Barbara Pieper PhD, RN, FAAN, CWOCN, ACNS-BC Module #4 Venous Ulcers Barbara Pieper PhD, RN, FAAN, CWOCN, ACNS-BC Module #4 Revised September 2018

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Objectives 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 nursing concepts, nursing diagnoses and nursing issues

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 Ambulation Compression Elevation

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

Key Concepts Assessment Body Image Infection Infection Control Pain Patient Education Prevention Self Care Deficit Safety Wound Healing

Key Diagnoses: CVI and/or Venous ulcer Potential for Alteration in Skin Integrity Potential for Alteration in Tissue Integrity Impaired Skin Integrity Impaired Tissue Integrity Pain Self-care deficit Self-image

Key Practice Issues Registered Nurses assess wounds; Licensed Practice Nurses monitor wounds per state nurse practice acts Physicians diagnose wound etiology; some Advance Practice Nurses diagnose wound etiology per state nurse practice acts Correct etiology is key to selecting the correct clinical practice guideline to follow for an individualized wound care plan of care

Websites for Further Information on Venous Ulcers Association for the Advancement of Wound Care www.aawconline.net - National Pressure Ulcer Advisory Panel www.npuap.org - Wound Healing Society www.woundheal.org - Wound Ostomy Continence Nurses Society www.wocn.org - Wounds Canada www.woundscanada.ca

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