Unit 1 - Peripheral Vascular Disease Flashcards
Edema is defined as
either a generalized or local swelling in which there is an excessive amount of fluid in tissue
This can involve any of the tissues in the body, for example;
cerebral edema or pulmonary edema
Localized edema may occur as part of the body’s normal
normal response to injury or trauma in a lower limb.
Localized edema may occur as part of the body’s normal response to injury or trauma in a lower limb. This type of edema resolves when?
as the injury resolves
dependent edema
Is characterized by…?
3 causes
Characterized by being
Temporary/transient
prolonged standing,
prolonged lack of motion to stimulate venous and lymphatic fluid return
the effects of gravity
Someone may have swollen legs after standing for an unusually long period, but the swelling will abate after the legs are elevated.
When does dependent edema resolve?
when the conditions that brought it on are removed
dependent edema
Someone may have swollen legs after…
But…
Typically…
Someone may have swollen legs after standing for an unusually long period,
but the swelling will abate after the legs are elevated.
Typically, the person sleeps and the edema is gone in the morning.
Dependent edema is usually not cause for concern as…
it may be attributed to a particular set of circumstances and resolves easily
Lower limb edema that develops without a visible cause and does not resolve easily with leg elevation may be due to?
a systemic disease
5 Systemic Diseases
that can lead to lower limb edema
Cardiac Disease Heart Failure Hepatic Disease Renal Disease Inflammatory Disease Malnutrition or Starvation
Cardiac Disease Heart Failure is a condition where…
the heart no longer exerts the strength necessary to effectively return all the blood from the extremities
Cardiac Disease Heart Failure is a condition where the heart no longer exerts the strength necessary to effectively return all the blood from the extremities.
This results in…
excess pooling of blood in the lower limbs assisted by gravity
Cardiac Disease Heart Failure
Excess pooling of blood in the lower limbs assisted by gravity does what?
increases the pressure in the veins and capillaries of the legs
Cardiac Disease Heart Failure
Excess pooling of blood in the lower limbs assisted by gravity increases the pressure in the veins and capillaries of the legs.
This increased pressure…
makes it more difficult for fluid to move from the interstitial compartment into the capillaries and so it remains in the interstitial space causing edema
Hepatic or Liver Disease may effect the production of?
plasma proteins
Hepatic or Liver Disease may effect the production of plasma proteins.
These large plasma proteins do what?
provide a large part of the osmotic pressure that draws fluid from the interstitial space into the capillaries and bloodstream
Hepatic or Liver Disease may effect the production of plasma proteins.
These large plasma proteins provide a large part of the osmotic pressure that draws fluid from the interstitial space into the capillaries and bloodstream.
When the number of these proteins is decreased, what happens?
the osmotic pressure of the blood is decreased and more fluid is left behind in the interstitial space
Renal Disease results in?
fluid and electrolyte imbalances
Renal Disease results in fluid and electrolyte imbalances, particularly?
sodium retention
Renal Disease results in fluid and electrolyte imbalances, particularly sodium retention.
Sodium retention may result in? (2)
edema
excessive loss of protein from the body through proteinuria
Malnutrition or starvation results in?
inadequate protein intake
Malnutrition or starvation results in inadequate protein intake.
Inadequate protein intake will result in?
fewer plasma proteins being produced
Malnutrition or starvation could include? (2)
any malabsorption disease
such as
Celiac Disease
or
Inflammatory Bowel Disease
Inflammatory Disease may cause edema when?
example?
an immune response triggers
the release of chemical toxins,
increased local blood flow
and
influx of white blood cells mistakenly against the body’s own tissue
E.g. = RA
Inflammatory edema is usually? (4)
Red
Warm
Tender
Non-pitting
When inflammatory edema is chronic there may be evidence of?
simultaneous tissue destruction and repair
Diagnosis of the underlying systemic disease causing the edema is made by the client’s physician and may include…
bloodwork
EKG
x-rays
ultrasonography of the heart, liver, kidneys
Referral to specialists for further testing with
CT
MRI
nuclear scanning
Clinical Symptoms of Systemic Edema:
Systemic causes of edema will usually result in?
a symmetrical distribution of edema
for example; both legs, both eyes with periorbital edema, or both hands or feet
Clinical Symptoms of Systemic Edema:
Edema may? (3)
be pitting or non-pitting
be indurated
(Hardened, usually used with reference to soft tissues becoming extremely firm but not as hard as bone.)
extend from the toes to knees or start at the ankles and extend upwards
Clinical Symptoms of Systemic Edema:
Onset may be…
slow and gradual over many months
or
relatively sudden over hours, days or several weeks
Clinical Symptoms of Systemic Edema:
The more rapid the onset…
the more cause for serious concern
and
the more pressing the need for treatment
Goals and Treatments for Systemic Edema:
Goals and treatment for edema from systemic disease needs to focus on…?
edema caused by systemic disease will not resolve until the underlying cause is specifically treated.
Treatment with compression stockings does not begin until diagnosis.
accurate and timely diagnosis of the underlying cause
Goals and Treatments for Systemic Edema:
Once cause is established…?
a medical plan of treatment can be pursued by the client and doctor to treat and manage the symptoms of the underlying disease
Goals and Treatments for Systemic Edema:
Once cause is established, a medical plan of treatment can be pursued by the client and doctor to treat and manage the symptoms of the underlying disease; this will prevent…?
further complications of skin damage and/or infection
Lymphatic Disorders causing Edema
The Lymphatic System:
Describe.
lymphatic system is a web-like system of lymph capillaries, vessels, valves and nodes
that transport lymph fluid containing water, proteins, nutrients and white blood cells throughout our body tissues
Lymphatic Disorders causing Edema
The Lymphatic System is a web-like system of lymph capillaries, vessels, valves and nodes that transport lymph fluid containing water, proteins, nutrients and white blood cells throughout our body tissues.
It then…?
returns the lymph fluid to our vascular system
via
the thoracic duct into the left subclavian vein
and
the right lymphatic duct into the right subclavian vein
Lymphatic Disorders causing Edema
What is the function of the lymphatic system? (2)
to remove foreign material from our tissues after delivering fluid and nutrients to those tissues
to work with the circulatory system to absorb digested fats from the small intestine
Lymphedema etiology: (5)
anything that results in injury, destruction or blockage of the lymphatic system can lead to lymphedema by blocking or impeding the return of lymph fluid to the vascular system
injury to lymphatic vessels from trauma, surgery or radiation
chronic hereditary disease called Milroy’s disease
parasitic infection found in tropical climates called lymphatic filariasis
venous obstruction results in an increase in capillary pressure and this in turn leads to the increased production of tissue fluid
Medical Diagnosis of Lymphedema:
Usually diagnosed by?
What else may be used and why?
What is rarely used and why?
history and physical exam alone
lab tests
to exclude other systemic causes
lymphangiography
due to risk of complications
Clinical Symptoms and Complications of Lymphedema:
In the early stage?
But with time?
Eventually?
there is pitting edema that relieves with elevation
the edema becomes non-pitting and does not relieve with elevation
Eventually the swollen tissue becomes hardened and fibrotic and may have and “orange peel” appearance to the skin
Clinical Symptoms and Complications of Lymphedema:
With prolonged lymph stasis, what happens?
toxins remain in the tissue and inflammation (called lymphangitis) and infection are common complications
Lymph stasis - A stoppage or slowdown in the flow of blood or other body fluid, such as lymph.
lymphangitis
an infection of the lymph vessels that carry lymphatic fluid throughout the body
Signs of lymphangitis
the appearance of pain, warmth and red streaking along the track of the lymph vessels
There is no cure for lymphedema
Treatment is aimed at?
the prevention of complications of skin breakdown and infection
There is no cure for lymphedema
Treatment is aimed at the prevention of complications of skin breakdown and infection.
Through? (3)
reduction of swelling
containment of swelling
additional support measures
Lymphedema treatment
Reduction of swelling (2)
pneumatic extremity pumps
manual lymph drainage or complete decongestive therapy
Lymphedema treatment
Containment of swelling (3)
short stretch bandages (e.g. Comprilan)
reusable fabric devices with adjustable straps (e.g. Circ-Aid, Reid Sleeves)
custom compression garments (e.g. Jobst)
Lymphedema treatment
Additional support measures (4)
healthy diet and weight control
exercise is important in stimulating lymphatic fluid return
careful skin and nail care
drugs may be used to control infection
diuretics are rarely used
Thrombophlebitis
Deep vein thrombosis
Thrombophlebitis (throm-boe-fluh-BY-tis) is an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. The affected vein might be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT).
Deep vein thrombosis (DVT) is a blood clot (thrombus) in a deep vein, usually in the legs. Clots can form in superficial veins and in deep veins. Blood clots with inflammation in superficial veins (called superficial thrombophlebitis or phlebitis) rarely cause serious problems.
Thrombophlebitis etiology
Usually two of three following factors are present:
venous stasis or slowing of venous return
endothelial injury creating site for formation of clot
alteration in blood clotting mechanism
Clinical Symptoms of Thrombophlebitis:
Usually?
one limb only
Clinical Symptoms of Thrombophlebitis:
Superficial thrombophlebitis
WARTS
Warmth Affected site induration Redness Tenderness Swelling
Clinical Symptoms of Thrombophlebitis:
Deep vein thrombosis or DVT
Symptoms may vary from none to severe pain
swelling of affected limb
cyanosis of affected limb
fever and chills
Diagnosis of Thrombophlebitis: (4)
Venous duplex ultrasound imaging
uses sound waves to produce images of the veins. It is commonly used to search for blood clots, especially in the veins of the leg – a condition often referred to as deep vein thrombosis. Ultrasound does not use ionizing radiation and has no known harmful effects. A Doppler ultrasound study may be part of a venous ultrasound examination.
Venography
a procedure in which an x-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure.
Impedance plethysmography
evaluates the velocity of blood flow through the veins
(a non-invasive medical test that measures small changes in electrical resistance of the chest, calf or other regions of the body. These measurements reflect blood volume changes, and can indirectly indicate the presence or absence of venous thrombosis.)
Coagulation bloodwork Prothrombin time (PT or PT-INR) Platelet count Thrombin time Bleeding time
Goals for Thrombophlebitis: (3)
to prevent pulmonary embolus from DVT
to restore effective venous return
to limit damage to the valves of the deep and perforating veins
To prevent pulmonary embolus from DVT r/t surgery, what can be given? When? To who?
sub-cutaneous low molecular weight heparin
pre and post-op
to those at most risk
Treatments for Thrombophlebitis: (3)
use of anti-embolism stockings (TEDs) for non-ambulatory clients
before, during and immediately post-surgery to prevent pooling of blood in lower limbs during prolonged immobility
thrombolytic and anticoagulation therapy as needed
thrombectomy surgery in cases of severe compromise of circulation
Chronic Venous Insufficiency Etiology
3 main causes
- failure of the calf muscle pump
- venous reflux from damaged or incompetent valves
- obstruction of venous return or outflow
Calf muscle pump
When walking, the calf-muscle-pump contracts allowing the blood to flow proximally towards the heart. Blood flow from the superficial veins to the deeper veins occurs when the pressure decreases. In fully functional vessel valves, retrograde blood flow is prevented as the leg muscles relax.
The calf muscle pump is made up of all the muscles in the legs, but the motors that provide the power for the pump are the calf muscles – these are made up of two basic movers – they are Soleus which is primarily used for standing upright, and Gastrocnemius used for running and jumping.
As muscles move, they increase and decrease pressure of the vessel walls (the veins) which have one-way valves in them which open to let blood pass through them and close to prevent the blood flowing back toward the feet.
Chronic Venous Insufficiency Etiology
- failure of the calf muscle pump
What do calf muscles do?
During which phases of the gait cycle?
Squeeze deep veins
Open valves
Push blood toward the heart
Heel strike
Foot flat
Heel off
Chronic Venous Insufficiency Etiology
- failure of the calf muscle pump
What happens when the calf muscle relaxes?
During which phase of the gait cycle is the calf relaxed?
valves close preventing backflow of blood in the veins
between the toe off and next heel strike phase of the gait cycle
Chronic Venous Insufficiency Etiology
- failure of the calf muscle pump
The calf muscle pump fails to function unless…?
What does the calf muscle pump need to be activated?
normal walking motion has
dorsiflexion at the ankle of > 90 degrees
needs seven steps to be activated
Chronic Venous Insufficiency Etiology
- failure of the calf muscle pump
What will not activate the calf muscle pump effectively?
immobility
paralysis
a weak shuffling gait
Chronic Venous Insufficiency Etiology (3)
- venous reflux from damaged or incompetent valves
inherited
acquired with occupations that involve prolonged standing in one place
damage of
DVT
trauma
infection
Chronic Venous Insufficiency Etiology
- obstruction of venous return or outflow
T POMP
thrombosis
prolonged sitting
obesity
malignancy
pregnancy
Chronic Venous Insufficiency Etiology
3 main causes
- failure of the calf muscle pump
- venous reflux from damaged or incompetent valves
- obstruction of venous return or outflow
Clinical SIGNS of Chronic Venous Insufficiency: (3)
hemostasis leading to hemosiderin staining
chronic induration of tissue and eventual fibrosis
dermatitis
Stasis dermatitis is a long-term condition that causes inflammation, ulcers, and itchy skin on the lower legs. It often occurs in people who have underlying conditions that affect blood flow in the legs, such as chronic venous insufficiency, varicose veins, deep vein thrombosis (DVT), and congestive heart failure.
Complications of Chronic Venous Insufficiency:
V OR CC
venous stasis ulcers
obstruction of microcirculation with delayed healing
recurrent thrombosis
chronic edema eventually not relieved with elevation
cellulitis
Medical Diagnosis of Chronic Venous Insufficiency:
Venous duplex ultrasound imaging
uses sound waves to produce images of the veins. It is commonly used to search for blood clots, especially in the veins of the leg – a condition often referred to as deep vein thrombosis. Ultrasound does not use ionizing radiation and has no known harmful effects. A Doppler ultrasound study may be part of a venous ultrasound examination.
Impedance plethysmography
evaluates the velocity of blood flow through the veins
(a non-invasive medical test that measures small changes in electrical resistance of the chest, calf or other regions of the body. These measurements reflect blood volume changes, and can indirectly indicate the presence or absence of venous thrombosis.)
Goals for Chronic Venous Insufficiency:
restore intact skin
prevent further ulceration, thrombosis, dermatitis or infection
Treatment for Chronic Venous Insufficiency: (4)
compression therapy
infectious disease consultation
dermatology consultation
vascular surgery consultation
Treatment for Chronic Venous Insufficiency:
Compression therapy
What must first be evaluated prior to initiation of compression therapy?
How is this evaluated?
arterial flow – is it adequate enough to use compression therapy?!
ankle brachial pressure indices (ABPI)
The ankle brachial index, or ABI, is a simple test that compares the blood pressure in the upper and lower limbs. Health care providers calculate ABI by dividing the blood pressure in an artery of the ankle by the blood pressure in an artery of the arm.
Treatment for Chronic Venous Insufficiency:
Compression therapy – 3 types
pneumatic extremity pumps
compression dressings
compression garments or hosiery
Treatment for Chronic Venous Insufficiency:
Compression therapy – once started…?
compression therapy once started, is for life!
Treatment for Chronic Venous Insufficiency:
infectious disease consultation can help manage?
difficult cellulitis and wound care issues
Treatment for Chronic Venous Insufficiency:
dermatology consultation is helpful for?
managing dermatitis
Treatment for Chronic Venous Insufficiency:
vascular surgery consultation can?
identify any possible surgical options
Management of All Types of Edema
Effects of Edema on the Lower Limb:
What does prolonged edema do?
It is therefore?
impairs the overall function of the skin as an organ
a serious threat
Management of All Types of Edema
Effects of Edema on the Lower Limb:
Prolonged edema impairs the overall function of the skin as an organ.
Speak to the general condition of the skin (2)
epidermis thins, becomes more fragile and prone to injury from pressure and trauma
the skin is less elastic and accommodating and thus prone to tearing or splitting
Management of All Types of Edema
Effects of Edema on the Lower Limb:
Prolonged edema impairs the overall function of the skin as an organ.
Speak to breaks in the skin (1)
any break in the skin becomes a portal of entry for microorganisms to enter and cause infection
Management of All Types of Edema
Effects of Edema on the Lower Limb:
Prolonged edema impairs the overall function of the skin as an organ.
Speak to lesion formation (1)
edema can cause formation of blisters that can become ulcerations
Management of All Types of Edema
Effects of Edema on the Lower Limb:
Prolonged edema impairs the overall function of the skin as an organ.
Speak to circulation (2)
edema impedes blood and lymph circulation and this leads to inadequate delivery of nutrients or antibiotics needed for tissue repair
edema impedes the removal of waste and toxins from areas of injury and hence slows the healing process
Management of All Types of Edema
Effects of Edema on General Health and Mobility:
SLID Pro
swelling around joints decreases ROM and hinders ability to perform ADLs
less mobility in turn leads to less adequate venous return and this in turn leads to more edema
increased weight associated with large amounts of edema expends more energy to carry around leading to fatigue
decreased activity tolerance may seriously impair ability to manage ADL independently
prolonged impaired mobility eventually negatively effects all body systems
Effects of Edema on Common Foot Pathologies of Nails and Skin:
Pressure points
Feet
Toes
Infx (2)
edema makes any areas of increased pressure more prone to injury or skin breakdown
e.g. corns or calluses
foot edema increases the pressure of footwear on fragile skin
edema to the toes makes it easier for the edge of the nail plate to pierce surrounding skin
feet have indigenous bacterial flora and breaks in skin integrity lead to increased risk of infection from normal flora
slowed healing makes it easier for infection to spread to surrounding tissue
General Treatment for Managing Edema:
PEACHY
protect fragile skin from damage and keep clean and moisturized
elevation of effected limbs to improve venous return
ambulation as soon as possible to activate the calf muscle pump
change position or do ankle exercises to stimulate blood flow
have to strongly encourage clients to persist with therapy that has been ordered
you must direct any concerns that – as a nurse – you cannot answer back to their care provider in charge of the therapy
Education for Managing Edema:
Avoid (3)
Any concerns?
AVOID
restrictive clothing at waist, hips, groin, knees or ankles
sitting or standing for long periods of time
crossing legs, it reduces venous return by 15%
Nursing Foot Care for Clients with Lower Limb Edema:
Assessment
Identify 1A EIOU
?s
PQRSTU mnemonic
IDENTIFY
1ST AX – is edema present? to what extent?
edema caused by hx of systemic disease?
if client on anticoagulants
other health care providers involved e.g. doctor, home care or wound care nurse
understanding client has of condition and any current treatments
?s
onset, duration, what makes it better or worse?
Provoking/Paliation Quality/Quantity Region/Radiation Severity Timeframe (onset/duration) Understand pt's perception of problem
Nursing Foot Care for Clients with Lower Limb Edema:
Planning
3 things to plan
realistic goals for treatment
in consultation WITH CLIENT
and based on their preferences for treatment
interventions including education and referrals
WITH CLIENT
foot care to not interfere with other treatments
Nursing Foot Care for Clients with Lower Limb Edema:
Intervention:
In terms of medical supervision (4)
refer client to doctor if you identify persistent edema that has not been diagnosed
monitor the presence and extent of edema at subsequent visits
question the client about any changes
refer client back to doctor if edema gets worse without adequate explanation
Nursing Foot Care for Clients with Lower Limb Edema:
Intervention:
In terms of actual foot care (4)
exercise particular caution to protect fragile skin during foot and nail care
extra caution to avoid breach of skin if client is on anticoagulants
identify any areas of pressure from footwear and work with client to prevent skin breakdown
if compression stockings (not referring to compression dressings or bandages) are removed to do foot care, keep both legs elevated during foot care and reapply hose before allowing legs to dangle
Nursing Foot Care for Clients with Lower Limb Edema:
Evaluation: (3)
evaluate effectiveness of interventions including teaching and referrals
identify changes in client’s behaviour or lack of change (e.g. have they bought new compression hose or have they forgotten to put it on)
document changes to care plan along with any new goals or interventions
Foot Care Nurses and Wound Care
Wound care is part of the basic training for all nurses but demands…?
Wound care is NOT provided, however…?
more frequent visits and access to supplies that are beyond the scope of the foot care nurse in independent practice
All Licensed and Registered Nurses DO give first aid assistance if required
e.g. loosening a constrictive dressing in the event of pain, numbness or cyanosis of an extremity,
then refer client to
Home Care, MD, Urgent Care or ER as appropriate.
Foot Care Nurses and Wound Care
Wounds on the lower limb are often serious in elderly or chronically ill clients and best managed by?
a multidisciplinary health care team
Foot Care Nurses and Wound Care
What might cause a client to fail to seek appropriate tx???
Clients may fail to seek appropriate treatment if they believe that you can look after them.
Foot Care Nurses and Wound Care
Foot Care nurses DO need to be aware of…?
Why?
current wound care practices and best practice guidelines in their region
to be a supportive member of the health care team
Foot Care Nurses and Wound Care
Speak to wound dressings during routine foot care.
Typically wound dressings would not be disturbed during routine foot care.
Foot Care Nurses and Wound Care
If unable to access toes?
delay foot care
Foot Care Nurses and Wound Care
If delay in providing foot care will be prolonged?
discuss foot care with client and wound caregiver
Foot Care Nurses and Wound Care
What do to if S/S of wound infx???
Strongly advise all clients to seek medical aid
Document
Follow up outcomes at the next visit
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
LOCATION
Venous – Gaiter area*, often over malleolus
Arterial – Can occur anywhere on lower leg
Diabetic – Usually on foot, but can be anywhere on lower leg and hands
*Gaiter area = area extending from just above the ankle to below the knee
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
SIZE
Venous – Usually large
Arterial – Usually small
Diabetic – Small, but can be larger once callus is removed
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
DEPTH
Venous – Shallow
Arterial – Deep, punched out appearance
Diabetic – Can go to bone
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
BORDER
Venous – Irregular, ragged
Arterial – Sharp edges
Diabetic – Smooth edges
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
WOUND BED
Venous – Bright red
Arterial – Pale
Diabetic – Pale, dry
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
EDEMA
Venous – Generalized
Arterial – Minimal
Diabetic – Localized
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
PERIWOUND
Venous – Lipodermatosclerosis*, hemosiderin staining, dermatitis
Arterial – Pale, cool, shiny, hairless
Diabetic – Callus
Lipodermatosclerosis = a chronic inflammatory condition characterised by subcutaneous fibrosis and hardening of the skin on the lower legs.
Hemosiderin staining = occurs when red blood cells are broken down, causing hemoglobin to be stored as hemosiderin. Your white blood cells, or immune system cells, can clear up some of the excess iron released into your skin. But there are some medical conditions that can overwhelm this process, resulting in a stain.
Dermatitis = skin inflammation
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
ANKLE-BRACHIAL PRESSURE INDEX
Venous – 0.8 - 1.0+
Arterial – Below 0.6
Diabetic – Unreliable
Blood pressure is measured in units of millimeters of mercury (mmHg)
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
PULSES
Venous – Readily palpable once edema is reduced
Arterial – Reduced or absent
Diabetic – Can be bounding, but this is misleading
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
PAIN
Venous – Can be severe
Arterial – Claudication and/or pain on elevation of limb, most often noted at night in bed
Diabetic – Often absent d/t sensory neuropathy
Characteristics of Leg Ulcer Wounds
Venous / Arterial / Diabetic
COMPRESSION
Venous – Often used
Arterial – Never
Diabetic – Possibly, but modified
Role of the Foot Care Nurse as a Member of the Health Care Team
(5)
Supportive Referrals Advocating Follow-up Communication
Role of the Foot Care Nurse as a Member of the Health Care Team
Supportive: (2)
demonstrate support for whatever treatment and caregivers are currently in place
encourage clients to ask questions and be active participants in their own care
Role of the Foot Care Nurse as a Member of the Health Care Team
Referrals: (2)
refer clients to their family physician for diagnosis and treatment of persistent edema, especially edema that has no simple explanation or does not resolve readily with leg elevation
refer clients back to the home care or wound care nurse for questions about therapy
Role of the Foot Care Nurse as a Member of the Health Care Team
Advocating: (3)
advocate for clients to have access to a family physician
can suggest calling Health Links or Manitoba Medical Association for a list of physicians taking new clients
advocate for home care assessment through family physician
Role of the Foot Care Nurse as a Member of the Health Care Team
Follow-up:
document referrals and ask the client about outcomes at subsequent visits
Role of the Foot Care Nurse as a Member of the Health Care Team
Communication: (2)
if concerns are urgent or more detail is required consider a phone call, letter or fax to clarify communication
keep a record of communications
chronic venous insufficiency
Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis.
lymphedema
Lymphedema, or lymphatic obstruction, is a long-term condition where excess fluid collects in tissues causing swelling (edema).
Lymphedema results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.
Hemosiderin staining
occurs when red blood cells are broken down, causing hemoglobin to be stored as hemosiderin. Your white blood cells, or immune system cells, can clear up some of the excess iron released into your skin. But there are some medical conditions that can overwhelm this process, resulting in a stain.
edema
“Edema” is the medical term for swelling. Body parts swell from injury or inflammation. Edema happens when your small blood vessels leak fluid into nearby tissues.
venous stasis
Venous stasis, is a condition of slow blood flow in the veins, usually of the legs. Venous stasis is a risk factor for forming blood clots in veins (venous thrombosis), as with the deep veins of the legs (deep vein thrombosis or DVT).
venous reflux
Normally, one-way valves in the veins keep blood flowing toward the heart against the force of gravity. When the valves become weak and do not close properly, they allow blood to flow backward and this is a condition called reflux.
Compression therapy
The concept of compression therapy is the external application of a controlled pressure to an extremity to help increase the efficiency of the venous and lymphatic systems. This is done with an elastic garment that has a specific amount of compression that is strongest around the ankle and gradually decreases up the extremity/garment. Depending on the pathology, compression therapy can be applied in different forms such as socks, stockings, pantyhose, or sleeves.
