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venous ulcers
WOCN program
| Question | Answer |
|---|---|
| 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
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