1. 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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Conflict of Interest: Dr. Barbara Pieper declares that she has no potential conflict of interest related to the content of this presentation.

3. 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

5. 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

8. 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

12. 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

13. Safety: Balance, Gait & Falls
Chronic Venous Insufficiency + Trauma = Venous Ulcer

14. 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

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

18. 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

19. 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

20. Websites for Further Information on Venous Ulcers
Association for the Advancement of Wound Care
- National Pressure Ulcer Advisory Panel
- Wound Healing Society
- Wound Ostomy Continence Nurses Society
- Wounds Canada