Peripheral Vascular System Anatomy

• The peripheral vascular system includes all blood vessels outside the heart and brain.
• It is crucial for maintaining blood flow to limbs and organs.
• Conditions affecting this system leads to limb ischemia and organ dysfunction.
• PAD is a common condition characterized by narrowed arteries reducing blood flow to the limbs.
• Venous disorders include DVT and varicose veins, which can lead to complications like pulmonary embolism.
• Lymphatic disorders can cause lymphedema, impacting fluid balance and tissue health.
• Major risk factors for peripheral vascular disorders include smoking, diabetes, hypertension, and hyperlipidemia.
• Lifestyle factors such as sedentary behavior and poor diet significantly contribute to the development of vascular diseases.
• Genetic predisposition and age are critical factors influencing vascular health.
• Comprehensive assessment of the peripheral vascular system includes history taking, physical examination, and diagnostic tests such as Doppler ultrasound and angiography.
• Key symptoms to assess include claudication, rest pain, and skin changes in the extremities.
• Monitoring vital signs and peripheral pulses is essential for evaluating blood flow and identifying complications.
• Nursing care involves educating patients about lifestyle modifications, including smoking cessation and dietary changes.
• Medications are administered as prescribed, such as antiplatelet agents and statins, to manage symptoms and prevent complications.
• Regular tailored exercise improves circulation and overall health.
• Recognize symptoms of vascular disorders and when to seek medical attention.
• Manage risk factors through diet, exercise, and medication adherence.
• Follow-up appointments are important for monitoring vascular health.

Understanding Peripheral Vascular Disease (PVD)

• PVD encompasses any abnormal condition affecting blood vessels outside the heart, including lymphatic vessels.
• Aging leads to degenerative changes in blood vessel walls, impacting blood and nutrient transport to tissues.
• The inner walls (tunica interna) thicken and become less compliant, while the middle walls (tunica media) lose elasticity.
• Decreased elasticity and flexibility contribute to increased peripheral vascular resistance, leading to higher blood pressure and susceptibility to PVD.
• Risk factors for PVD can be categorized into non-modifiable and modifiable factors, influencing patient care strategies.
• Non-modifiable risk factors include age, gender, and family history, all of which contribute to vascular resistance and blood flow issues.
• Modifiable risk factors include smoking, hypertension, hyperlipidemia, obesity, lack of exercise, emotional stress, and diabetes mellitus.
• Smoking causes vasoconstriction and arterial spasms, significantly increasing the risk of PVD.
• Hypertension leads to vessel wear and tear, resulting in fibrous tissue buildup and narrowed lumens.
• Hyperlipidemia contributes to plaque formation, necessitating dietary management and potential drug therapy.
• Increased physical activity and stress management can mitigate many modifiable risk factors.

Arterial Assessment Findings

• Pain from tissue ischemia is often the first symptom of arterial disease, typically occurring during activity due to insufficient blood supply.
• Intermittent claudication is characterized by cramp-like pains in the calves, thighs, or buttocks, which subside with rest.
• As arterial disease progresses, pain may occur at rest, accompanied by burning, tingling, or numbness, especially at night.
• Weak, thready, or absent pulses in the affected extremity indicate decreased blood flow, necessitating further assessment.
• Timely intervention and management of vascular disorders improves outcomes.
• Regular assessments and patient education on recognizing symptoms improves outcomes.

Definition and Symptoms of PVD

• Intermittent claudication is characterized by weakness and cramp-like pain in the calves due to poor arterial blood circulation to leg muscles.
• Pain may also radiate to the thighs or buttocks and typically subsides with rest as oxygen demand decreases.
• As arterial disease progresses, pain can occur at rest, accompanied by burning, tingling, and numbness, especially at night.
• Weak, thready, or absent pulses in the affected extremity indicate decreased blood flow; comparison with the other leg is essential.
• Capillary refill time exceeding 2 seconds in the affected leg suggests poor circulation.
• Arterial disorders often present with dry, shiny, hairless skin that is cool to the touch, while venous disorders may show signs of edema and skin changes.
• Edema is usually absent in arterial disease due to insufficient blood flow, whereas venous insufficiency leads to edema due to fluid retention.
• Skin changes in venous disorders may include darker pigmentation, dryness, and scaling, potentially leading to stasis ulcers.

Key Assessment Tools and Mnemonics

• The mnemonic "The Five P’s" helps assess arterial occlusion: Pain, Pallor, Pulselessness, Paresthesia, and Paralysis.
• The mnemonic "PATCHES" assists in uniform assessment of arterial and venous problems, focusing on Pulses, Appearance, Temperature, Capillary refill, Hardness, Edema, and Sensation.

Arterial Assessment Techniques

• Assess pulses in the affected extremity first, then compare with other major pulse points (e.g., carotid, brachial, femoral).
• Use Doppler ultrasound for pulse assessment when necessary, documenting findings for consistency.
• Evaluate the quality of pulses using a scale from 0 (absent) to +4 (bounding).

Venous Assessment Techniques

• Assess for color changes in the extremity, noting any signs of necrosis or ulceration.
• Measure temperature differences; coolness indicates arterial issues, while warmth may suggest venous problems.
• Evaluate capillary refill time, which should be less than 2 seconds in healthy individuals.

Edema Assessment

• Assess for pitting vs. non-pitting edema; pitting is often seen in acute conditions, while non-pitting is chronic.
• Use a grading scale for pitting edema from +1 (2 mm indentation) to +4 (8 mm indentation).
• Measure and compare the circumference of affected and unaffected extremities for accurate assessment.

Non-Invasive Diagnostic Procedures

• Treadmill Test: Evaluates blood flow in extremities post-exercise and identifies claudication pain.
• Plethysmography: Measures changes in blood volume in extremities to assess circulation.
• Doppler Ultrasound: Utilizes a flowmeter to measure blood flow in arteries and veins, aiding in the diagnosis of PVD.
• Non-invasive tests are crucial for determining the severity of PVD and guiding treatment options.
• Early detection through these tests can prevent complications such as ulcers and limb loss.
• Regular monitoring of PVD patients can help manage symptoms and improve quality of life.

Overview of Doppler Ultrasound

• Doppler ultrasound flowmeter is a non-invasive tool used to measure blood flow in arteries and veins.
• Doppler ultrasound flowmeter it provides critical information for diagnosing vascular conditions.
• It is useful in assessing intermittent claudication, deep vein obstruction, and other forms of PVD.
• The device is essential when conditions like pulmonary vascular disease, low blood pressure, or significant subcutaneous tissue hinder pulse assessment.
• Pulsation should be recorded as present or absent instead of using a numeric scale, enhancing accuracy in clinical settings.
• Nurses often mark the skin where pulses are detected to facilitate future assessments and improve efficiency.

Duplex Scanning and Its Applications

• Duplex scanning combines traditional ultrasound imaging with Doppler capabilities, allowing for the visualization of blood flow and the detection of thrombi in veins.
• It is the most widely used test for diagnosing DVT, providing both anatomical and functional information about blood vessels.
• The technique helps in determining the location and extent of thrombi, which is crucial for treatment planning.

Invasive Procedures for Vascular Assessment

• Phlebography (Venography): Considered the gold standard for assessing deep leg veins and diagnosing DVT.
• Phlebography involves injecting a contrast medium through a catheter to visualize filling defects in the veins.
• I-fibrinogen Uptake Test: Detects acute calf vein thrombosis by tagging fibrinogen with iodine-125, which is then tracked in the bloodstream using a gamma ray detector.
• Angiography: Involves injecting a contrast medium intravenously to visualize arteries through radiography, aiding in the diagnosis of vascular conditions.
• D-dimer Test: Measures the levels of D-dimer, a fibrin degradation product, in the serum.
• A thrombus is present if D-dimer levels exceed 1591 ng/mL.
• Digital Subtraction Angiography (DSA): Uses an intravenous contrast solution to visualize blood vessels in extremities, enhancing the clarity of vascular images.

Definition and Classification of Hypertension

• Normal blood pressure is defined as less than 120/80 mmHg.
• Systolic pressure represents the force during heart contraction.
• Diastolic pressure represents the force during relaxation.
• Hypertension is diagnosed when systolic pressure exceeds 140 mmHg or diastolic pressure exceeds 90 mmHg.
• Stages of Hypertension: Stage I (140-159/90-99 mmHg), Stage II (≥160/≥100 mmHg), and hypertensive crisis (≥180/≥110 mmHg).
• A hypertensive crisis requires emergency care.

Etiology and Pathophysiology of Hypertension

• Blood pressure is influenced by blood flow (volume pumped by the heart) and peripheral vascular resistance (affected by vessel diameter and blood viscosity).
• Increased peripheral vascular resistance often results from vasoconstriction, a common factor in hypertension development.
• The sympathetic nervous system and the Renin-Angiotensin-Aldosterone System (RAAS) play crucial roles in regulating blood pressure through vasoconstriction and fluid retention.
• Essential (Primary) Hypertension: Accounts for 90-95% of cases and is influenced by genetic, lifestyle, and environmental factors.
• Non-modifiable (age, gender, race, family history) and modifiable (smoking, obesity, high sodium intake, stress) factors contribute to hypertension risk.
• Untreated hypertension leads to organ damage due to decreased tissue perfusion, particularly affecting the heart, kidneys, and brain.

Secondary Hypertension

• Secondary hypertension is due to an identifiable medical diagnosis, often reversible with treatment of the underlying condition.
• Common conditions associated with secondary hypertension include:Renal Vascular Disease: Affects renin and sodium levels, leading to increased vascular volume and blood pressure.
• Adrenal Cortex Diseases can lead to increases in blood volume.
• Primary Aldosteronism causes sodium and water retention.
• Cushing’s Syndrome results in increased blood volume due to excess cortisol.
• Pheochromocytoma: A tumor that secretes catecholamines, raising peripheral vascular resistance.
• Coarctation of the Aorta causes high blood pressure in the upper body and low in the lower body due to a narrowing of the aorta.
• Head Trauma or Cranial Tumor increases intracranial pressure, stimulating the medulla oblongata, raising blood pressure.
• Pregnancy-Induced Hypertension: The cause is often unknown, but vasospasm is a contributing factor.

Malignant Hypertension

• Malignant Hypertension involves severe and rapidly progressing elevation in blood pressure, typically with diastolic readings over 120 mm Hg.
• Malignant hypertension causes damage to small arterioles in vital organs such as the heart, kidneys, brain, and eyes.
• A primary distinguishing feature is the inflammation of arterioles in the eyes, which can be observed during examination.
• Malignant Hypertension is more prevalent in African American men under 40 years of age.
• The prognosis is poor without medical intervention, with rapid fatality.

Clinical Manifestations

• Hypertension is often asymptomatic until significant vascular changes occur in target organs.
• Awakening with a headache indicates increased intracranial pressure.
• Blurred vision may suggest retinal damage.
• Spontaneous epistaxis (nosebleeds) are a sign of elevated blood pressure.
• Persistent untreated hypertension can lead to target organ damage.

Assessment Techniques

• Subjective Data: Includes patient history of hypertension and symptoms such as morning headaches, risk factors, and understanding of the disease process.
• Objective Data:
• Blood pressure measurement using the correct cuff size in both arms, in supine and sitting positions; two or more elevated readings confirm hypertension.
• Measurement of height and weight to assess obesity-related risks.
• Assessment of heart sounds and palpation of peripheral pulses to evaluate cardiovascular health.

Diagnostic Tests

• Assess baseline is important for the brain, heart, and kidneys.
• Complete Blood Count (CBC) checks for anemia or infection.
• Electrolytes: Sodium, potassium, calcium, and magnesium levels assess metabolic function.
• Lipid Profile evaluates cardiovascular risk.
• Fasting Blood Glucose checks for diabetes mellitus.
• Creatinine, BUN, and Urinalysis assess renal function.
• Imaging tests such as chest radiographs and EKGs evaluate heart and lung health.

Medical Management

• The primary goal of medical management is to control hypertension and prevent complications, aiming for blood pressure < 140/90 mm Hg.
• Treatment strategies depend on:Severity of hypertension, presence of associated risk factors, and evidence of damage to major organs.
• Management may include both non-pharmacologic and pharmacologic approaches to lower blood pressure.

Non-Pharmacological Therapy

• Weight Loss reduces blood pressure and improves overall health; involves calorie restriction and increased physical activity.
• Regular Exercise enhances cardiovascular health with 30-45 minutes of aerobic exercise 3-4 times a week.
• Dietary Changes:Reducing saturated fats and adopting a diet rich in fruits and vegetables is beneficial.
• Sodium intake should be limited to 2.4 grams per day, especially for high-risk populations such as African Americans and the elderly.
• Smoking Cessation improves medication efficacy and overall health.

Pharmacologic Therapy

• Pharmacologic treatments are often used alongside lifestyle changes to effectively manage hypertension.
• Diuretics (thiazides and loop diuretics) help reduce blood volume.
• Beta-Blockers (metoprolol and propranolol) lower heart rate and blood pressure.
• ACE Inhibitors (lisinopril) help relax blood vessels.
• Calcium Channel Blockers (amlodipine and diltiazem) prevent calcium from entering heart and blood vessel cells, lowering blood pressure.
• Diabetes Mellitus: ACE inhibitors are preferred to protect renal function.
• Heart Failure: Combination of ACE inhibitors and diuretics is often effective.

Overview of Hypertension

• Hypertension can lead to serious health complications if left untreated.
• Primary hypertension is often idiopathic.
• Secondary hypertension results due to identifiable causes such as kidney disease or hormonal disorders.
• African Americans show a higher incidence and severity of hypertension.

Pharmacological Treatment of Hypertension

• Antihypertensives are the primary class of medications used to manage hypertension.
• ACE Inhibitors block the conversion of angiotensin I to angiotensin II, reducing blood pressure.
• CCBs relax blood vessels and decrease heart rate, effective in African American populations when combined with diuretics.
• Diuretics help eliminate excess fluid and sodium, reducing blood volume and pressure.

Blood Pressure Dynamics

• SBP represents the pressure in the arteries during heartbeats, indicating the force exerted by the heart's contraction.
• DBP represents the pressure in the arteries when the heart is at rest between beats, reflecting the heart's relaxation phase.

Factors Influencing Blood Pressure

• Peripheral vascular resistance is influenced by:Diameter of Blood Vessels: Narrower vessels increase resistance, raising blood pressure.Blood Viscosity: Thicker blood increases resistance, also contributing to higher blood pressure.
• The body regulates blood pressure through mechanisms such as the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS).
• Hypertension is defined as a systolic pressure greater than 130 mm Hg or a diastolic pressure greater than 80 mm Hg.
• Long-term hypertension can lead to serious complications, including damage to the heart, kidneys, and blood vessels.
• Secondary hypertension can arise from other diseases affecting blood supply, such as renal artery stenosis.

Lifestyle Modifications

• Regular exercise, maintaining a healthy weight, reducing sodium intake, and managing stress is crucial for patients with mild hypertension.
• Smoking cessation is also crucial as nicotine constricts blood vessels and raises blood pressure.
• Regular monitoring of blood pressure is essential, with the target for older adults being below 130/80 mm Hg.

Pharmacological Treatment

• Common drug classifications for hypertension include diuretics (e.g., hydrochlorothiazide), ACE inhibitors (e.g., lisinopril), and beta-blockers (e.g., metoprolol).
• Each classification has specific mechanisms of action and side effects that should be discussed with patients.

Arteriosclerosis and Atherosclerosis

• Arteriosclerosis - thickening and hardening of arterial walls, leading to decreased elasticity and blood supply.
• Atherosclerosis - plaque buildup in arteries, which can lead to narrowing and reduced blood flow, increasing the risk of ischemia and infarction.
• Both conditions can progress to serious complications such as thrombosis, aneurysm, and tissue necrosis.

Clinical Manifestations of Arterial Disorders

• The 'Five P's' of arterial occlusion include:Pain: Often occurs with activity (intermittent claudication) and may persist at rest in severe cases.Pulselessness: Weak or absent pulses in affected extremities.Pallor: Pale appearance of the skin due to reduced blood flow.Paresthesia: Numbness or tingling sensations in the affected area.Paralysis: Loss of movement in the affected limb due to severe ischemia.
• Assessment includes subjective data (pain characteristics) and objective data (pulse strength, skin condition).

Assessment and Management of Arterial Disorders

• Diagnostic tests may include treadmill tests, Doppler ultrasound, and angiography to evaluate blood flow.
• Management strategies focus on preventing complete occlusion, including lifestyle modifications (e.g., smoking cessation), medications (e.g., anticoagulants), and surgical interventions (e.g., bypass surgery).
• Nursing Interventions: Encourage balanced exercise and rest to improve circulation, positioning the patient to enhance blood flow (e.g., legs dependent), and educating the patient on avoiding vasoconstriction and recognizing symptoms of ischemia.

Assessment of Shock

• Subjective Data: Focus on the onset, location, quality, and duration of pain and numbness experienced by the patient.
• Objective Data: Assess pulses in the affected extremity and compare with the unaffected side. Evaluate skin temperature and color, as well as pulse volume.
• Diagnostic Tests: Doppler ultrasonography and angiography are essential for diagnosing arterial occlusions, providing visual confirmation of blood flow and blockages.

Medical Management of Shock

• Medications: Anticoagulants are used to prevent further clot formation, while fibrinolytics (thrombolytics) are employed to dissolve existing clots.
• Surgical Interventions: Endarterectomy involves the surgical removal of the intimal lining of an artery, while embolectomy is performed to remove larger clots.
• Surgical interventions occur within 6-10 hours of symptom onset to prevent irreversible damage to the affected limb.
• Monitoring Symptoms: Increased pallor, cyanosis, and coolness of the skin are indicators of worsening arterial circulation.

Postoperative Care

• Regularly assess skin color, temperature, sensation, movement, and peripheral pulses.
• Teach patients about anticoagulation therapy, including potential side effects, dietary restrictions, and the importance of avoiding alcohol.
• An aneurysm is an enlarged, dilated portion of an artery, typically more than 1.5 times its normal circumference.
• An aneurysm often resulting from arteriosclerosis, trauma, or congenital defects.

Etiology and Pathophysiology

• Aneurysms frequently occur in the popliteal artery, thoracic and abdominal aorta, and coronary and cerebral arteries.
• Aortic aneurysms are most prevalent in men aged 60-70, especially smokers, with hypertension and atherosclerosis as significant contributing factors.
• Large pulsating mass may be the only visible sign.
• Thoracic aortic aneurysms symptoms can include chest pain, shortness of breath, and dysphagia
• Abdominal aortic aneurysms can be palpitated as a non-tender, pulsating mass.

Assessment Techniques

• Imaging techniques such as fluoroscopy, chest X-ray, CT scan, ultrasound, and arteriography are essential for diagnosis and monitoring.
• Regular monitoring for complications such as dissection, rupture, and thrombi is critical, with a focus on controlling hypertension as a priority.
• Surgical intervention (ligation/grafting) is recommended for aneurysms larger than 5 cm.
• Recognizing signs of rupture, including paleness, weakness, tachycardia, and abdominal pain is important in patients.
• Managing risk factors like hypertension is important.

Buerger’s Disease

• Buerger’s disease, or thromboangiitis obliterans, involves inflammation and thrombosis of small and medium-sized arteries, primarily affecting male smokers aged 25-40.
• Lead to occlusion of small arteries in the hands and feet, resulting in ischemia, pain, and potential ulceration in later stages.
• Instep claudication is the most common symptom, characterized by pain in the arch of the foot during exercise.
• Affected extremities may appear cold and pale, with possible ulcers and gangrene.
• Management Goals: Focus on preventing disease progression through risk factor modification and smoking cessation.
• Buerger-Allen exercises may be recommended to enhance collateral circulation. Proper care of ulcerations is essential to prevent infection and promote healing, with amputation considered in severe cases.
• Emphasize the importance of hydration, hygiene, and wearing well-fitting shoes to prevent pressure sores and promote tissue perfusion.
• There is a strong correlation between Buerger’s disease and tobacco use.

Raynaud’s Disease

• Raynaud’s disease is characterized by intermittent arterial spasms that lead to ischemia.
• Raynaud’s disease primarily affects the fingers, toes, ears, and nose, often triggered by cold exposure or emotional stress.
• The spasms cause temporary reductions in blood flow, leading to symptoms such as color changes in the skin, pain, and numbness.
• Patients may experience color changes in the extremities (white, blue, red), pain, and numbness during episodes, which can be exacerbated by cold or stress.
• Management Strategies include lifestyle modifications, including avoiding cold exposure and managing stress, as well as pharmacological interventions if necessary.
• Teach patients about the importance of keeping warm, recognizing triggers, and managing symptoms effectively.
• Patients typically report chronic coldness in hands and feet, which can be exacerbated by environmental factors or stress.

Symptoms During Arterial Spasms

• Symptoms during arterial spasms include pallor, coldness, numbness, cyanosis, and pain.
• Chronic cases may lead to severe complications such as ulcerations on fingers and toes.
• First-line treatment includes calcium channel blockers to alleviate arterial spasms and improve blood flow.
• Non-pharmacological strategies such as biofeedback, stress management, and avoiding temperature extremes are crucial for patient education.
• Surgical options may be considered in severe cases, including sympathectomy or amputation for gangrenous tissue.

Peripheral Venous Disease

• Focus on enhancing blood flow and venous return, especially in patients with venous insufficiency, both pre- and post-operatively.
• Encourage mobility in bedrest patients through exercises like ankle rotations and foot flexing to prevent stasis and promote circulation.
• Use of compression stockings or SCDs is essential for patients at risk of thrombus formation.
• Educate patients on the importance of avoiding prolonged sitting or standing and maintaining a healthy weight to reduce pressure on veins.
• Teach techniques for leg elevation and exercises that promote venous return, especially during periods of inactivity.

Assessment and Diagnostic Tests

• Subjective data collection focuses on pain characteristics and history of venous disorders.
• Objective data includes skin temperature, color, and limb circumference measurements.
• Diagnostic tests such as venous Doppler, duplex scanning, and venograms are critical for confirming the presence of thrombosis.
• Thrombophlebitis is more common in women and increases with age, often associated with venous stasis, hypercoagulability, and trauma.
• Clinical signs include pain, edema, and increased limb circumference, with superficial cases presenting erythema and tenderness along the vein.

Deep Vein Thrombosis (DVT)

• Elevated serum D-dimer levels are indicative of thrombotic activity in the body, particularly in DVT patients, as it reflects the presence of fibrin degradation products.
• Superficial Thrombophlebitis: Typically managed with immobilization, warm compresses, elevation, and NSAIDs to reduce inflammation and pain.
• Deep Vein Thrombophlebitis: Requires more intensive management including bed rest, anticoagulants (IV heparin, oral Coumadin), and possibly fibrinolytics for severe cases.
• LMWH is administered subcutaneously for prevention in at-risk patients, reducing the risk of thrombus formation.
• Surgical interventions are Indicated when conservative measures fail.
• Indicated surgical measures include thrombectomy or placement of a Greenfield filter to prevent pulmonary embolism.
• Early mobilization is crucial; patients should ambulate at least three times a day to reduce DVT risk.
• Compression stockings or SCDs enhance venous return and prevent stasis.
• Varicose veins are tortuous, dilated veins with incompetent valves, most commonly affecting women aged 40-60 years.

Etiology and Pathophysiology

• Varicose veins arise from weakened vessel walls leading to valve incompetence, resulting in blood pooling and venous stasis in the saphenous veins of the legs.
• Contributing factors include congenital valve defects, pregnancy, prolonged standing, and constrictive clothing.
• Symptoms may include fatigue, dull aches, muscle cramps, and a feeling of heaviness in the legs, with visible darkened veins.
• In severe cases, edema, skin color changes, and ulcerations may develop due to chronic venous insufficiency.
• Assess for varicosities, edema, skin temperature, and any ulcerations present.
• To assess venous filling time and valve competency apply a tourniquet and the patient stands to observe filling patterns in the Trendelenburg’s Test.
• Venous stasis ulcers result from chronic deep vein insufficiency and blood stasis, leading to necrotic lesions due to inadequate oxygen and nutrient supply.
• Venous stasis ulcers are contributed to by severe varicose veins, diabetes, and hereditary factors.
• Assess the onset, duration, and relief measures for pain, along with any predisposing factors.

Clinical Manifestations of Venous Stasis Ulcers

• Patients with venous stasis ulcers may experience varying degrees of pain, often relieved by elevating the affected extremity.
• Ulcers typically appear on the medial aspect of the ankle, with dark pigmentation and leathery skin.
• Focus on improving circulation, preventing infection, and promoting healing through elevation, compression, and appropriate wound care.

Assessment

• Patients should be interviewed about predisposing factors such as thrombophlebitis, venous insufficiency, and diabetes mellitus.
• Common complaints include pain ranging from mild discomfort to dull, aching pain, often relieved by elevating the extremity.
• Assess ulcers for size, location, skin condition, color, and temperature.
• Venography: Involves administering a contrast medium through a catheter in the foot vein, followed by X-rays to detect filling defects.
• Doppler Ultrasonography: Measures blood flow in arteries and veins, providing non-invasive assessment of venous function.
• Promote protein intake due to albumin loss.
• Administer vitamins A, C, and zinc for healing support.
• Debridement: Removal of necrotic tissue can be done mechanically or with enzyme ointments
• Surgical removal may be necessary if other methods fail.
• Implement Unna’s boot therapy for protection and compression of the ulcerated area.
• Regular assessment for signs of infection is important.

Nursing Priorities

• Promote tissue healing and comfort while maintaining peripheral tissue perfusion.
• Prevent infections through diligent monitoring and patient education on signs of infection.
• Collaborate with dietitians to ensure adequate nutritional intake, emphasizing protein.
• Educate patients on the importance of dietary choices, emphasizing high protein and vitamin intake for healing.
• Discuss the significance of elevating the legs to reduce swelling and improve venous return.
• Provide information on the use of compression therapy and the role of Unna’s boot in treatment.