Chronic Venous Insufficiency: Management and Care (Nursing)

00:00 Now we talked about cues that you're looking for, and things that you could recognize.

00:04 Now we're gonna think about how you put these all together and figure out what's most important to follow up on.

00:11 Now, for clients with chronic venous insufficiency skincare is incredibly important.

00:16 Hey, I just want to do a little shout out here for the basics of nursing care whether you're in a highly technological complex critical care unit, or the patient is at home skincare matters.

00:27 This can lead to such incredible complications, that it's really important that you teach the client how important it is to clean their skin and to use emollients because we want to do everything we can to maintain that skin as an intact barrier.

00:43 So you don't want it dry or cracking or having fissures.

00:46 So skincare while not the sexiest the fancy technology is critically important.

00:53 Because a patient that develops an ulcer that becomes infected can end up with the worst of complications.

00:59 Now speaking a sexy, look at these stockings here.

01:03 These are compression therapy, hosiery.

01:07 These are a lot of fun to teach your patients to put on but what they do is they end up compressing those vessels.

01:13 That kind of add some extra pressure to hopefully get that blood going in the correct direction.

01:18 Now, this is primary initial management.

01:21 And for those of you that are going into nursing does not matter whether you are male or female, as much as you are on your feet, you put yourself at an increased risk for developing varicose veins.

01:33 So compression hose when you're on your feet a lot.

01:36 And an overnight flights or very long flights, they're critically important to help with that blood flow.

01:42 Now, if the patient should develop an ulcer, make it to the point where you have to debride it.

01:48 And when you debride it, that means you're removing the surrounding tissue that's dead or necrotic.

01:53 So that's what's going to help promote healthy tissue and granulation tissue so the patient can heal.

01:58 But this can be a very long process, particularly if the patient has chronic venous insufficiency and part of healing is good blood flow.

02:07 Then on top of that, if they have diabetes or some other comorbidity, this can take an extremely long period of time.

02:14 If the patient does develop an ulcer, we might use some topical agents like you see listed there.

02:19 But they're not that effective in improving the healing rates.

02:23 Usually what we're going to do is go for some type of IV.

02:26 But how we do use these, we use them to help reduce the likelihood of the bacteria just going crazy within the wound.

02:34 So that helps kind of level the playing field and make an environment that's more conducive to healing.

02:40 If we have to use antibiotics, we'll use systemic antibiotics.

02:44 Now these are only for patients with acute cellulitis or a clinically infected ulcer. So keeping an eye on that, watching it every day, you're going to need to use your best wound assessment skills to note if it's resolving or becoming worse.

03:02 If the patient develops an ulcer, here's some things we do for care.

03:05 Now there's some really cool dressings that are available and it's changing all the time.

03:10 So it's likely that you'll consult with a wound care team or a specific health care provider to know exactly what types of dressings you should use.

03:19 If it gets really severe, skin grafts are also an option.

03:24 Compression stockings and all sorts can be a little trickier.

03:28 Okay, so things that you're going to want to keep in mind its going to be further assessment might involve a cardiologist or another specialist, but a couple of things are going to happen.

03:38 They'll likely try to rule out to make sure that the patient doesn't have peripheral arterial disease in addition to the chronic venous insufficiency.

03:47 Now, if it's determined that compression stockings will help this particular patient, make sure you replace them as needed, but at a minimum with every few months.

03:57 Looking at that picture, you can tell that's a vein because we've got it blue for you.

04:02 And then you see like there's some mesh there.

04:04 When other treatment option is to use catheter based mean they slotted in with a catheter, invasive venography.

04:11 So you see there you put like this little stint in there to help keep that vein remain open.

04:19 Now other specific types of nursing care.

04:22 We'd recommend the patient elevate their legs.

04:25 You want the legs higher than their heart.

04:28 30 minutes three to four times a day can be really helpful.

04:31 And this will help improve the venous drainage with that leg above the heart and get a better shot of getting more blood back up to the heart.

04:40 Now, this is good for everything.

04:42 Exercise is good for everything. But think about it, when you're using your legs in the exercise, this helps your calf muscle pump harder and that's only going to improve the blood flow.

04:53 Yeah, here's another one.

04:56 Weight loss is good for all of us and something a lot of us are working on most of the time.

05:02 You want to make sure that you keep your weight down to as healthy weight as you can.

05:06 You exercise regularly, and try to keep that pressure off your legs.

05:12 Now, avoid trauma. Good advice whether you have chronic venous insufficiency or not, but know that a client that has chronic venous insufficiency, if they experienced trauma to their lower legs, it's gonna be more difficult or extended healing process because they don't have the same blood flow to get things moving and resolving.

05:32 Now what you can do with your diet, are foods in protein, vitamin C, and zinc.

05:37 Now, we've got some options up there for you.

05:39 And trust me, these types of questions show up on exams and can even show up on the NCLEX exam.

05:45 So do your due diligence now to know which foods contain protein, vitamin C, and zinc.

05:52 Now, if you're looking at that, also, I want to make sure that you're watching closely for signs of infection.

05:58 If you're working with elderly clients, sometimes they don't like to take their socks off very often.

06:04 And when you're the one that gets to take it off after extended period of time, I've seen some really scary things.

06:11 So you're going to need to explain to an elderly client, why it's worth the extra effort it takes for them to take their socks down and to really look at their lower legs.

06:22 They're not being lazy, it's just it's a lot of work.

06:27 They have to bend, they have to be mobile, and then they have to pull those off.

06:31 So help them understand that this is to prevent bigger problems.

06:35 That you're not just trying to be mean.

06:36 That you just want them to know that they really need to keep a close check on their lower legs and feet.

06:43 So that wraps up chronic venous insufficiency.