Leg Ulcers

Chapter One *A Brief Overview of a Venous Leg ulcerationation *and the Assessment Process The nurse must have the skills and knowledge to identify a venous ramification ulcer. Dowsett (2005) believes that it is substantial that nurses and other health care professionals look for the underlying cause of an ulcer.Whereas, the Royal College of Nursing (1998) has antithetic views, and argues that, professionals who are fully trained in leg ulcer management should only be fitting to identify an underlying cause as it is easily mistaken that diagnosis of an arterial leg ulcer is made rather than venous which could cause serious treatment complications for the wound as well as the patient. thither are major problems associated with a venous leg ulcer such as, pain, loss of mobility, financial implications and much more which will be discussed in chapter 3.Leg ulcers appear as shallow holes or craters in which the tissue underneath is exposed. They passel vary in size, discolouration and depth (National Health dish Direct 2008) (NHS). The clinical factors of a venous leg ulcer are, lipodermatosclerosis (champagne bottle shaped leg) ,which is cellulites affecting the dermis and subcutaneous tissue (Finlay & Chowdhery, 2007), hyperpigmentation, derived red tear cells extravagated from dilated, leaky capillaries which produces areas of brown discolouration (Brown & Burns, 2007).Atrophic Blanche, where interspersed by visible(a) engorged capillaries seen as tiny red dots just below the surface of the skin (Moffat et al, 2007). However onwards looking at the patients wound it is the nurses role to look at the patient holistically and find out chivalric medical and family history as well as personal factor that could contribute to the term (Moffat et al, 2007). There are requisite details that the patient can tell the nurse about their ulcer and the factors that whitethorn contribute to this.Such factors are their full medical history these details should inc lude varicose veins, diabetes, darksome Vein Thrombosis (DVT), previous leg surgery and any family history of leg ulceration (Dougherty and Lister 2004). The splendor of this is that if a leg ulcer is diagnosed incorrectly, such as a venous ulcer being erroneously diagnosed as an arterial one can have serious complications for the patient and causing further delays in the healing of the wound. Also the nurse must undertake baseline observations this includes, the patients weight, height, blood mash (BP), oxygen saturations levels, temperature nd respiratory rate, and in any case the patients nutritional intake, urine samples and routine blood tests such as glucose and haemoglobin levels must be gained, as diabetes is present in approximately 5% of patients with leg ulcer (SIGN 1998). Murray (2004) also agrees with Dougherty & Lister (2004) & Bolton et al (2004) stating that that hyperglycaemia can have an effect in the wound healing process, as this can be linked with infection and decreased oxygen levels in the haemoglobin will slow down the healing process and go onto starve tissue. These factors are important to know as it plays a big part in the wound healing process.In clinical practice thesebasic observations are a vital part of information gained to ensure safer patient care and beforehand(predicate) recognition of deterioration. The key factor in order to gain a thorough assessment it is essential that the nurse must have is communication and listening skills not only for this purpose but also for a nurse patient family relationship. Dealey, (1994) believes that fear is one of the most common experiences a human can feel and a patients illness release many fears, in which health care professionals are otiose to identify when not allowing the patient to express their needs freely.If the patient has a full understanding of their condition they are more likely to comply with treatment regimes and have a more productive relationship with healthcare professionals (Anderson 2006). The RCN (2008) states, that the nurse-patient relationship is founded on trust. The nurse patient relationship allows the conversation to spring easy in order to gain a holistic commence to the patients care. The Code (2008) also agrees that as nurses we must listen to people in our care and respond to their concerns and preferences.Much research has taken commit regarding nurse patient relationships, McCabe (2002) carried out a study which aimed to explore and produce statements relating to the patients experiences of how nurses communicate. A qualitative phenomenological approach was used. This focuses on individuals interpretations of experiences and ways in which they express them (Parahoo 1997), followed by unstructured questionnaires which were tape preserve and lasted for approximately thirty minutes. The results found that four themes emerged, these were, lack of communication, attending, empathy and friendly nurses.Therefore the conclusio ns were that in business to the literature, nurses are not good at communicating with patients, however nurses can communicate well if the toil undertaken was a patient centred approach. Although research has taken place the limitations were that only eight patients participated, therefore this could reduce the grimness and reliability of the study. Also with such a small sample the study could be used as a pilot study which could be replicated in the UK as this study was undertook in Ireland.