Ulcers are open skin sores. They can affect any area of the skin. But they most often occur on the legs. Venous ulcers are leg ulcers caused by problems with blood flow (circulation) in your leg veins. Normally, when you get a
cut or scrape, your body's healing process starts working to close the wound. In time, the wound heals. But ulcers may not heal without proper treatment. Venous ulcers most often form around the ankles. Venous ulcers typically occur because of damage to the valves inside the leg veins. These valves control the blood pressure inside the veins. They allow it to drop when you walk. If the blood pressure inside your leg veins doesn't fall as you're
walking, the condition is called sustained venous hypertension. That increase in blood pressure causes ulcers to form on your ankles. Venous ulcers may also be caused by other problems with your leg veins. These include:
Caring for venous ulcersVenous ulcers need proper care and treatment to prevent infection and to heal. It's important to have any venous ulcers checked right away by your healthcare provider. Treatment may require focusing on the circulatory or vein problems that are causing the ulcers. Or it may mean removing some tissue around the wound. You may be asked to:
Wearing a compression wrap to keep blood flowing back up to your heart can also help ulcers heal more quickly. In some cases, surgery or a skin graft is needed to close up the opening in the skin. Preventing venous ulcersTo prevent venous ulcers, you first need to prevent vein problems. You can do this by having healthy habits that help the blood flow in your legs. These lifestyle changes can improve your circulation and reduce the risk for venous ulcers:
Wearing compression stockings can also help. They can:
Chronic venous insufficiency is impaired venous return, sometimes causing lower extremity discomfort, edema, and skin changes. Postphlebitic (postthrombotic) syndrome is symptomatic chronic venous insufficiency after deep venous thrombosis (DVT). Causes of chronic venous insufficiency are disorders that result in venous hypertension, usually through venous damage or incompetence of venous valves, as occurs (for example) after DVT. Diagnosis is by history, physical examination, and duplex ultrasonography. Treatment is compression, wound care, and, rarely, surgery. Prevention requires adequate treatment of DVT and compression stockings. Venous return from the lower extremities relies on contraction of calf muscles to push blood from intramuscular (soleal) sinusoids and gastrocnemius veins into and through deep veins. Venous valves direct blood proximally to
the heart. Chronic venous insufficiency occurs when venous obstruction (eg, in DVT
Deep Venous Thrombosis (DVT) Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. DVT is the primary cause of pulmonary embolism. DVT results from conditions... read more
The most common risk factor for chronic venous insufficiency is
Other risk factors include
Idiopathic cases are often attributed to a history of occult DVT. Postphlebitic syndrome is symptomatic chronic venous insufficiency that follows DVT. Risk factors for postphlebitic syndrome in patients with DVT include proximal thrombosis, recurrent ipsilateral DVT, and body mass index (BMI) ≥ 22 kg/m2. Age, female sex, and estrogen therapy are also associated with the syndrome but are probably nonspecific. Use of compression stockings after DVT decreases risk. Symptoms and Signs of Chronic Venous InsufficiencyClinically evident chronic venous insufficiency may not cause any symptoms but always causes signs; postphlebitic syndrome always causes symptoms. Both disorders are a concern because their symptoms can mimic those of acute DVT and both can lead to substantial reductions in physical activity and quality of life. Symptoms
include a sense of fullness, heaviness, aching, cramps, pain, tiredness, and paresthesias in the legs; these symptoms worsen with standing or walking and are relieved by rest and elevation. Pruritus may accompany skin changes. Signs occur along a continuum: no changes to
varicose veins
Varicose Veins Varicose veins are dilated superficial veins in the lower extremities. Usually, no cause is obvious. Varicose veins are typically asymptomatic but may cause a sense of fullness, pressure, and... read more  Venous stasis dermatitis consists of reddish brown hyperpigmentation, induration, venous ectasia, lipodermatosclerosis (fibrosing subcutaneous panniculitis), and venous stasis ulcers. In general, unless the lower extremities are adequately cared for, patients with any manifestation of chronic venous insufficiency or postphlebitic syndrome are at risk of progression to more advanced forms.
Diagnosis is usually based on history and physical examination. A clinical scoring system that ranks 5 symptoms (pain, cramps, heaviness, pruritus, paresthesia) and 6 signs (edema, hyperpigmentation, induration, venous ectasia, blanching hyperemia, pain with calf compression) on a scale of 0 (absent or minimal) to 3 (severe) is increasingly recognized as a standard diagnostic tool of disease severity. Scores of 5 to 14 on 2 visits separated by ≥ 6 months indicate mild-to-moderate disease, and scores of ≥ 15 indicate severe disease.
Some experts also believe that weight loss, regular exercise, and reduction of dietary sodium may benefit patients with bilateral chronic venous insufficiency. However, all interventions may be difficult to implement. Elevating the leg above the level of the right atrium decreases venous hypertension and edema, is appropriate for all patients, and should be done a minimum of 3 times/day for ≥ 30 minutes. However, most patients cannot adhere to this schedule during the day. Compression is effective for treatment and prevention of the effects of chronic venous insufficiency and postphlebitic syndrome and is indicated for all patients. Elastic bandages are used initially until edema and ulcers resolve and leg size stabilizes; commercial compression stockings are then used. Stockings that provide 20 to 30 mm Hg of distal circumferential pressure are indicated for smaller varicose veins and mild chronic venous insufficiency; 30 to 40 mm Hg is indicated for larger varicose veins and moderate disease; and 40 to > 60 mm Hg is indicated for severe disease. Stockings should be put on when patients awaken, before leg edema worsens with activity, and should exert maximal pressure at the ankles and gradually less pressure proximally. Adherence to this treatment varies; many younger or more active patients consider stockings irritating, restricting, or cosmetically undesirable; elderly patients may have difficulty putting them on. Intermittent pneumatic compression (IPC) uses a pump to cyclically inflate and deflate hollow plastic leggings. IPC provides external compression, squeezing blood and fluid out of the lower legs. It effectively treats severe postphlebitic syndrome and venous stasis ulcers but may be no more effective than compression stockings alone and is much less practical for patients to adhere to on an ongoing basis. Drugs have no role in routine treatment of chronic venous insufficiency, although many patients are given aspirin, topical corticosteroids, diuretics for edema, or antibiotics. Surgery (eg, venous ligation, stripping, valve reconstruction) is also typically ineffective. Grafting autologous skin or skin created from epidermal keratinocytes or dermal fibroblasts may be an option for patients with stasis ulcers when all other measures are ineffective, but the graft will reulcerate unless underlying venous hypertension is managed. Primary prevention of chronic venous insufficiency involves adequate anticoagulation after DVT and use of compression stockings for up to 2 years after DVT or lower extremity venous trauma. However, a recent study using sham-compression stockings failed to show any decrease in postphlebitic syndrome. Lifestyle changes (eg, weight loss, regular exercise, reduction of dietary sodium) can decrease risk by decreasing lower extremity venous pressure.
What can be done for chronic venous insufficiency?Treatment may include:. Improving blood flow in your leg veins. Keeping your legs raised (elevated) can reduce swelling and help increase blood flow. ... . Medicines. ... . Endovenous laser ablation or radiofrequency ablation (RFA). ... . Sclerotherapy. ... . Surgery.. Which nursing intervention is correct for a client with venous insufficiency quizlet?Which nursing intervention is correct for a client with venous insufficiency? Elevate the client's legs above heart level. After reviewing a client's reports, the primary health care provider suggests palliative care for the client.
What is the primary goal of treatment for chronic venous insufficiency?Treatment / Management
Patients with chronic venous insufficiency should be treated based on the severity and nature of the disease. The treatment goals include reducing discomfort and edema, stabilizing skin appearance, removing painful varicose veins and healing ulcers.
What is the most common cause of chronic venous insufficiency?Deep vein thrombosis (DVT) is the most common cause of chronic venous insufficiency. The blood clot damages the valve in your leg vein. People with a history of DVT face a higher risk of developing CVI.
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Which intervention would the nurse include in the care of a patient who has chronic venous insufficiency?
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