NURSING 1 EXAM 3 Rasmussen College, Minneapolis NURSING 1

Chapter 11 PPE several questions, types of wounds, causes of wounds proper skin care/ diabetic/venous ulcer Venous Ulcers A common problem in older adults is the development of venous ulcers in the lower extremities. It is believed that there is disruption in normal venous return through the deep vein system in the leg because of incompetent valves in the veins. Normally, as the calf muscles contract, blood is forced upward in the venous system against gravity pressure. If the valves along the venous system cannot prevent back flow, excess blood can be pumped into the superficial venous system and increase fluid pressure in the area. The excess pressure causes fluid to leak into the tissue causing edema. Even a slight injury to this edematous area can be the cause of ulcer formation. Pressure Ulcers Pressure ulcers are an all too common occurrence in people who remain in one position for long periods of time (Figure 11-5). When caring for bedridden patients and those confined to wheelchairs for long times, the nurse must be on high alert for pressure ulcer formation. Several theories about the cause of pressure ulcer development exist. Vertical pressure over a bony prominence has long been known to be responsible for pressure ulcer development. Pressure ulcers can also develop from friction as when a person is moved across a bed surface and by shearing as when a person slides down in bed. Both of these are thought to rupture small blood vessels as the superficial and deep tissues move in opposite directions (Moore & Cowman, 2008). Diabetic Foot Ulcers Another common wound that nurses frequently encounter is a diabetic foot ulcer. These ulcers most commonly involve the tibial and peroneal arteries. People with uncontrolled blood sugars for long periods experience damage to the microcirculation and nerves. The arterioles become sclerotic and blood flow to the area is reduced, leading to ischemia. The nerve damage makes the person less aware of injury to the area and thus he or she does not take action when a minor injury occurs. With the decreased blood flow to the area, the normal inflammatory response is delayed and healing is retarded. In addition, high glucose levels inhibit leukocyte activity. All of these factors lead to a high