Download

Nursing Best Practice Guideline
Practice Recommendations
A. ASSESSMENT OF VENOUS LEG ULCERS
Recommendation • 1
Assessment and clinical investigations should be undertaken by healthcare professional(s)
trained and experienced in leg ulcer management.
(Level of Evidence = C – RNAO Consensus Panel, 2004)
A complete client assessment precedes evaluation of the limb and ulcer characteristics. A
comprehensive assessment is essential to determine the underlying ulcer etiology and
appropriate treatment approaches.
29
Discussion of Evidence:
Although little guidance is given, the literature strongly supports the importance of assessment
and clinical investigations for venous leg ulcers. Recognizing significant arterial insufficiency
is important, as no healing will occur in the presence of severe occlusive arterial disease of the
affected limb. Kunimoto et al. (2001) caution that the high levels of compression necessary to
correct venous hypertension will be potentially dangerous in this situation. Keast & Orsted
(1998) add that a chronic wound should prompt a search for underlying causes.
According to Zink, Rousseau & Holloway (2000), twenty-one percent of individuals with venous
ulcers experience concomitant arterial disease, with the risk of co-existing arterial dysfunction
increasing with age, which again supports the importance of a thorough assessment.
Research repeatedly confirms the necessity of trained healthcare professionals in leg ulcer
management. Surveys of reported practice by nurses demonstrate that knowledge of nurses
in wound care often falls short of what is ideal (RCN, 1998). Providers of healthcare recognize
that the mismanagement of wounds is both costly and unnecessary. Kerstein, van Rijswijk &
Betiz (1998), among others, maintain that providing optimal cost-effective wound care
requires extensive skills, as well as knowledge, and that classroom teaching alone will not
meet the needs of our aging population.
While findings as to what constitutes adequate training levels for nurses involved in leg ulcer
care are inconclusive, the essential point is that the person conducting the assessment must