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 leading to decreased nutrient diffusion

Question 2

Venous Ulcer risk factors

Answer 2

trauma
DVT
pregnancy
obesity
clotting disorder
family history
varicose vein

Question 3

Presentation of Venous Ulcer

Answer 3

good pulses (may be obstructed by edema)
usually on lower extremities, not including feet
shallow, partial or full thickiness
minimal necrosis
little pain (pain due to edema possible)
brawny edema
hemosiderin staining
moderate to heavy drainage
"wood-like" tissue over gaiter area (right above) 
inverted champagne bottle deformity
maceration common

Question 4

lipodermatosclerosis

Answer 4

brawny edema with hardening and induration
hyperpigmentation of skin
fibrosis
eczema like skin changes

Question 5

Edema scal

Answer 5

1+ mild, 1/4 inch pitting
2+ moderate 1/2 inch pitting under 15s
3+ severe 1 inch pitting for 15-30s
4+ very severe >1 inch pitting for >30s

Question 6

Doppler US

Answer 6

examines venous system

Resting test: supine, listening for spontaneous sounds

Augmentation test: squeeze distal to probe to enhance doppler system

Reflux test: squeeze proximal for signal to disappear

Question 7

Care of VLU

Answer 7

debridement: needed for re-epithelialization
cleansing
dressings: maintain temp/pH, protect, keep moist
antibiotics
pressure redistribute

Question 8

Management of chronic wounds

Answer 8

Treat underlying condition
optimize blood glucose control
adequate nutrition
revascularization
pain management
infection control

Question 9

Barriers to healing a VLU

Answer 9

presence of unresponsive or senscent cells
inflammatory environment (MMP’s wreak havoc)
deficient or unavailable growth factors
presence of bacteria

Question 10

VLU plan of care

Answer 10

consider sx
compression (after ABI)
exercise and walking
elevation
debridement
wound care
for every 2 hrs standing, elevate for 30 min

Question 11

Compression

Answer 11

for ABI’s over .6

30-40mmHg needed to treat
TED hose 15mmHg
ACE wrap: 8-12 mmHg
Prophylactic: 20-30 mmHg

base of toes to knee, distal to proximal with overlap of 25-50%. used with ABI of >.6
change 1/2 times/week.
use caution with CHF

Question 12

Med/Surg options for VLU

Answer 12

• Ligation: tying off
• vein stripping: resection of perforating veins/vericosities
• Sclerotherapy: injection to fibrose dysfunctional veins
• SPES interruption of perforating veins.

Question 13

Unna boot

Answer 13

overlap 25-50%
add kerlix and ACE or Coban to maintain compression
MUST BE AMBULATORY
dont stretch with application

Question 14

OTC/ Custom compression hosiery

Answer 14

Replaced every  mo.
measure for in morning
must be worn completely
variable compression
NOT Ted hose

Question 15

Mixed vascular ulcers

Answer 15

About 20% of venous ulcers have a significant arterial insufficiency as well.

High compression not indicated for these patients