Week 4 | Venous Ulcers (17180-SP)
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How Big Is the Problem of Lower Extremity Ulcers?
- 2% population will develop poorly healing ulcer
- Prevalence increases with age
- Causes many days lost work
- Costs up to $40,000.00 for long-term treatment
- Causes considerable clinical issues- Exudate, Changes in limb sizes, Altered shape of leg, Odor, Discomfort
Impact to the Person
- Long term management difficult (compliance, recurrence)
- Economic impact (treatments, lost work)
Types of Lower Leg Ulcers
- Venous ulcers
- Arterial/ischemic ulcers
- Combined venous/arterial
Normal Venous Anatomy Components
- Deep venous system (accompany arteries, same name, have valves)
- Superficial venous system (just below skin, have valves)
- Greater saphenous
- Lesser saphenous
- Perforator Veins (connect the 2, have valves)
Need for Orthograde Flow
- Competent valves
- Calf muscle contraction
- Venous wall condition
Anatomy/Physiology Venous Disease
- Impeded venous return to the heart
- Incompetent, mal-functioning valves
- Hemosiderin staining, skin changes
- Fibrin bands constrict capillaries - results in decreased oxygen and nutrients to area
Assessment of the Patient
- Determine patient history and risk factors
- Conduct brief physical exam, including lower extremities
- Assess vascular status
- Determine ulcer status and duration
- Discuss patient’s understanding of ulcer and treatment
- Identify prior treatment
- Inquire about patient support network
Contributing Factors to Venous Ulcers
- Deep vein thrombosis
- Congestive heart failure
- Trauma to lower leg
- Incompetent valves
- Weakness of lower extremity musculature
- Thrombophilic conditions (Factor V, Protein C or S)
Chronic Venous Insufficiency
- Progressive primary reflux disease secondary to varicose veins – 1/3 to1/2
- Others follow a DVT – 1/3 cases
Clinical Signs with Ulceration
- Hemosiderosis/ Hyperpigmentation
- Atrophie Blanche
- Venous Dermatitis
- Ankle Flare
- Ulceration with Serpiginous Edges
Principles of Management
- Compression provides the most dramatic effect on wound closure
- Decreased pain
- Increased mobility
- Improved quality of life
- External compression increases local tissue pressure, reinforces reabsorption by squeezing fluid into venous and lymph system.
- BEFORE YOU COMPRESS!!!
- Determine if arterial disease is present.
- Practice safely for your patient.
- Measure Ankle-Brachial Index (ABI) before you proceed.
Objectives for Learning Outcomes
After completing this session, you will be able to:
- Discuss how venous ulcers happen.
- Assess the client with venous ulcers.
- Identify characteristics seen in the patient with venous ulcers.
- Individualize an appropriate plan of care for the venous ulcer patient.
- Determine when to refer the patient with mixed disease ulcers.
Betty Hanrahan, MSN, CNS, ARNP-BC, CWCN-AP, CWS, FACCWS, CFCN
Certified Wound Care Nurse; Co-Director, Wound Management Education Program (WMEP) and Wound Management Fundamentals Course (WMFC), Continuing Nursing Education, University of Washington School of Nursing, Seattle; Fellow, College of Certified Wound Specialists