow to heart Decrease exudate/weeping of the leg Reduces MMP s and inflammatory cytokines Improve wound healing Decreases aching and heaviness of the leg Management of edema In patients with mixed venous and arterial disease, use reduced compression under close supervision ABI >0.5 to <0.8: modified compression, mm/hg ABI <0.5: compression should not be used 16
17 3M All Rights Reserved 49 3M All Rights Reserved 50 Thank You Did I meet the objectives for this session? Differentiate between arterial, neuropathic and venous leg ulcerations Identify key risk factors for lower extremity ulcerations List five key wound assessment parameters Describe appropriate methods of treating lower extremity ulcerations Questions? References Ermer-Seltun J. Lower Extremity Assessment. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4th ED. St. Louis, MO: Elsevier Mosby; 2012:Chapter 10. Arterial: A quick reference guide for lower-extremity wounds: venous, arterial, and neuropathic. Doughty D. Arterial Ulcers. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4 th ED. St. Louis, MO: Elsevier Mosby; 2012: Chapter 11. Wound, Ostomy and Continence Nurses Society. (2014). Guideline for the Management of Wounds in Patients with Lower-Extremity Arterial Disease. WOCN clinical practice guideline series 1. Mt. Laurel: NJ. Author. Neuropathic: Driver VR, LeBretton Jm, et al. Neuropathic Wounds: The Diabetic Wound. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4th ED. St. Louis, MO: Elsevier Mosby; 2012: Chapter 14. Wound, Ostomy and Continence Nurses Society. (2012). Guideline for the Management of Wounds in Patients with Lower-Extremity Neuropathic Disease. WOCN clinical practice guideline series 3. Mt. Laurel: NJ. Author. Venous A quick reference guide for lower-extremity wounds: venous, arterial, and neuropathic. Carmel JE. Venous Ulcers. In: Bryant BA, Nix DP. In: Acute & Chronic Wounds; Current Management Concepts, 4th ED. St. Louis, MO: Elsevier Mosby; 2012: Chapter 12. Wound, Ostomy and Continence Nurses Society. (2011). Guideline for the Management of Wounds in Patients with Lower-Extremity Venous Disease. WOCN clinical practice guideline series 4. Mt. Laurel: NJ. Author. 17
Lower Extremity Venous Disease (LEVD)
Lower Extremity Venous Disease (LEVD) Lower Extremity Venous Disease (LEVD) Wounds Etiology Lower extremity venous leg ulcers are caused by chronic venous hypertension. Failure of valves in the veins or
More informationDiabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist
Diabetic Foot Ulcers Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist Organization of Wound Care Nurses www.woundcarenurses.org Objectives Identify Diabetic/Neuropathic
More informationLeg ulcer assessment and management
Leg ulceration The views expressed in this presentation are solely those of the presenter and do not necessarily represent the views of Smith & Nephew. Smith & Nephew does not guarantee the accuracy or
More informationAddress: Left Leg. other: Nails: thick yellow brittle fungus abnormal thick yellow brittle fungus abnormal
South West Regional Wound Care Toolkit: Interdisciplinary Lower Leg Assessment Form Instructions for use: Competent/ Proficient/ Expert level HCP to complete if lower leg ulcer present or risk of ulcer
More informationArterial & Venous Ulcers. A Comprehensive Review Assessment & Management
Arterial & Venous Ulcers A Comprehensive Review Assessment & Management 1 Objectives Understand Arterial & Venous disease Understand the etiology of lower extremities ulcers Understand assessment of lower
More informationVASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT
VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT Lucy Stopher, A/CNS Vascular Surgery ...it is best to think of a wound not as a disease, but rather as a manifestation of disease. Joe McCulloch In order
More informationPerson s Name: ID Number: Date:
South West Regional Wound Care Program Person s Name: ID Number: Interdisciplinary Diabetic/Neuropathic Foot Assessment Form MEDICAL HISTORY: Question Year diabetes diagnosed: Characteristics of onset
More informationVenous Insufficiency Ulcers. Patient Assessment: Superficial varicosities. Evidence of healed ulcers. Dermatitis. Normal ABI.
Venous Insufficiency Ulcers Patient Assessment: Superficial varicosities Evidence of healed ulcers Dermatitis Normal ABI Edema Eczematous skin changes 1. Scaling 2. Pruritus 3. Erythema 4. Vesicles Lipodermatosclerosis
More informationWound Assessment Report
Wound Assessment Report Single Assessment, Single Wound Mary Taylor Assessment Patient ID MT4367147 Date of Birth 1939-4-18 Left Foot, Sole: Wound A Image taken 16-45-43 Area 1.7cm2 Perimeter 48mm Maximum
More informationAppendix D: Leg Ulcer Assessment Form
Nursing Best Practice Guideline Appendix D: Ulcer Assessment Form Person Completing Assessment: Date: Client Name: Caf # CM# VON ID #: District CCAC ID # Address Telephone Home: Work: Date of Birth Y/M/D:
More informationThe Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care
The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care Anita Murray - Senior Podiatrist Diabetes, SCH Learning Outcomes Knowledge of the Model of Care For The Diabetic Foot
More informationWound, Ostomy and Continence Nursing Certification Board (WOCNCB) Certified Foot Care Nurse (CFCN) Detailed Content Outline
Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) Certified Foot Care Nurse (CFCN) Detailed Content Outline Description Domain I: Assessment and Care Planning 010000 40 Task 1: Obtain focused
More informationDefinitions and criteria
Several disciplines are involved in the management of diabetic foot disease and having a common vocabulary is essential for clear communication. Thus, based on a review of the literature, the IWGDF has
More informationWill it heal? How to assess the probability of wound healing
Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male
More informationWound Classification. Overview
Overview Jeffrey A. Niezgoda, MD FACHM, MAPWCA, CHWS Review of Initial Wound Care Consultation Rational for Classification Wound Appearance Wound Etiology Management Algorithms Initial Wound Care Consult
More informationVASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE
More informationWound Jeopardy: Name That Wound Session 142 Saturday, September 10 th 2011
Initial Wound Care Consult History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed History and Physical (wound)
More informationHigh Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC
High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC A new paradigm? Foot ulceration 101 Assessing Perfusion a new challenge Pressure
More informationWound Care Assessment in the Home Care Setting
Wound Care Assessment in the Home Care Setting Lynn Peterson, RN, BSN, CWOCN Technical Service Specialist 3M Health Care Wednesday, May 14, 2008 Objectives Describe essential elements of a wound assessment
More informationVenous Leg Ulcers. Care for Patients in All Settings
Venous Leg Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a venous leg ulcer. The scope of the standard
More informationWound Care Program for Nursing Assistants-
Wound Care Program for Nursing Assistants- Wound Cleansing,Types & Presentation Elizabeth DeFeo, RN, WCC, OMS, CWOCN Wound, Ostomy, & Continence Specialist ldefeo@cornerstonevna.org Outline/Agenda At completion
More informationPeripheral Vascular Examination. Dr. Gary Mumaugh Western Physical Assessment
Peripheral Vascular Examination Dr. Gary Mumaugh Western Physical Assessment Competencies 1. Inspection of upper extremity for: size symmetry swelling venous pattern color Texture nail beds Competencies
More informationWound Care Evaluation by Kris Dalseg MS PT CWS CLT
Wound Care Evaluation by Kris Dalseg MS PT CWS CLT This document is intended to describe a standard wound care evaluation for healthcare practitioners. In healthcare, all aspects of our treatment have
More informationVenous, Arterial, and Neuropathic Lower-Extremity Wounds: Clinical Resource Guide
Venous, Arterial, and Neuropathic Lower-Extremity Wounds: Clinical Resource Guide The Wound, Ostomy and Continence Nurses Society suggests the following format for bibliographic citations: Wound, Ostomy
More informationOrganization of Wound Care Nurses
Organization of Wound Care Nurses www.woundcarenurses.org Lower extremity arterial disease refers to disorders affecting the leg arteries Also known as PVD, PAOD, and PAD Cardiovascular Disease (CVD) is
More informationULCERS 1/12/ million diabetics in the US (2012) Reamputation Rate 26.7% at 1 year 48.3% at 3 years 60.7% at 5 years
Jay Christensen D.P.M Advanced Foot and Ankle of Wisconsin 2-4% of the population at any given time will have ulcers 0.06-0.20% of the total population Average age of patients 70 years increased as more
More informationDetermining Wound Diagnosis and Documentation Tips Job Aid
Determining Wound Diagnosis and Job Aid 1 Coding Is this a traumatic injury from an accident? 800 Codes - Injury Section of the Coding Manual Code by specific site of injury. Only use for accidents or
More informationVenous. Arterial. Neuropathic (e.g. diabetic foot ulcer) Describe Wound Types & Stages of. Pressure Ulcers. Identify Phases of Healing & Wound Care
A dressing the situation at hand Describe Wound Types & Stages of Pressure Ulcers Identify Phases of Healing & Wound Care Goals Clarify Referral Protocol Lacerations- The goal is nearest to complete approximation
More informationSuccessful Wound Management Strategies : An Introduction. Alex Khan, APRN ACNS-BC. Organization of Wound Care Nurses
Successful Wound Management Strategies : An Introduction Alex Khan, APRN ACNS-BC Organization of Wound Care Nurses www.woundcarenurses.org Goals & Objectives The role and importance of wound care management
More informationPeripheral Arterial Disease Extremity
Peripheral Arterial Disease Lower Extremity 05 Contributor Dr Steven Chong Advisors Dr Ashish Anil Dr Tay Jam Chin Introduction Risk Factors Clinical Presentation Classification History PHYSICAL examination
More informationAWMA MODULE ACCREDITATION. Module Five: The High Risk Foot (Including the Diabetic Foot)
AWMA MODULE ACCREDITATION Module Five: The High Risk Foot (Including the Diabetic Foot) Introduction - The Australian Wound Management Association Education & Professional Development Sub Committee-(AWMA
More informationNational Clinical Conference 2018 Baltimore, MD
National Clinical Conference 2018 Baltimore, MD No relevant financial relationships to disclose Wound Care Referral The patient has been maximized from a vascular standpoint. She has no other options.
More informationHow can DIABETES affect my FEET? Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust
How can DIABETES affect my FEET? By: Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust HOW CAN DIABETES AFFECT MY FEET? What is neuropathy? This leaflet explains how
More informationEDUCATION. Peripheral Artery Disease
EDUCATION Peripheral Artery Disease Peripheral Artery Disease You may have circulation problems that have to do with your blood vessels. You may feel aches, pains, cramps, numbness or muscle fatigue when
More informationRole of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
More informationDON T LET LEG PAIN BECOME A REAL THREAT.
DON T LET LEG PAIN BECOME A REAL THREAT. These three words have the power to change lives. Between 8 to 10 million Americans are estimated to suffer from poor blood flow to the legs and feet potentially
More informationAetiology Macroangiopathy occurs mainly distally ie Popliteal artery There is arterial wall calcification Microangiopathy is less common
DIABETIC FOOT Facts 5% of the population is diabetic 12% of diabetic admissions are with foot problems 1/3rd of diabetic foot ulcerations are neuropathic, 1/3rd are ischaemic and 1/3 are of a mixed in
More informationLower Extremity Wound Evaluation and Treatment
Lower Extremity Wound Evaluation and Treatment Boni-Jo Silbernagel, DPM Describe effective lower extremity wound evaluation and treatment. Discuss changes in theories of treatment in wound care and implications
More informationSteven Hadesman, MD Chief Medical Officer, MeridianRx Internal Medicine Physician, St. John Hospital
Steven Hadesman, MD Chief Medical Officer, MeridianRx Internal Medicine Physician, St. John Hospital Deep Venous Thrombosis Varicose Veins Venous insufficiency Phlebitis Lymphedema Elephantiasis nostras
More informationAcute and Chronic WOUND ASSESSMENT. Wound Assessment OBJECTIVES ITEMS TO CONSIDER
WOUND ASSESSMENT Acute and Chronic OBJECTIVES Discuss classification systems and testing methods for pressure ulcers, venous, arterial and diabetic wounds List at least five items to be assessed and documented
More informationEVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists
EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists Nothing To Disclosure DISCLOSURES I have no outside conflicts of interest, financial incentives, or
More informationDiabetes - Foot Care
Diabetes - Foot Care Introduction People with diabetes are more likely than others to have problems with their feet. These problems can lead to dangerous infections of the foot. Recognizing and treating
More informationLower Leg Ulceration. Wendy McInnes Vascular Nurse Practitioner; Northern Adelaide Local Health Network;
Lower Leg Ulceration Wendy McInnes Vascular Nurse Practitioner; Northern Adelaide Local Health Network; wendy.mcinnes@sa.gov.au 0447 051 036 1 Lower Leg Ulceration A manifestation of underlying pathology/disease
More informationDiabetic Foot Pathophysiology. Professor Donald G. MacLellan Executive Director Health Education & Management Innovations
Diabetic Foot Pathophysiology Professor Donald G. MacLellan Executive Director Health Education & Management Innovations AGEs & RAGEs in Diabetes AGE levels increased & RAGEs highly expressed in diabetic
More informationThe Diabetic Foot Latest Statistics
The Diabetic Foot Latest Statistics There are 2.6 million people with diagnosed diabetes in the UK. There are predicted to be 500,000 who have the condition but are unaware of it. There are 11,859 in TH
More informationHappy Feet: Feeling good about diabe.c foot screening! Family Medicine Forum 2014, Quebec City November 14, 2014
Happy Feet: Feeling good about diabe.c foot screening! Family Medicine Forum 2014, Quebec City November 14, 2014 Dr. Michael Yan, MD, CCFP Clinical Lecturer, Department of Family Medicine, University of
More informationIntroduction. Epidemiology Pathophysiology Classification Treatment
Diabetic Foot Introduction Epidemiology Pathophysiology Classification Treatment Epidemiology DM largest cause of neuropathy in N.A. 1 million DM patients in Canada Half don t know Foot ulcerations is
More informationRapid Foot Screening
GP Symposium 2015 Workshop Rapid Foot Screening Ms Chelsea Law, Principal Podiatrist Mr Henry Lee, Podiatrist Ms Ng Jia Lin, Podiatrist Ms Polly Lim, Podiatrist Ms Wong Wan Mun, Podiatrist Mr Yeo Boon
More informationPreventing Foot Ulcers in the Neuropathic Diabetic Foot. Glossary of Terms
Preventing Foot Ulcers in the Neuropathic Diabetic Foot Warren Woods, Certified Orthotist, Health Sciences Centre, Rehabilitation Engineering Department What you need to know Glossary of Terms Neuropathic
More informationPractical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
More informationPressure Ulcer Staging. Staging of Wounds are based on the deepest level of tissue damage
Pressure Ulcer Staging Staging of Wounds are based on the deepest level of tissue damage Pressure Ulcer Staging New Pressure Ulcer Staging Stage I Stage II Stage III Stage IV Unstageable Suspected Deep
More informationHow to manage leg ulcers in the elderly
How to manage leg ulcers in the elderly David Riding Clinical Research Fellow / Specialty Registrar in Vascular Surgery University of Manchester / MFT British Geriatric Society Trainees Meeting 2018 Objectives
More informationDIABETIC FOOT BOOK THE. A guide to keeping it simple and preventing complications. Practice genii. the Diabetic Foot Book
DIABETIC THE FOOT BOOK A guide to keeping it simple and preventing complications Understanding how diabetes can affect foot health and the measures that are taken to prevent diabetic foot complications
More informationWOUND MANAGEMENT. A Clinical Perspective. Furqan Alex Khan, APRN ACNS-BC MSN
WOUND MANAGEMENT A Clinical Perspective Furqan Alex Khan, APRN ACNS-BC MSN alexkhan@prohealthcare.us Ket Harris Davis, APRN FNP-C DNP keturahnp@keturah-hms.com. Objectives Understand types of wounds Discuss
More informationBacterial Burden (Bioburden) The metabolic load imposed by bacteria in tissue.
Glossary Ankle Brachial Index (ABI) Is a numerical figure which indicates a quantifiable pressure index. The pressure index is determined by means of Doppler Ultra Sound. The ABI is obtained by dividing
More informationClinical Examination of VASCULAR PATIENTS. Stephanie Hirst & Alexander Sunde
Clinical Examination of VASCULAR PATIENTS Stephanie Hirst & Alexander Sunde Goals of Medical History To record the patient s symptoms at time of presentation. To organize the events which have lead to
More informationPRODIGY Quick Reference Guide
PRODIGY Quick Venous leg ulcer infected How do I assess a venous leg ulcer? Chronic venous insufficiency and venous hypertension result from damage to the valves in the veins of the leg and inadequate
More informationDiabetes Mellitus and the Associated Complications
Understanding and the complications relating to the disease can assist the fitter to better serve patients. and the Associated Complications Released January, 2011 Total: 25.8 million people, or 8.3% of
More informationDiabetic Foot Ulcers. Care for Patients in All Settings
Diabetic Foot Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a diabetic foot ulcer. The scope of the standard
More informationDiabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated April 7,
Developed in collaboration with the Wound Care Champions, Wound Care Specialists, Enterostomal Nurses, and South West Regional Wound Care Program (SWRWCP) members from Long Term Care Homes, Hospitals,
More informationTreat the whole patient, not just the hole in the patient! 3/21/2017 CAN YOU CONNECT THE DOTS?? PHILOSOPHY OBJECTIVES
CAN YOU CONNECT THE DOTS?? Boone Hospital Wound Healing Center Kimberly Jamison, MD, FACP, FAPWCA, PCWC Kim Mitchell, RN, BSN OBJECTIVES Describe the basic concepts of chronic wound care to ensure an optimal
More informationAppropriate Dressing Selection For Treating Wounds
Appropriate Dressing Selection For Treating Wounds Criteria to Consider for an IDEAL DRESSING Exudate Management Be able to provide for moist wound healing by absorbing exudate or adding moisture Secure
More informationPUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
More informationDiabetes Foot and Skin Care. Diabetes and the feet. Foot problems: Major cause of morbidity and mortality
Session # 11 Diabetes Foot and Skin Care Betty Harvey, RNEC BScN MScN Amanda Mikalachki, RN BScN CDE Diabetes and the feet Diabetes affects circulation and immunity. Over time, the sensory nerves in the
More informationIntended Learning Outcomes
2011 Acute Limb Ischemia Definition, Etiology & Pathophysiology Clinical Evaluation Management Ali SABBOUR Prof. of Vascular Surgery, Ain Shams University Acute Limb Ischemia Intended Learning Outcomes
More informationVeinOPlus Vascular Peripheral Vascular & Wound Therapy Device
VeinOPlus Vascular Peripheral Vascular & Wound Therapy Device Calf Muscle Pump Dysfunction Therapy Increases blood flow, accelerates wound healing, and improves CVD and PAD symptoms Tomorrow s Technology
More informationTeaming Together to Understand Pressure Injuries / (Ulcers): NPUAP Terminology and Staging Clarification
Teaming Together to Understand Pressure Injuries / (Ulcers): NPUAP Terminology and Staging Clarification We encourage you to share this information with your staff and colleagues by facilitating clinician
More informationSkin Integrity and Wound Care
Skin Integrity and Wound Care By Dr. Amer Hasanien & Dr. Ali Saleh Skin Integrity and Wound Care Skin integrity: the presence of normal Skin & Uninterrupted skin layers by wounds. Factors affecting appearance
More informationACOFP 55th Annual Convention & Scientific Seminars. New Physicians and Residents: Introduction to Wound Care. Katherine Lincoln, DO, FAAFP
8 ACOFP 55th Annual Convention & Scientific Seminars New Physicians and Residents: Introduction to Wound Care Katherine Lincoln, DO, FAAFP Introduction to Wound Care KATHERINE LINCOLN, DO, FAAFP ACOFP
More informationDiabetes Foot Care Clinical Pathway Healthcare Provider s Guide
Diabetes Foot Care Clinical Pathway Healthcare Provider s Guide Diabetes, Obesity & Nutrition Strategic Clinical Network Version 1.0 Acknowledgement This healthcare provider s guide has been adapted from
More informationIntroduction. Risk factors of PVD 5/8/2017
PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental
More informationEnd Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema. Original Policy Date
MP 2.02.12 End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date
More informationArterial Leg Ulcer Clinical Pathway
Waterloo Wellington Integrated Wound Care Program Evidence-Based Wound Care Arterial Leg Ulcer Clinical Pathway 0-7 Days Expected Outcomes Notes Patient admitted to service/facility Most Responsible Physician(MRP)/Nurse
More informationAssisted Living Resident Assessment (To be used when yes is indicated for skin issues under Section 5 of Assisted Living Resident Assessment)
Skin Assessment Current open skin areas: Yes No Current pressure ulcer: Yes No A. Stage 1 Ulcers Report based on highest stage of existing ulcers at its worst; do not reverse stage. Number of existing
More informationIdentification and recommended management of leg ulcers Jill Robson RGN and Gerard Stansby MA, MChir, FRCS
Identification and recommended management of leg ulcers Jill Robson RGN and Gerard Stansby MA, MChir, FRCS thickened skin, lipodermatosclerosis skin stained haemosiderin shallow ulcer irregular shape Our
More informationMy Diabetic Patient Has No Pulses; What Should I Do?
Emily Malgor, MD Assistant Professor of Surgery University of Oklahoma, Oklahoma City My Diabetic Patient Has No Pulses; What Should I Do? There are no disclosures. Background Diabetes affects 387 million
More informationDue to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice.
A summary Disclaimer The information contained in this document is intended to provide general information only. It is not intended to be, nor does it constitute, medical advice. Under no circumstances
More informationI have no financial interests to disclose in regards to this lecture.
Evaluation and Treatment of Diabetic Foot Ulcerations John M. Giurini, D.P.M. Associate Professor in Surgery Harvard Medical School Disclosure Statement I have no financial interests to disclose in regards
More informationA Healthy Heart. IN BRIEF: Your Guide to
IN BRIEF: Your Guide to A Healthy Heart If you re like most people, you may think of heart disease as a problem for other folks. If you re a woman, you may believe that being female protects you from heart
More informationCoding for Ulcer Debridement
Coding for Ulcer Debridement Faculty Jeffrey D. Lehrman, DPM, FASPS, MAPWCA Adjunct Clinical Professor Temple University School of Podiatric Medicine Panel Physician Crozer Center for Wound Healing and
More informationLeg Ulcer Case Study
Leg Ulcer Case Study Wound Healing Community Outreach Service Mrs Ivy Hurtzalot, a 71-year-old lady, presents to her general practitioner with an ulcer on her right medial malleolus. Ivy reveals that the
More information4-layer compression bandaging system (includes microbe binding wound contact layer) Latex-free, 4-layer compression bandaging system
JOBST Comprifore JOBST Comprifore at a glance: provides effective levels of sustained graduated compression provides built in safety and ease of application Insures compliance and maximum healing for cost
More informationPerfusion Assessment in Chronic Wounds
Perfusion Assessment in Chronic Wounds American Society of Podiatric Surgeons Surgical Conference September 22, 2018 Michael Maier, DPM, FACCWS Cardiovascular Medicine Cleveland Clinic Disclosures Speaker,
More informationAGONY FEET. The. of the. Prevention and management of diabetic foot ulcers
The AGONY of the FEET Prevention and management of diabetic foot ulcers By Margaret Falconio-West, BSN, rn, APN/CNS, CWOCN, DAPWCA Nearly 25 percent of people with diabetes will develop a diabetic foot
More informationWound and Ostomy Care: Basics and Troubleshooting
Wound and Ostomy Care: Basics and Troubleshooting Catherine Clarey-Sanford, PhD, RN, CWOCN Conflict of Interest No conflict of interest exists No commercial interest No financial benefits Specific wound
More informationWound Care per HHVNA Wound Product Formulary
Venous Ulcers ABI of 0.9-1.2 = normal blood flow An ABI MUST be obtained prior to inititiation of compression therapy. Compression is the Gold Standard of care to promote wound of venous ulcers. Elevation
More informationSpinal Cord Injury Info Sheet An information series produced by the Spinal Cord Program at GF Strong Rehab Centre.
Spinal Cord Injury Info Sheet An information series produced by the Spinal Cord Program at GF Strong Rehab Centre. What does skin do? 1. It protects you. 2. It provides sensory information. 3. It helps
More informationDIABETES AND FOOTCARE
DIABETES AND FOOTCARE Self-Care and Treatment for Healthy Feet Don t Take Your Feet for Granted Every day, you depend on your feet to keep you moving. But when you have diabetes, your feet need special
More informationOur Vision NADA BoD Strategic Planning Session -
Who we are NADA is a not-for-profit members-led organization established in 1995 as a result of the rising rates of diabetes among First Nations, Inuit and Métis Peoples in Canada Our Vision - 2016 NADA
More informationPALLIATIVE WOUND CARE
PALLIATIVE WOUND CARE Scott Bolhack, MD, FACP President/CEO TLC HealthCare Companies Learning Objectives: Describe the aspects of palliative wound care.. Demonstrate palliative practices used in the care
More informationC A R O L S I E M M S N, R N, B C, G N P M U S I N C L A I R S C H O O L O F N U R S I N G Q I P M O WHAT S IN A NAME?
M D S A N D P R E S S U R E U L C E R S C A R O L S I E M M S N, R N, B C, G N P M U S I N C L A I R S C H O O L O F N U R S I N G Q I P M O WHAT S IN A NAME? 1777: decubitus is the oldest term used 1942
More informationFoam dressings have frequently
The practical use of foam dressings Efficient and cost-effective management of excessive exudate continues to challenge clinicians. Foam dressings are commonly used in the management of moderate to heavily
More informationAdvanced Clinical Solutions. Pressure Ulcer. Carilex Medical Group 1
Advanced Clinical Solutions Pressure Ulcer Carilex Medical Group 1 Advanced Clinical Solutions Contents About Pressure Ulcer! 2 Stages of Pressure Ulcer! 5 Reference! 7 Carilex Medical Group 1 About Pressure
More informationSores That Will Not Heal
Sores That Will Not Heal Introduction Some sores have trouble healing on their own. Sores that will not heal are a common problem. Open sores that will not heal are also known as wounds or skin ulcers.
More informationBritish Columbia Provincial Nursing Skin and Wound Committee
Developed by the BC Provincial Nursing Skin and Wound Care Committee in collaboration with Wound Clinicians from: / Education Module Ankle Brachial Index(ABI) Procedure in Adults for Handheld Doppler &
More informationArterial Leg Ulcer Clinical Pathway
Waterloo Wellington Integrated Wound Care Program Evidence-Based Wound Care Arterial Leg Ulcer Clinical Pathway 0-7 Days Expected Outcomes Notes Most Responsible Physician(MRP)/Nurse Practitioner (NP)
More informationIndependent evaluation of BEMER physical vascular regulation therapy
of BEMER Liezl Naudé Advanced nurse specialist: wound management Advanced lower limb and wound management centre, Pretoria Heart 4 the Wounded 5-7 July Pretoria Introduction Lower limb wounds have always
More informationRapid Recovery Hyperbarics 9439 Archibald Ave. Suite 104 Rancho Cucamonga CA,
Foot at risk Age Well By Dr LIEW NGOH CHIN Are limb amputations due to diabetes preventable? DIABETES mellitus is a major global health problem and has reached epidemic proportions in many developed and
More informationPressure Injury Staging Update 2016
Pressure Injury Staging Update 2016 A Review of the New Changes for Pressure Injury Documentation and Staging Jeanne Terefenko, BSN, RN, CWOCN Ext. 5855 Pressure Ulcer Staging Updates: In April, 2016,
More information