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Ulcers: commonly a sign of underlying disease, trauma or allergic response…
Ulcers: commonly a sign of underlying disease, trauma or allergic response
Venous Ulcers: involved veins
Occur due to abnormal vein function (can be inherited)
Commonly caused by : blood clots, injury, ageing process, obesity.
Venous ulcers commonly develop after minor injury to legs which fail to heal due to poor or insufficient blood circulation
Increased risk for morbidly obese, overweight, varicose veins or deep vein thrombosis, limited mobility, previous venous leg ulcers, over 60 years of age.
Commonly people with a venous ulcer will experience will have swelling, moderatepain, clear exudate or aching in legs.
Signs of an infected venous leg ulcer include: increased pain, green or odorous exudate, increased temperature, increased redness and swelling at ulcer site.
poor circulation in leg veins causes venous ulcers. The valves in legs are responsible for pushing blood back to the heart. If damaged the blood pools within leg veins resulting in pressure and changes to skin.
Appearance of ulcer: Uneven edges, ruddy granulation tissue, no necrotic tissue
changes in feet and legs: Normal pedal and leg pulses, firm oedema, red or brown pigment, previously healed ulcer, warm limb.
Arterial Ulcers: involving arteries
Arterial ulcers develop due to damage in arteries as a result of decreased blood flow to tissue.
Common sites are outside of ankle, feet, heels and toes.
Described as exceedingly painful with a raised appearance.
Characteristics include red yellow or black ulcers, deep wounds in tight and hairless skin, leg pain, absence of bleeding, decreased circulation to area makes this cool to touch, affected leg is red at rest and pale when elevated.
Also referred to as ischemic ulcers.
Age, diabetes, smoking, high blood pressure, high cholesterol, kidney failure, trauma, atherosclerosis and vasculitis all increase risk factor
Ulcer appearance: decramented edges, black or necrotic tissue, deep with a pale base.
Venous treatment
Specialist wound care
Compression therapy: this compression bandaging forces pressure onto affected leg reducing blood pooling and assisting blood to flow back to the heart. Additionally helps to reduce swelling and encourages oxygen and nutrients to the would site which encourages healing.
Lifestyle changes, nutrition, exercise and healthy weight management.
District nurses are specialist trained to manage leg ulcers.
If the wound fails to heal, referral to ulcer clinic or vascular specialist should be completed.
Measurement and confidential photos assist to monitor wound healing
Arterial treatment
Key goals are to reduce pain with analgesia, heal wound and enhance recovery process
Underlying cause treated with antibiotics and reduce symptoms.
Surgery may be indicated to restore blood flow i.e. angioplasty.
District nurse wound mnagment goals are - keep wound clean, dry and bandaged to decrease risk of infection.
Lifestyle changes, nutrition, exercise and healthy weight management.
Bandaging of arterial and mixed ulcer: Tubi-grip in day to be removed at night or white crepe bandages
Mixed ulcer: This involves both arteries and veins.
Neuropathic: ulcer due to loss of protective sensation
References: Health Navigator New Zealand. (2019).
Venous leg ulcers
.
https://www.healthnavigator.org.nz/health-a-z/v/venous-leg-ulcers/
Carville, K. (2011).
Wound Care manual
(4th ed.). Silver Chain Foundation.
Leg ulcers in the population over 55 years are common. Vast range of causes and therefore variable management is required. Ulcers cause considerable distress, decreased quality of life and expense to those affected. District nursing identifying appropriate management early on increases incidence of wound healing.