WOCN program
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| name 3 elements essential for normal venous function | calf pump, competent venous valves and perforater veins competent venous walls
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| what is the classification system for chronic venous insufficiency (CVI) | CEAP Clinical indicators, Etiologic factors, Anatomic location, specific Pathophysiologic processes
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| what are contributing factors to CVI | Sedentary lifestyle, obesity, hx dvt, shuffling gait, pregnancy, prolonged standing, advanced age, leg trauma, tha or tka
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| what is the classic indicator for venous insufficiency | edema between ankle and knee that reduces with elevation, is pitting,
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| describe hemosiderin staining | brown appearance of skin due to breakdown of rbc's, a classic indicator of CVI
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| 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
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| 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
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| 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
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| what is the gold standard non invasive test for CVI | duplex ultrasound
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| what 2 interventions are indicated for managing CVI | Compression and reduction of risk factors (lifestyle changes)
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| the amount of compression considered therapeutic for venous insufficiency is what | 30-40 mmHg
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| list three types of compression therapy devices | Elastic, nonelastic, dynamic pump
(multi-layer, paste wrap, tubular sleeve, circ-aid, compression stockings)
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| 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
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| True or false: intermittent pneumatic compression is an adjunct therapy that can be used with a compression wrap | true
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| True or false: once a venous ulcer has healed and the edema is resolved the patient needs to continue to have lifelong compression | True
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| what is the etiologic factor common to all people with LEVD | Ambulatory venous hypertension
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| atrophie blanche | Thin whit trophic skin that looks like scarring, is high risk for ulceration, common presentation in LEVD
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| venous dermatitis | often the earliest sequelae of CVI, scaling, crusting, weeping, erythema, erosions, itching
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| 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
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| risk factors for valvular dysfunction | obesity, pregnancy, thrombophlebitis, leg trauma, thrombophilic conditions, varicose veins, inflamm. Autoimmune disease
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| venous ulceration is a direct result of this | ambulatory venous hypertension .
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| hallmark of venous dermatitis | dermal fibrosis
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| 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
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| What would modified compression be? | 20-30 mmHg
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| What pressure does two layers of tubigrip produce | Modified pressure
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| Short stretch and UNNA are what type of compression and what type of pressure do they apply | Inelastic, modified pressure
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| What products can apply therapeutic pressure? | Multilayer kits, long stretch, jobst stockings, intermittent pumps
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| CEAP clinical classification c0 | no visible or palpable signs of venous disease
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| CEAP clinical classification c2 | Varicose veins (use 20-30mmHg)
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| CEAP clinical classification c3 | edema (use 20-30mmHg)
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| CEAP clinical classification c4a | pigmentation or eczema (use 30-40mmHg)
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| CEAP clinical classification c4b | lipodermatosclerosis or atrophie blanche
(use 30-40mmHg)
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| CEAP clinical classification c6 | active venous ulcer
(use 30-40mmHg)
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| CEAP clinical classification CEAP "s" | symptomatic including ache, pain, tightness, skin irritation, heaviness, and muscle cramps and other complaints attributable to venous dysfunction
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| CEAP clinical classification CEAP "a" | asymptomatic
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| CEAP Etiologic Classification Ec | congential
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| CEAP Etiologic Classification Ep | primary
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| CEAP Etiologic Classification Es | secondary (postthrombotic)
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| CEAP Etiologic Classification En | no venous cause identified
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| CEAP anatomic classification As | superficial veins
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| CEAP anatomic classification Ap | perforator veins
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| CEAP anatomic classification Ad | deep veins
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| CEAP anatomic classification An | no venous location identified
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| CEAP pathophysiologic classification Pr | reflux
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| CEAP pathophysiologic classification Po | obstruction
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| CEAP pathophysiologic classification Pr,o | reflux and obstruction
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| CEAP pathophysiologic classification Pn | no venous pathophys identifiable
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| CEAP clinical classification C1 | telangiectasis or reticular veins
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| CEAP clinical classification C5 | healed venous ulcer
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| what labs are indicated for LEVD workup | HgB HCT PT and INR if pt on warfarin, homocysteine level
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| 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
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| what ABI readings influence compression | ABI <0.5 contraindicates high compression, >0.5 to <0.8 can try modified (23-30) with close monitoring
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| what does horse chestnut seed extract do | decreases itching and pain, may reduce edema
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| list surgical options | SVS(surgical vein stripping) EVLA(endovenous laser ablation) RFA(radiofrequency ablation) USFS ultraound-guided foam sclerotherapy) SEPS (subfascial endoscopic perforator surgery
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| 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
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| 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)
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| are topical antibiotics indicated for venous ulcers and why? | no- VU's are usually heavily colonized, can try cadexomer iodine, silver, or manuka honey
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| explain adjuvant therapy fro VU's | Apligraf has strongest evidence for use with refractory VU's (is a bilayered skin substitute)
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| what are contraindications for continuous compression and what is the alternative | uncompensated heart failure, venous thrombosis in the extremity. alternative is IPC
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| 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
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| 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
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| What is an essential assessment component when evaluating CVI | ABI- need to determine if arterial insufficiency is present
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Created by:
Beth Perry
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