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venous ulcers

WOCN program

QuestionAnswer
name 3 elements essential for normal venous function calf pump, competent venous valves and perforater veins competent venous walls
what is the classification system for chronic venous insufficiency (CVI) CEAP Clinical indicators, Etiologic factors, Anatomic location, specific Pathophysiologic processes
what are contributing factors to CVI Sedentary lifestyle, obesity, hx dvt, shuffling gait, pregnancy, prolonged standing, advanced age, leg trauma, tha or tka
what is the classic indicator for venous insufficiency edema between ankle and knee that reduces with elevation, is pitting,
describe hemosiderin staining brown appearance of skin due to breakdown of rbc's, a classic indicator of CVI
what is the condition that involves inverted champagne bottle appearance of the lower leg with hardening of the tissue and firm "woody" appearance called lipodermatosclerosis
describe the difference in presentation of venous dermatitis and cellulitis C is warm, D is not. C-tender, D-may be but more likely itching . C-no,crusting, D- crusting C-may be febrile, C- unilateral D-may be bilateral C- leukocytosis D-nl WBC's
describe the classic characteristics of a venous ulcer located in the gaiter area and around the medial malleolus, shallow, large amount of drainage, dark red/ruddy or yellow slough in wound base, irregular edges, periwound maceration/dermatitis, periwound crusting, scaling, and/or hemosiderin staining
what is the gold standard non invasive test for CVI duplex ultrasound
what 2 interventions are indicated for managing CVI Compression and reduction of risk factors (lifestyle changes)
the amount of compression considered therapeutic for venous insufficiency is what 30-40 mmHg
list three types of compression therapy devices Elastic, nonelastic, dynamic pump (multi-layer, paste wrap, tubular sleeve, circ-aid, compression stockings)
True or False: compression stockings can be applied to an edematous leg withuot ulcers and a normal ABI- false- should be applied after the edema has been controlled
True or false: intermittent pneumatic compression is an adjunct therapy that can be used with a compression wrap true
True or false: once a venous ulcer has healed and the edema is resolved the patient needs to continue to have lifelong compression True
what is the etiologic factor common to all people with LEVD Ambulatory venous hypertension
atrophie blanche Thin whit trophic skin that looks like scarring, is high risk for ulceration, common presentation in LEVD
venous dermatitis often the earliest sequelae of CVI, scaling, crusting, weeping, erythema, erosions, itching
risk factors for calf muscle dysfunction sedentary lifestyle, occupations that require prolonged standing, conditions that compromise calf muscle function (paralysis) reduced mobility, shuffling gait, injection drug use, arthroscopic surgery, advanced age, restricted ROM of ankle
risk factors for valvular dysfunction obesity, pregnancy, thrombophlebitis, leg trauma, thrombophilic conditions, varicose veins, inflamm. Autoimmune disease
venous ulceration is a direct result of this ambulatory venous hypertension .
hallmark of venous dermatitis dermal fibrosis
Explain Laplaces law applied to compression wraps The more layers, the higher the pressure and the greater the circumference the lower the pressure. Pressure is greater at the ankle
What would modified compression be? 20-30 mmHg
What pressure does two layers of tubigrip produce Modified pressure
Short stretch and UNNA are what type of compression and what type of pressure do they apply Inelastic, modified pressure
What products can apply therapeutic pressure? Multilayer kits, long stretch, jobst stockings, intermittent pumps
CEAP clinical classification c0 no visible or palpable signs of venous disease
CEAP clinical classification c2 Varicose veins (use 20-30mmHg)
CEAP clinical classification c3 edema (use 20-30mmHg)
CEAP clinical classification c4a pigmentation or eczema (use 30-40mmHg)
CEAP clinical classification c4b lipodermatosclerosis or atrophie blanche (use 30-40mmHg)
CEAP clinical classification c6 active venous ulcer (use 30-40mmHg)
CEAP clinical classification CEAP "s" symptomatic including ache, pain, tightness, skin irritation, heaviness, and muscle cramps and other complaints attributable to venous dysfunction
CEAP clinical classification CEAP "a" asymptomatic
CEAP Etiologic Classification Ec congential
CEAP Etiologic Classification Ep primary
CEAP Etiologic Classification Es secondary (postthrombotic)
CEAP Etiologic Classification En no venous cause identified
CEAP anatomic classification As superficial veins
CEAP anatomic classification Ap perforator veins
CEAP anatomic classification Ad deep veins
CEAP anatomic classification An no venous location identified
CEAP pathophysiologic classification Pr reflux
CEAP pathophysiologic classification Po obstruction
CEAP pathophysiologic classification Pr,o reflux and obstruction
CEAP pathophysiologic classification Pn no venous pathophys identifiable
CEAP clinical classification C1 telangiectasis or reticular veins
CEAP clinical classification C5 healed venous ulcer
what labs are indicated for LEVD workup HgB HCT PT and INR if pt on warfarin, homocysteine level
interventions for LEVD treat dermatitis, clean and debride wound, manage pain, use dressing appropriate for wound, treat cellulitis with po abx, compression, consider pentoxifylline, increase activity, treat underlying causes
what ABI readings influence compression ABI <0.5 contraindicates high compression, >0.5 to <0.8 can try modified (23-30) with close monitoring
what does horse chestnut seed extract do decreases itching and pain, may reduce edema
list surgical options SVS(surgical vein stripping) EVLA(endovenous laser ablation) RFA(radiofrequency ablation) USFS ultraound-guided foam sclerotherapy) SEPS (subfascial endoscopic perforator surgery
what is EVLA endovenous laser ablation- laser destroys the endothelium of the greater saphenous vein thus causing it to close. Highly effective compared to SVS
how is venous dermatitis treated midpotency steroid like Triamcinolone 0.1% but only for two weeks. Cleanse with mild cleanser (nonsoap),nonlanolin (Dove, Olay, Neutrogena, Cetaphil)
are topical antibiotics indicated for venous ulcers and why? no- VU's are usually heavily colonized, can try cadexomer iodine, silver, or manuka honey
explain adjuvant therapy fro VU's Apligraf has strongest evidence for use with refractory VU's (is a bilayered skin substitute)
what are contraindications for continuous compression and what is the alternative uncompensated heart failure, venous thrombosis in the extremity. alternative is IPC
explain IPC intermittent pneumatic compression can be used for pt who cannot tolerate or are too compromised for sustained compression, or need higher level of compression that stockings or wraps can provide, 1-2x a day for 1-2 hrs
General appearance of CVI Lipodermatosclerosis, edema, hemosiderin staining and atrophie Blanche, dermatitis or varicosities, dull pain incr's w/dependency, pain improves w/compression, wound in gaiter area, is exudative and shallow
What is an essential assessment component when evaluating CVI ABI- need to determine if arterial insufficiency is present
Created by: Beth Perry