Venous Ulcers

Question 1

etiology?

Answer 1

acquired valvular dysfunction, especially of the communicating system

venous hypertension leads to fibrin cuff formation around small vessels, potentially inducing fibrosis and decreased nutrient diffusion

Question 2

what are risk factors for venous ulcers?

Answer 2

trauma
DVT
pregnancy
obesity
clotting disorder
family history

Question 3

Venous ulcers are usually found on the ________, but not on the ______. the pulse is usually _______ and ______ in depth. Pain is _______ with standing and _______ with elevation. The area is brawny in color due to ________ staining.

Answer 3

lower extremity, foot
good, shallow
increased, relieved
hemosiderin

Question 4

With more advanced venous disease, the tissue develops a ______ appearance over the ______ area. Pulses may be difficult to palpate due to _______ and the shape is _______ deformity.

Answer 4

wood-like
gaitor
edema
inverted champagne -bottle

Question 5

what is lipodermatosclerosis?

Answer 5

brawny edema with hardening and induration, hyper pigmentation of skin, fibrosis of the tissue, skin changes like eczema

Question 6

What are some venous test and measures?

Answer 6

History of DVT, phlebitis, or trauma 
palpable pulse
doppler
ABI
Girth measurements
Doppler ultrasound

Question 7

what are the 3 location used for girth measurements?

Answer 7

midfoot
ankle
10-11 cm distal in inferior patella

Question 8

edema severity based off pitting?

Answer 8

0-1/4 inch = 1+
1/4-1/2 inch = 2+
1/2-1 inch=3+
over 1 inch= 4+

Question 9

Explain the three parts of the doppler ultrasound test?

Answer 9

Resting= pt supine listening for spontaneous sound
Augmentation= squeeze distal to probe to enhance doppler signal
Reflux= squeeze proximal for signal to disappear

Question 10

What are the typical treatments for treating venous ulcers?

Answer 10

debridement
cleansing
dressing
compression
antibiotics
pressure redistribution

Question 11

in the management of chronic wounds it is important to treat the underlying ______ and _______. 5 Examples would be ? (OAR PI)

Answer 11

conditions and comorditites
Optimize blood glucose control
Adequate nutritional status
Revascularization
Pain management
infection control

Question 12

Two protocols for venous leg ulcers are?

Answer 12

compression therapy

bioengineered

Question 13

What are 5 barriers to healing VLU?

Answer 13

Presence of unresponsive or senescent cells
Inflammatory or proteolytic environment
Deficient or unavailable GF
Presence of bacteria 
MMPs

Question 14

What are 6 things thats should be part of the Plan of Care for treating VLU?

Answer 14

consider surgical interventions
compression therapy
exercise and walking program
elevation
debridement
wound care

Question 15

Before administering compression it is important to check ________.

Answer 15

ABI

Question 16

Wound care is especially important for __________ control and ________ reduction.

Answer 16

drainage

bacteria

Question 17

Name 3 important education components for treatment of VLU

Answer 17

elevation and compression
application or maintenance of compression treatment device
usually lifelong vigilance is required

Question 18

Surgical options for VLU include: _______ which is the tying off of perforating veins. _______ which is the resection of perforating veins and/or varicosities. _________ which is the injection to fibrose dysfunctional veins. ________ which interrupts perforating veins and may also improve lipodermatosclerosis.

Answer 18

Ligation
Vein stripping
Sclerotherapy
Subfascial endoscopic perforator surgery

Question 19

When using compression bandages, how much pressure is needed to treat VLU? You begin _____ and move ________ with a ____-_____% overlap. Bandages should be changed _____ or _____ weekly. ABI should be greater than ___-____.

Answer 19

30-40 mmHg
distal, proximal
once or twice
.6-.8

Question 20

People with _____ need precaution for compression bandages.

Answer 20

CHF

Question 21

True or False

Ted hose is strong enough to be used for compression therapy.

Answer 21

False

only for DVT

Question 22

When using the Unna boot which is a ____stretch material, the person must be able to ________ because the boot acts _______ the muscle. It is important to not _____ when being applied and covered with ____ and ___/___ to maintain pressure.

Answer 22

short
walk
against
stretch
kerlix or ace/coban

Question 23

Custom compression hosiery should be measured _______ and typically last for ________.

Answer 23

in the morning

6 months

Question 24

When conventional therapy has failed after 6 months, then ________ are then used. True or false. Pt no longer needs their hosiery with this pump

Answer 24

power graduated compression pumps

False, needed for maintenance

Question 25

About _____ % of venous ulcers have an arterial insufficiency component and ________ is not indicated for these cases.

Answer 25

20

high compression

Question 26

Long term goals in wound healing vascular insufficiency.

Answer 26

Pain is decreased
Protection of body part is increased
sense of well-being
soft tissue swelling, inflammation or restriction is reduced
tolerance to positions and activities is increased