Venous Ulcers

Question 1

etiology of venous ulcers

Answer 1

valvular dysfunction, venous HTN

Question 2

Risk Factors for venous ulcers include:

Answer 2

trauma, DVT, pregnancies, obesity, clotting disorders, family history

Question 3

Venous Ulcers present as: (7)

Answer 3

1. LE have good pulses, 2. wound is shallow (PT to FT), 3. minimal necrotic tissue,4. little pain, 5. edema, 6. hemosiderin, 7. moderate drainage

Question 4

Where do venous ulcers normally develop?

Answer 4

gaiter area of the ankle

Question 5

What is lipodermatosclerosis

Answer 5

edema with hardening and induration, hyperpigmentation of skin, fibrosis of tissue, eczema

Question 6

What is lymphedema?

Answer 6

edema due to insufficiency in the lymphatic system sometimes from progressive venous disease or from surgical history (requires additional therapy)

Question 7

What are the venous tests and measures? (4)

Answer 7

1. history of DVT, phlebitis, or trauma, 2. palpable pulses/doppler, 3. ABI, 4. girth measurements

Question 8

Where do you measure for girth?

Answer 8

ankle, midfoot, and 10-11 cm distal to patella

Question 9

Edema Scale

Answer 9

1+ = mild, 2+ = moderate, 3+ severe, 4+ very severe

Question 10

What are the 3 parts of the doppler ultrasound?

Answer 10

resting, augmentation, and reflux test?

Question 11

How do you perform the 3 parts of the doppler ultrasound?

Answer 11

Resting: patient is supine (listening for spontaneous sound), augmentation: squeeze distal to probe to enhance signal, Reflux: squeeze proximal for signal to disappear

Question 12

Standard Treatments for venous ulcer?

Answer 12

debridement, cleansing, dressings, compression, antibiotics, and pressure redistribution

Question 13

How do you manage a chronic wound?

Answer 13

treat underlying condition and co-morbidities (blood glucose control, nutrition, revascularization, pain, and infection control)

Question 14

Protocols for venous ulcers?

Answer 14

compression therapy and bioengineered tissue

Question 15

Barriers to Healing a venous leg ulcer?

Answer 15

present of unresponsive cells, inflammatory/proteolytic environment, deficient or unavailable growth factors, presence of bacteria

Question 16

POC for venous leg ulcers

Answer 16

Surgical intervention? compression therapy, exercise, elevation, debridement and wound care (drainage control and bacterial reduction)

Question 17

Education to patient for POC?

Answer 17

elevation and compression, LIFE LONG COMMITMENT ; every 2 hours of dependent position = 30 minutes of elevation

Question 18

Surgical Options for VLU (4 answers)

Answer 18

ligation, vein stripping, sclerotherapy, and subfasical endoscopic perforator surgery (SEPS)

Question 19

compression bandages - how much pressure?

Answer 19

30-40 mmHg to treat venous edema (prophylactically, a patient needs 20-30)

Question 20

precaution of compression bandages?

Answer 20

CHF

Question 21

Unna Boots - what kind of wrap do you use?

Answer 21

short stretch (inactive compression against the calf muscles) - don’t use for non-ambulatory patients

Question 22

what is another form of compression therapy?

Answer 22

powered graduated compression pumps - should be done in conjunction with a maintenance therapy such as hoisery

Question 23

what % is mixed vascular ulcers?

Answer 23

20%

Question 24

what is not indicated for mixed vascular ulcers?

Answer 24

high compression

Question 25

What does a mixed vascular ulcer look like?

Answer 25

irregular, but punched out and deep; drainage but no hair and dry skin with some necrosis

Question 26

LTG for vascular insufficiency? (5)

Answer 26

pain decreased, protection of body part and sense of well being increased, soft tissue swelling/inflammation/restriction reduced, and tolerance to positions and activities increased