Venous Ulcers Barbara Pieper Ph D RN FAAN
Venous Ulcers Barbara Pieper Ph. D, RN, FAAN, CWOCN, ACNS-BC Module #4
Objectives 1. 2. 3. 4. To define chronic venous insufficiency To identify at least three common traits of venous ulcers To describe treatment options for venous ulcers To correlate venous ulcers to therapy concepts, diagnoses and therapy issues
Heather Revisions 1. 2. 3. 4. 5. 6. 7. 8. Superficial vs. deep vein dysfunction as pathophysiology for CVI New evidence about phlebolymphedema CVI can cause with respect to skin changes, lymphatic impairment and edema, ROM issues, gait/balance, etc. Update VLU chraracteristics slide Discuss compression for treatment vs. compression for maintenance (presence of wound vs. just swelling) Update evidence slide for venous ulcer management Update slides on functional issues and mobility related to CVI/VLU as it pertains to PT Provide updated guidelines
Risk Factors for Chronic Venous Insufficiency (CVI) Older age Immobility Major surgery General anesthesia Major trauma Heart disease Cancer Varicose veins Injection drug use Pregnancy Oral contraceptive use Post-menopausal hormone replacement therapy Hypercoagulation states Obesity History of DVT
Venous Ulcers: Treatment Goals 1. Decrease edema & facilitate venous return § Ambulation (exercise / use calf muscle pump) § Compression therapy (e. g. Unna’s boot, compression bandages, support stockings and/or compression pumps) § Leg elevation (elevate legs above level of the heart) 2. Facilitate wound healing (e. g. , clean, moist wound environment, optimal nutrition) ACE n o i t a l u b m A n o i s s e r p C om n o i t E leva
Venous Ulcers and Nutrition § Nutrition needs to be assessed in patients with venous leg ulcers as protein deficiency is associated with: § Increased inflammation § Greater wound area § More frequent wound complications § Protein requirements tend to be underestimated in patients with wounds
Safety: Balance, Gait & Falls Chronic Venous Insufficiency + Trauma = Venous Ulcer
Fall Prevention – Venous Disease § Shoe on foot versus walking on back of shoe § Assistive devices (cane, walker) § tips in good condition § used properly § Podiatry referral for nail/foot care § Balance assessment – work with physical therapist § Get-up and Go Test § Functional Reach § Watch gait – walk with foot versus shuffle
Websites for Further Information - Association for the Advancement of Wound Care www. aawconline. net - National Pressure Injury Advisory Panel www. npiap. org - World Union of Wound Healing Societies www. wuwhs. org - Wound Ostomy Continence Nurses Society www. wocn. org - Wounds Canada www. woundscanada. ca
Why Wound Care? A Campaign for a Rewarding Career in Wound Care www. Why. Wound. Care. com
- Slides: 18
