Venous Ulcers Flashcards
etiology?
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
what are risk factors for venous ulcers?
trauma DVT pregnancy obesity clotting disorder family history
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.
lower extremity, foot
good, shallow
increased, relieved
hemosiderin
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.
wood-like
gaitor
edema
inverted champagne -bottle
what is lipodermatosclerosis?
brawny edema with hardening and induration, hyper pigmentation of skin, fibrosis of the tissue, skin changes like eczema
What are some venous test and measures?
History of DVT, phlebitis, or trauma palpable pulse doppler ABI Girth measurements Doppler ultrasound
what are the 3 location used for girth measurements?
midfoot
ankle
10-11 cm distal in inferior patella
edema severity based off pitting?
0-1/4 inch = 1+
1/4-1/2 inch = 2+
1/2-1 inch=3+
over 1 inch= 4+
Explain the three parts of the doppler ultrasound test?
Resting= pt supine listening for spontaneous sound Augmentation= squeeze distal to probe to enhance doppler signal Reflux= squeeze proximal for signal to disappear
What are the typical treatments for treating venous ulcers?
debridement cleansing dressing compression antibiotics pressure redistribution
in the management of chronic wounds it is important to treat the underlying ______ and _______. 5 Examples would be ? (OAR PI)
conditions and comorditites Optimize blood glucose control Adequate nutritional status Revascularization Pain management infection control
Two protocols for venous leg ulcers are?
compression therapy
bioengineered
What are 5 barriers to healing VLU?
Presence of unresponsive or senescent cells Inflammatory or proteolytic environment Deficient or unavailable GF Presence of bacteria MMPs
What are 6 things thats should be part of the Plan of Care for treating VLU?
consider surgical interventions compression therapy exercise and walking program elevation debridement wound care
Before administering compression it is important to check ________.
ABI
Wound care is especially important for __________ control and ________ reduction.
drainage
bacteria
Name 3 important education components for treatment of VLU
elevation and compression
application or maintenance of compression treatment device
usually lifelong vigilance is required
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.
Ligation
Vein stripping
Sclerotherapy
Subfascial endoscopic perforator surgery
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 ___-____.
30-40 mmHg
distal, proximal
once or twice
.6-.8
People with _____ need precaution for compression bandages.
CHF
True or False
Ted hose is strong enough to be used for compression therapy.
False
only for DVT
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.
short walk against stretch kerlix or ace/coban
Custom compression hosiery should be measured _______ and typically last for ________.
in the morning
6 months
When conventional therapy has failed after 6 months, then ________ are then used. True or false. Pt no longer needs their hosiery with this pump
power graduated compression pumps
False, needed for maintenance
About _____ % of venous ulcers have an arterial insufficiency component and ________ is not indicated for these cases.
20
high compression
Long term goals in wound healing vascular insufficiency.
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
