Chronic Venous Insufficiency: Manifestations and Assessment (Nursing)

00:00 Now, the clinical manifestations, these are the things that you're going to be looking for.

00:04 The kind of cues that you want to recognize in your clients.

00:08 Now, we're gonna teach you how to recognize them in your clients, but I'm just telling you, take a trip to Walmart or anywhere out in public, and you're going to see the same signs these cues that you should be looking for.

00:21 Now, we're in the third layer of the Clinical Judgment Measurement Model.

00:25 This is teaching you to think like a nurse and we're talking about the cues you should recognize, and how you should analyze those cues and put them together.

00:34 Now, we have an animation for you.

00:36 Okay. So take a look at the animation, and I'm going to talk you through it.

00:40 Because in this animation, we're going to show you how the veins managed to drain the deoxygenated blood found in the periphery of our body and carry it to the heart.

00:50 Now, on the sides, those reddish structures, you see those are muscles.

00:55 Muscles play a super important role in the drainage of deoxygenated blood.

01:00 Now, the reason you see those muscles there, what their role is, is because when muscles contract, for example, when we walk, they squeeze the veins and allow blood to flow to the heart.

01:12 Of course, when they contract and the veins are squeezed, the blood should travel in one direction, but it technically can travel in any direction.

01:22 The reason blood just should flow in one way is the valves of the vein.

01:27 Normally these close to prevent the blood from returning in the wrong direction.

01:31 So in this way, veins only allow the movement of blood in one direction towards the heart.

01:38 Okay, so this is what helps that happen are the muscles contracting is what helps to mobilize the blood in the correct direction.

01:48 Now, patients with venous insufficiency the valves don't play by the rules. They don't function properly.

01:55 So because of the problems with the valves, they don't keep all of the blood moving in the one direction back up towards the heart.

02:03 Therefore, the blood starts kind of stagnate, and pull, and hang out.

02:08 And so because of these damage valves cause extra blood to hang out and stagnate, the blood starts to accumulate, and eventually that's what remodels the shape of the vein.

02:19 That's where they become thicker and torturous.

02:23 So that's what happens in the case of chronic venous insufficiency.

02:28 Let's take a look at a drawing of a varicose vein.

02:31 It's unattractive enough right there, but we're going to blow it up so you see it even closer.

02:37 Because I want you to be able to recognize what it looks like on the outside like this.

02:42 This image shows you what I want you to be on the lookout for Walmart or with your patients.

02:47 Look at these veins and look at the patient's skin.

02:50 Do you know the differences in the coloring? Yep, they have a kind of a brownish or a brawny appearance on their skin on their lower legs.

02:59 Now, this comes from hemosiderin.

03:02 Now this is depositing into their skin.

03:05 That means that the capillaries, the tiniest vessels are leaking.

03:09 Because that blood is not able to drain well continue in one direction up to the heart.

03:14 Remember, we told you those veins get torturous, and that extra blood is around there? That's why it starts leaking into the tissues.

03:21 So this would be an obvious sign or cue that you want to watch for on any patient assessment.

03:28 Now, because of all this that's going on, you might also see Telangiectasias. You can also develop pitting edema.

03:36 So if you look at the patient's leg because the fluids are not flowing in one direction or efficiently, their legs become edematus or swollen.

03:46 Now, this is not comfortable for the client.

03:49 In fact, they kind of describe it as their legs feeling "Waterlogue" or heavy.

03:54 They may complain of throbbing, or aching, or cramping, or maybe even numbness or tingling depending on how severe it is.

04:02 Also, their skin may itch. That's what pruritus means.

04:06 So none of this sounds like any fun.

04:09 But if that chronic venous insufficiency progresses to be bad enough, you're going to see these things.

04:16 Pitting edema, the patient will describe it as heavy weight.

04:20 Why are we telling you how the patient would describe it? Well, first of all, we want to make you an excellent assessor.

04:27 We want you to be able to look at a patient, interact with them, and get the kind of information out of them you want.

04:34 So your patient might not necessarily know, "I should go in and tell them my legs feel heavy." They may not feel like they're saying anything.

04:41 So what we want you to do as a nurse is when you recognize the cues, when you see the differences in the color on their leg, I want you want to ask them, "Hey, have you noticed any problem with your legs? Have they felt extra heavy? Have you noticed any pain or cramping, maybe some numbness or tingling?" Those are great questions to ask them.

05:02 Because oftentimes, patients aren't trying to hide something from you.

05:06 They just want to make sure that they don't over complain or bring up something that doesn't matter.

05:11 So our job as nurses is to ask the right questions and the best questions based on the cues we're seeing in the patient.

05:20 Now, this one, oh, this hurts me to see this picture.

05:24 This is an ulcer. This came from severe edema, and that's what led to the formation of ulcers.

05:32 Because the tissues were so swollen.

05:34 It was easy to start a small area of breakdown and then it just got larger and larger.

05:39 Think about all the things of chronic venous insufficiency, not great blood flow, right? We know that.

05:46 We know extra blood is hanging around there that leads to edema.

05:49 It's difficult for them to move sometimes their legs feel heavy.

05:53 So these are the clients that are most likely to be the least mobile.

05:58 That's why there's an increased risk for the formation of these ulcers.

06:02 Now, if those ulcers get infected, we've got a whole nother set of problems.

06:07 Now you can do some testing like a duplex ultrasonography.

06:11 This will let us know what's going on with the blood flow in the legs and kind of how many directions things are going.