Chronic leg ulcers are a common and costly ongoing problem facing patients and the healthcare system (Moffat 2010). The total cost of hospital admissions, out patient therapy, treatment in the community and loss of work due to venous leg ulcers has been estimated close to £2 leg ulcers have an estimated prevalence of between 0.1% and 0.3% (SIGN 2010). Of all leg ulcers that develop 70% are the result of venous disease (Newton 2010). The prevalence of leg ulcers also increase with age with women being more commonly affected (Cullum et al 1997). The significant impact on patients’ lives combined with the high cost of long term treatment make venous leg ulcers a major health concern (Weller et al 2010). Accurate assessment of the patient is essential for successful management of leg ulcers in the community. Nurses must have comprehensive understanding of the pathophysiology of venous leg ulcers and incorporate evidence based knowledge into their practice in order to deliver specialised interventions as well as preventative care (Harrison et al 2005). In doing so improvements can be made to ulcer healing time and patient quality of life.
Venous leg ulcers are a common recurring problem defined as areas of skin loss on the leg or foot which take more than 6 weeks to heal as well as being a major cause of suffering and morbidity for those affected (Mekkes 2003). Chronic venous insufficiency is a functional disorder of the venous system affecting the lower limb. Venous hypertension occurs in the limb when the venous valves are damaged or when the calf muscle, which usually works as a pump that forces blood back to the heart, is inactivated. The microcirculation is altered by the increasing pressure in veins and insufficient valve function which cause expansion of the blood vessels (Sandor 2004). Blood cells then leak into the tissue resulting in oedema where the slightest trauma to these damaged areas can result in a chronic non healing ulceration (Dowsett 2006).
The majority of venous leg ulcers are treated in the community by district nurses (Harrison 2005). It is essential that nurses can assess patients accurately and manage treatment effectively in order to achieve desired outcomes and improved patient wellbeing (Newton 2001). The case study of leg ulcer patient Joan Campbell is going to be looked at in depth to consider and discuss the type of nursing assessment and intervention that is required for effective treatment. Mrs. Campbell, a retired school teacher of 70 visited her G.P. a few days ago concerning a wound on her left calf resulting from a fall at home that has failed to heal after 7 months. The wound is situated just above the ankle and has irregular edges with some brown staining to the surrounding skin. Mrs. Campbell’s ankle is swollen and the wound is producing a considerable amount of exudate. She has been dressing the wound herself. Mrs. Campbell admits a lack of exercise in her lifestyle and also reports a long history of ankle swelling and varicose vein surgery on the affected leg 20 years ago. Mrs. Campbell has become embarrassed about the wound and now avoids socialising. The district nurse is now meeting with Mrs. Campbell at home to assess and discuss the appropriate treatment of her wound.
Due to an ageing population venous leg ulcer management makes up a significant proportion of community nursing. In fact around 80% of all venous leg ulcers are treated in the community (Kirby 2005). Venous disease has a considerable impact on patients’ quality of life if it is not correctly assessed and appropriately managed (Newton 2010). Assessing the limb at an early stage for skin breakdown is essential in preventing the condition from becoming chronic (NHS Tayside 2010). Patients presenting with either their first or recurring ulcers must discuss their full medical history with a healthcare professional and be subject to a physical examination. Swabs of exudate can be obtained if infection...
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