Examine for fecal and urinary incontinence. nous insufficiency and ambulatory venous hypertension. The ultimate aim is to promote evidence-based nursing care among patients with venous leg ulcer. St. Louis, MO: Elsevier. Compression therapy is a standard treatment modality for initial and long-term treatment of venous ulcers in patients without concomitant arterial disease. The student can make adjustments as soon as they receive feedback, as opposed to practicing the skill incorrectly. Severe complications include cellulitis, osteomyelitis, and malignant change. (2020). Referral to a wound subspecialist should be considered for ulcers that are large, of prolonged duration, or refractory to conservative measures. arterial pulse examination, and measurement of ankle-brachial index is recommended for all patients with suspected venous ulcers. These are most common in your legs and feet as you age and happen because the valves in your leg veins can't do their job properly. These actions are intended to improve overall muscle tone and strength, as well as boost venous return from the lower extremities and decrease venous stasis. Chronic venous ulcers significantly impact quality of life. St. Louis, MO: Elsevier. Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency.23,45 A recent Cochrane review found that venous ulcers heal more quickly with compression therapy than without.45 Methods include inelastic, elastic, and intermittent pneumatic compression. Intermittent pneumatic compression may be considered when there is generalized, refractory edema from venous insufficiency; lymphatic obstruction; and significant ulceration of the lower extremity. Traditional conservative management of venous ulcers usually entails compression therapy, leg elevation to reduce edema, and dressings on the wound. Duplex Ultrasound We and our partners use cookies to Store and/or access information on a device. 11.0 Low level laser treatment 11.1 There is no evidence that low level laser therapy speeds the healing of venous leg ulcers. Nursing Diagnosis: Acute Pain related to pressure ulcers as evidenced by a pain level of 10/10, restlessness, and irritability, especially during wound care secondary to venous stasis ulcers. Nursing Interventions 1. Signs of chronic venous insufficiency, such as: The patient will verbalize an understanding of the aspects of home care for venous stasis ulcers such as pressure relief and wound management. Severe complications include infection and malignant change. 2 Irrigate in the shower or bathe in buckets or bowls lined with a clean plastic bag to reduce the risk of cross-infection. Pentoxifylline (Trental) is an inhibitor of platelet aggregation, which reduces blood viscosity and, in turn, improves microcirculation. Print. Compression therapy is beneficial for venous ulcer treatment and is the standard of care. Abstract: Chronic venous insufficiency (CVI) is a potentially debilitating disorder associated with serious complications such as lower extremity venous ulcers. Despite a number of studies to support its effectiveness as adjunctive therapy, and possibly as monotherapy, the cost-effectiveness of pentoxifylline has not been established. Saunders comprehensive review for the NCLEX-RN examination. Start providing wound care according to the decubitus ulcers development. Surgical options for treatment of venous insufficiency include ablation of the saphenous vein; interruption of the perforating veins with subfascial endoscopic surgery; treatment of iliac vein obstruction with stenting; and removal of incompetent superficial veins with phlebectomy, stripping, sclerotherapy, or laser therapy.19,35,40, In one study, ablative superficial venous surgery reduced the rate of venous ulcer recurrence at 12 months by more than one half, compared with compression therapy alone.42 In another study, surgical management led to an ulcer healing rate of 88 percent, with only a 13 percent recurrence rate over 10 months.43 There is no evidence demonstrating the superiority of surgery over medical management; however, evaluation for possible surgical intervention should occur early.44. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. Nursing care plans: Diagnoses, interventions, & outcomes. Venous ulcers (also known as venous stasis ulcers or nonhealing wounds) are open wounds around the ankle or lower leg. Nursing Care Plan for: Impaired Skin Integrity, Risk for Skin Breakdown, Altered Skin Integrity, and Risk for Pressure Ulcers. 1, 28 Goals of compression therapy. This causes blood to collect and pool in the vein, leading to swelling in the lower leg. Professional Skills in Nursing: A Guide for the Common Foundation Programme. Data Sources: We conducted searches in PubMed, Essential Evidence Plus, the Cochrane database, and Google Scholar using the key terms venous ulcers and venous stasis ulcers. Most venous ulcers occur on the leg, above the ankle. Characteristic differences in clinical presentation and physical examination findings can help differentiate venous ulcers from other lower extremity ulcers (Table 1).2 The diagnosis of venous ulcers is generally clinical; however, tests such as ankle-brachial index, color duplex ultrasonography, plethysmography, and venography may be helpful if the diagnosis is unclear.1518. o LPN education and scope of practice includes wound care. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Affect 9% of patients admitted to hospital and 23% of those admitted to nursing homes. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. Teach the caretaker how to properly care for the afflicted regions of the wounds if the patient is to be discharged. Patients treated with debridement at each physician's office visit had significant reduction in wound size compared with those not treated with debridement.20. Nursing Diagnosis: Impaired Peripheral Tissue Perfusion related to deficient knowledge of risk factors secondary to venous stasis ulcers as evidenced by edema, decreased peripheral pulses, capillary refill time > 3 seconds, and altered skin characteristics. Timely specialized care is necessary to prevent complications, like infections that can become life-threatening. There is no evidence that collagenase is superior to sharp debridement.23 Larval therapy using maggots is an effective method of debridement with added potential for disinfection, stimulation of healing, and biofilm inhibition and eradication.24,25 Potential barriers to larval debridement include patient acceptability and pain.26,27 Autolytic debridement uses moisture-retentive dressings and may be used in addition to other forms of debridement. Venous stasis ulcers are wounds that are slow to heal. -. Citation: Atkin L (2019) Venous leg ulcer prevention 1: identifying patients who are at risk. This provides the best conditions for the ulcer to heal. There is currently insufficient high-quality data to support the use of topical negative pressure for venous ulcers.30 In addition, the therapy generally has not been used in clinical practice because of the challenge in administering both topical negative pressure and a compression dressing on the affected leg. Leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema contribute to venous ulcer development and impaired wound healing.2,14, Determining etiology is a critical step in the management of venous ulcers. Employed individuals with venous ulcers missed four more days of work per year than those without venous ulcers (29% increase in work-loss costs).9, Venous hypertension is defined as increased venous pressure resulting from venous reflux or obstruction. Buy on Amazon. In diabetic patients, distal symmetric neuropathy and peripheral . Any delay in care increases the risk of infection, sepsis, amputation, skin cancers, and death. It might be necessary to apply the prescription antibiotic cream or ointment directly to the affected area. This content is owned by the AAFP. The Unna boot improves healing rates compared with placebo or hydroactive dressings.22,26 However, a 2009 Cochrane review found that adding a component of elastic compression therapy is more effective than inelastic compression therapy alone.45 Also, because of its inelasticity, the Unna boot does not conform to changes in leg size and may be uncomfortable to wear. C) Irrigate the wound with hydrogen peroxide once daily. A 25-year-population research found that it typically takes 5 years from the diagnosis of chronic venous insufficiency to the development of an ulcer. Compression stockings can be used for ulcer healing and prevention of recurrence (recommended strength is at least 20 to 30 mm Hg, but 30 to 40 mm Hg is preferred).31,32 Donning stockings over dressings can be challenging. Oral antibiotics are recommended to treat venous ulcers only in cases of suspected cellulitis. 17 Patient information: See related handout on venous ulcers, written by the authors of this article. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. Cellulitis or sepsis may develop in complicated wounds, necessitating antibiotic therapy. Venous stasis commonly presents as a dull ache or pain in the lower extremities, swelling that subsides with elevation, eczematous changes of the surrounding skin, and varicose veins.2 Venous ulcers often occur over bony prominences, particularly the gaiter area (over the medial malleolus). Recent trials show faster healing of venous ulcers when early endovenous ablation to correct superficial venous reflux is performed in conjunction with compression therapy, compared with compression alone or with delayed intervention if the ulcer did not heal after six months. Venous incompetence and associated venous hypertension are thought to be the primary mechanisms for ulcer formation. Elastic compression bandages conform to the size and shape of the leg, accommodate to changes in leg circumference, provide sustained compression during rest and walking, have absorptive capacity, and require infrequent changes (about once a week).5 There is strong evidence for the use of multiple elastic layers vs. single layers to increase ulcer healing.30, Inelastic.