Chronic Venous Insufficiency & Venous Ulcers

Chronic venous insufficiency is a condition in which damaged leg-vein valves let blood flow backward and pool, raising venous pressure, and a past deep vein thrombosis is its most important risk factor. The client has leg swelling that worsens with standing and by the end of the day and improves with elevation, with dull aching or heaviness. Over time the skin develops brown hemosiderin staining, thick leathery texture, weepy stasis dermatitis and varicose veins, yet the leg stays warm and the pedal pulses are present. Venous ulcers form above the inner ankle and are shallow, with irregular edges, a red granular base, moderate-to-heavy drainage and only mild pain. Arterial ulcers are the opposite: deep, punched-out and very painful, on the toes and heels, with weak or absent pulses. Compression stockings or wraps are the mainstay of treatment, but only after arterial disease has been ruled out with pulses and an ankle-brachial index. Teach the client to elevate the legs above the heart, put stockings on before getting out of bed, walk daily, avoid crossing the legs and report signs of ulcer infection.