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April 2003, Volume 33 Number 4 , p 73 - 74





  • Assessment tips

  • Diagnostic tests

  • Patient-care goals

  • Conditions that can mimic venous ulcers

  • Graphics

  • Figure. No caption a...

  • VENOUS ULCERS account for 70% to 90% of chronic leg ulcers, and the incidence of these ulcers increases with age. Difficult to heal and often recurring, they can be challenging to health care providers and painful and debilitating for patients.

    Venous ulcers are caused by valve incompetence in perforating veins. Over time, the high pressures and backflow of blood into the venous system can cause fluid and protein to leak into the tissues, resulting in edema and ulceration. Most patients have a history of deep vein thrombosis (DVT), and they may also have a history of ulceration.

    The ulcer, which typically develops on the lower leg or ankle, is shallow, irregular, ruddy, and granulating. The wound borders are well defined, and the surrounding skin may be edematous or indurated and hyperpigmented (see photograph). Although yellow-white exudate and varicose veins are common, the patient may not have pain unless superficial nerves are exposed.

    Assessment tips

    Your assessment should focus on risk factors such as previous venous disease (or family history of venous disease, especially thromboembolic events, varicose veins, and past vein treatments), trauma, DVT, pregnancies, heart failure, obesity, and advanced age. Women are more likely to develop venous ulcers than men.

    Assess and document when the patient noticed the ulcer, how long it's been present, how it's been treated to date, associated symptoms, and any history of similar lesions. Also assess the patient's nutritional status.

    Ask about other chronic diseases (especially arterial disease or diabetes), infections, and medication use. Check for substance abuse, tobacco and alcohol use, and allergies. ...

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