MDS Alert

Published on Sun Jan 16, 2005 PDF

New survey guidance provides key clues to assess the difference.

Test your assessment prowess by identifying each parameter below as associated with a vascular insufficiency or arterial ulcer. 

1. The ulcer is characteristically painful and usually located on distal portion of lower extremity (may be over ankle or bony areas of foot).

2. Foot on affected extremity may show coolness to touch, diminished or absent pedal pulses.

3. May be associated with venous hypertension due to one or a combination of factors, such as obesity, deep vein thrombosis, malignancy, inactivity or paralysis.

4. Open lesion of the skin and subcutaneous tissue on lower leg - usually pretibial area of lower leg or above medial ankle.

5. Pain may increase when foot is in a dependent position (resident sits with feet on the floor).

6. Pain may decrease when foot is dependent (hanging down) and increase when elevated.

7. Ulcer may have a moist, granulating wound bed and may be superficial with minimal to copious serious drainage unless infected.

8. Wound bed is frequently dry and pale with minimal or no  exudate.

Answers: 1 arterial; 2 arterial; 3 venous insufficiency; 4 venous insufficiency; 5 venous insufficiency; 6 arterial; 7 venous insufficiency; 8 arterial.

Source: The above test was developed by Eli Healthcare with answers based on definitions of ulcers in revised survey guidance at F314/F309. Read the guidance at www.cms.hhs.gov/manuals/pm_trans/R4SOM.pdf.