Exam 2 - Pulmonary Edema and Ulcers Flashcards
Priority in treatment of pulmonary edema
Reduce fluid volume overload
How do you reduce fluid volume overload in pulmonary edema pts?
Administer Lasix (usually IV push) Administer morphine (anxiety)
What are other treatments for pulmonary edema?
Improve ventricular function (may be given beta blocker)
Increase respiratory exchange
Nursing care for pts with pulmonary edema
Positioning - elevate HOB, administer oxygen, lower legs over side of bed
Psychological support
Monitor meds
Where are venous ulcers usually located?
Gaiter area - medial malleolus; infrequently later malleolus or anterior tibial area
Pain with venous ulcers?
Minimal pain if superficial, may be very painful
“Achy” pain
Depth of venous ulcers
Superficial
Shape of venous ulcers
Irregular borders
What does a venous ulcer look like?
Granulation tissue - beefy red to yellow fibrinous in chronic, long-term ulcer
Skin of lower leg is leathery with brawny appearance
leg edema with venous ulcers
Moderate to severe; persistent for prolonged time
What else is present with venous ulcers?
Eczema with pruritis
Lg amount of exudate
Slough
Usual locations of arterial ulcers
Tip of toes
Toe webs
Heel or other pressure areas if confined to heel
Pain with arterial ulcers
Very painful
Intermittent claudication
Rest pain of digits/forefoot
Unrelenting pain
Depth of arterial ulcer
Deep, often involving joint space
Shape of arterial ulcer
Circular, small
Arterial ulcer appearance
Pale to black, dry gangrene
Little exudate, slough and necrotic tissue
Edema with arterial ulcer
Minimal, unless extremity kept in dependent position constantly to relieve pain
Expected treatment for venous ulcers
Compression Moist dressings (as long as not infected)
What is NOT indicated for venous ulcers?
prophylactic antibiotic therapy
Expected treatment for arterial ulcers?
Restore circulation to area by interventional radiology, balloon angioplasty, place a stent, bypass graft (in severe cases)
Other treatments for ulcers
Culture and antibiotic therapy for active infection Amputation if gangrene Debridement Calcium alginate dressings - change when would starts to seep out or every 7 days Foam dressings Keep wound area clean Stimulated healing Hyperbaric oxygenation Negative pressure wound therapy
Nursing considerations for compression treatment of ulcers
It is important to assess arterial status to assure that co-existing arterial disease is not present. If there is bad arterial supply and compression is tried, necrosis can occur!
Nursing interventions for pts with ulcers
Nutrition - balanced diet with adequate protein, calories, and micronutrients
Weight reduction
Smoking cessation
Exercise - daily walking program when ulcer is healed
Pt teaching for ulcers
Avoid sitting or standing with feet dependent for prolonged periods of time
Do not elevate arterial ulcers
Prescription compression stockings should be worn daily and replaced q 4-6 months to decrease incidence of chronic venous insufficiency
Venous dermatitis could result from contact with sensitizing products (i.e. gentamyacin, bandages, adhesives, ointments with lanolin, parabens, alchol, benzocaine, or balsam of Peru, and OTC creams with fragrances and preservatives)
