Arterial Ulcers vs. Venous Ulcers of the LE

Question 1

Describe peripheral arterial disease

Answer 1

• Involves progressive narrowing and degeneration of arteries of upper and lower extremities
• Atherosclerosis is the leading cause in majority of cases
• PAD is strongly related to other types of cardiovascular disease (CVD) and their risk factors.
• Patients with PAD have a significantly higher risk of mortality (in general), CVD mortality, and major coronary events.
• Thus PAD is a marker of advanced systemic atherosclerosis.
• Arteries transport oxygenated blood but may develop atherosclerosis (narrowing of arteries due to build up of plaque) leading cells become ischemic because there is no oxygen
• Cold temp causes them to become pale, blue

Question 2

Arterial Clinical Manifestations of PAD

Answer 2

• Paresthesia: Numbness or tingling in the toes or feet; Produces loss of pressure and deep pain sensations; Injuries often go unnoticed by patient
• Thin, shiny, and taut skin
• Loss of hair on the lower legs
• Diminished or absent pedal, popliteal, or femoral pulses
• Intermittent claudication
• Pallor of foot with leg elevation: (blanching of the foot) develops in response to leg elevation (elevation pallor).
• Reactive hyperemia of foot with dependent position
• Rest pain
• Conversely, reactive hyperemia (redness of the foot) develops when the limb is in a dependent position (dependent rubor).
• Tell diabetics to check feet once a day because they can lose their sensation
• Taut – tight skin
  Intermittent claudication: not enough oxygen reaching muscles; pain in calf induced by exercise that is relieved by rest, when increasing oxygen demand; really bad when client is always in pain
• Arterial = Allow extremities to go down

Question 3

Recognizing clinical manifestations

Answer 3

• Tips of toes, foot, or lateral malleolus
• Rounded, smooth, looks “punched out”
• Minimal drainage
• Black eschar or pale pink granulation
• Arterial is black, dead tissue because oxygenated blood isn’t reaching the area

Question 4

Complications of PAD ulcers

Answer 4

• Atrophy of the skin and underlying muscles
• Delayed healing
• Wound infection
• Non-healing arterial ulcers and gangrene are most serious complications
• Tissue necrosis
• Amputation: If adequate blood flow is not restored; If severe infection occurs
• Non healing ulcers that can become gangrene (infection) or necrosis
• More ampt to have amputations since everything dies off; amputate limb or live with infection that can spread

Question 5

PAD ulcer nursing diagnoses

Answer 5

• Ineffective tissue perfusion (peripheral)
• Impaired skin integrity
• Activity intolerance
• Ineffective self-health management

Question 6

PAD ulcer collaborative care

Answer 6

• Cessation of risk factor habits: Diet modification, smoking, weight management, hygiene
• Medication Management: BP control, BG regulation, coagulation, cardiovascular pulmonary support and care
• Surgical/Radiographic interventions: debridement, angioplasty, bypass
• Diagnostic needs: monitoring labs, ultrasound (US), cultures, ankle-brachial index (ABI)
• Surgery is indicated in patients with long areas of stenosis or severely calcified arteries.
• Be empathetic with clients
• Synthetic grafts typically are used for long bypasses, such as an axillary-femoral bypass. When a person’s own vein is not available, human umbilical vein or a composite sequential bypass graft (native vein plus synthetic graft) is an alternative.

Question 7

Describe venous insufficiency

Answer 7

• veins and valves fail to move; calf muscle pump; incompetent valves
• venous HTN, varicosities venous thromboembolism (VTE)
• painful/debilitating ulcers medial
• Calves fail to move blood up towards head
• Have problems with veins getting blood back to the body
• More at risk with venous problems because of blood clots
• More painful and debilitating than ulcers since you have a lot of pressure and fluid that is collecting
• Ulcers tend to be on medial malleolus - venous
• Lateral malleolus – arterial
• Likely related to where vessels are

Question 8

Venous insufficiency clinical manifestations

Answer 8

• Edema present, unilateral or bilateral
• Hemosiderin staining: life of a RBC is done so it releases iron causing the staining to ooze to the skin
• Thick hardened skin “leathery” appearance
• Wounds “weep”
• Skin becomes friable
• Near medial malleolus
• Irregularly shaped
• Moderate to large amount of drainage
• Yellow slough or dark red “ruddy” granulation
  Venous = eleVate
  Arterial = Allow extremities to go down

Question 9

Complications of Venous insuffiency

Answer 9

• Pain worse when dependent
• Non-treatment leads to increase in wound size
• Acute leads to chronic if continued treatment not adhered to
• Wound(s) reopening in same location common
• Rarity of amputation
• Putting legs above level of heart is helpful because youre helping blood go back to the heart
• V goes up, legs go up, venous
• A goes down, arterial problem, legs go down

Question 10

Venous insufficiency nursing diagnoses

Answer 10

• acute pain
• ineffective health maintenance
• risk of impaired skin integrity

Question 11

Venous insufficiency collab care

Answer 11

• Compression (Thromboembolic deterrent (TED) hose)
• Moist environment dressings
• High protein diet
• Elevation
• Hyperbaric support: angiogenesis; Hyperbaric pushes oxygen under pressure to put oxygen into body and directed into wound to help healing
• Underlying medical management support
• Drug Therapy: anticoagulants
• Cessation of risk factors (as with PAD)