Leg Ulcerated

Discussion

As per the view of NHS, the disease of Venous leg-ulcer is mainly occurred in the area of damaged skin below the knee of the leg and it takes more than six weeks to recover fully. This leg ulcer disease is one of the most common diseases among the patients of leg ulcer, almost 80% to 85% of patient suffered by this disease. This is one of the most costly diseases and it needs to do diagnose first and needs early treatment.

In the case of Venous leg-ulcer, when the veins of an individual's leg fail to make the primary function then it leads to the disease of Venous leg-ulcer and the various risk factors is such as diabetes, hypersensitive, obesity can happen with the person (Tollow & Ogden, 2016). The possibility of this disease happens to the older than the young people. Women suffered from this disease rather than men. The major implication of this disease is chronic wound and it is difficult to heal easily. There are various symptoms of Venous leg-ulcer such as itching, pain, swelling and aching as well.

As per the case study, Mrs A is suffering by Venous leg-ulcer. She is 65-years old woman, Venous leg-ulcer happened in her left leg and this disease has healed but her leg broken several times.
There are mainly four stages of managing the wounds of Mrs A. The steps to manage the wounds are such as the step of assessment, the second step is to make proper treatment of the disease, and the third step is to review the process of progress and the final steps is to make the total management of the disease. The pain of the leg ulcer is extremely high. All the phases of healing the wound are very important to go systematically. Being a nurse the main purpose of the learner is to look after Mrs A and to cleansing the affected area then needs to granulation and in the phase of epithelization. The four steps of managing the wound of Mrs A are stated below:

Diagnosis: It is an important step to make the diagnosis of the patient of leg ulcer. It must be the first stage among the all. Almost 90% of the patient, the reason of the disease is due to venous hypertension. 6% of the patient, the reason of leg ulcer due to the insufficiency of venous. 4% of the patients, the reason of this disease due to various skin issues. It is an important factor to make a diagnosis and to increase the work of venous. In the case of Mrs A, she has already faced this stage.

Doppler studies: Basically, the Doppler studies are a kind of test to know about the success of the diagnosis process and to check the arterial insufficiency that is checking the blood pressure of the patient. Like the venous insufficiency, this arterial insufficiency is about the flow of the blood through the arterial of the patient. There is various sign of arterial insufficiency such as hair falling, skin affection of the patient; the affected portion of the patient becomes pale and so on. In the case of Mrs A, she has diabetes so for her this treatment is unreliable. Here who have diabetes arthritis for them this test is not reliable (Lazarus et al. 2014).

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Treatment: There are many processes of making treatment for the patients, who have leg ulcer. Among them, the process of diverse and the process of contentious can be effective for the patient. Then the compression therapy is another process of treatment of the patients with leg ulcer. The main goal of the treatment is to make the pressure of veins sufficient and to heal the disease with minimal complications. Leg ulcer can be occurred by both the matter of insufficiency of venous and insufficiency of arterial, so need utmost care to make the treatment of the patient (Ashby et al. 2014). In the case of having no problem of arterial the treatment would be through the exercise and compression therapy as well. Reducing pain from the affected area is an important factor for the treatment. The pain of the affected area can increase by the non removable bacteria, skin damage, or any kind of bandage problem of the patient. Being a nurse, it is one of the most crucial factors to look after all these factors to heal the pain of Mrs A, who is suffering from Leg ulcer.

Wound cleansing: The reason of the leg ulcer may be many but cleansing the patient’s wound would be always the first criteria. To complete the initial phase of checking the patient of leg ulcers needs more patience (O’Meara, Richardson & Lipsky, 2014). For cleansing, the affected area of the patient needs to clean gently so that the tissue would not be affected. Rigorous cleaning can make damage the affected area of the patient.

As per the case study, being a nurse needs to clean the area of the wound of Mrs A gently so that the risk of damaging the affected place would be less.
Dressing the wound has less influence on the patient of leg ulcers. There are various stages of dressing wound such as the time of non-absorbent, the time of self-adhering, debriding and absorbent as well.

The dressing would be like occlusive for the patient of ulcers, to heal the disease in the moist environment. To heal the wound of the leg ulcers dressing is the less effective rather than the other treatments. For dressing the wound of the patient of leg ulcers, non-adherent can be enough. The antimicrobacterial dressing is an important process to remove the bacteria from the affected area (Bohn & Gass, 2014). To remove the local bacteria Antimicrobacterial dressing can be included. However, the dressing pain is excessive for the patient with leg ulcers so the particular dressing process like analgesic can be included to less the pain during the time of dressing the wound. In the case of Mrs A, she has already dressed and due to the heavy dressing, she has suffered and got pain. So for Mrs A, the process of analgesic can be used to make her pain less and to give her little relief. Apart from this, local anaesthetic can be used to reduce her pain.

In the case of those patients whose Venous leg-ulcers cannot be healed by all the above-stated processes and when the ulcer becomes more painful and also becomes large then it is necessary to make surgery. After the treatment of both the factors of arterial and venous insufficiency even after any such bacteria would affect then the risk factors cannot control by medicine. In the case of the patients whose ulcers do not heal after the treatment then have no other option except surgery (Olyaie et al. 2013). Being a nurse it could be recommended to Mrs A can go for the surgery to recover fully. During the surgery, the skin of the affected area of Mrs A would be removed. At the affected place, the skin would be given from the any part of the body of Mrs A.

Compression therapy is another process of healing the Venous leg-ulcer of the patients. With the help of compression therapy, the Venous ulcers of the patients can be healed within twelve weeks. Almost 405 to 60% of patients have cured by this therapy. Compression therapy cannot be used for the patients having less than 0.8 ABPI or have arterial diseases. In the case of small ulcers, compression therapy cannot be used.

To use this therapy need to make concern of the patients. To make the therapy it is very important to know the skill and knowledge of the practitioners. Apart from this, the therapy can help to the patients of leg ulcers to reduce the heal with high accuracy and it can remove the matter of bandaging the affected areas. Compression therapy must be applied with the help of appropriate sub-bandage pressure (Augustin et al. 2014). It is crucial how the bandage can be used. Using bandage elastic can make the ulcer more damage. As per the case study, Mrs A can use the compression therapy to heal her pain completely.

To make the bandage of the ulcer patients there are two types of bandage such as elastic bandage and non-elastic bandage. As per the view of the health, professionals there are many limitations to use the bandage (Mosti et al. 2016). In the case of intolerance of the patients can lead to more damage of the ulcers same way discomfort of the patients due to bandage can be the result of poor compliance.

As per the view of Elastic stocking at the area of hypersensitive elastic bandage must not be given. In the case of the patients of high pressures elastic bandage can make them intolerant. According to the case study of Mrs A, she is hypersensitive, so being a nurse elastic bandage must not be used for her treatment. According to EWMA, almost 60% of the patients who have leg ulcers are recovering fully within the time bound of twelve weeks. Management of this disease is always the crucial part.

Leg-ulcer can make the patient isolate from the society (Raffetto et al. 2016). As per the case study of Mrs A, she is also suffering by the same problem. She does not go out due the bad smell of her leg and the pain as well. However, she has her own family. Around the world, many patients are suffering by the diseases of leg-ulcer. The quantity of this disease is increasing day by day.

Venous leg-ulcer is extremely painful and most importantly women have suffered the most rather men. Instead of having family friends, the patients of leg-ulcers become isolate from the world. Leg-ulcer has bad smell so the patients do not go out often and it makes them very alone from the world. Sometimes the patients of leg-ulcer left alone for their diseases. Same here in the case of Mrs A, who have her family but she is alone in her room due to her disease. One she had interest in cooking but at present time she had lost the interest in cooking. Being a nurse would like to recommend to Mrs A, to go to the outside and stay with the family.

Conclusion

In conclusion all, it can be said that the disease of leg-ulcer is extremely painful for the patients. In this essay, the steps of managing the disease have been stated and Mrs A can choose any of the treatment to make her leg-ulcer heal totally. The various symptoms of leg-ulcers can help to identify the disease. It has been seen that the matter of dressing the wound has less importance.

However, in the case of dressing elastic bandage does not use for the patients who are hypersensitive. The importance of compression therapy is extremely useful for the patience of leg-ulcer and Mrs A can take this therapy to heal her pain completely. Apart from this Mrs, A can also take the option of surgery. Wound cleaning can play a vital role for the patience of leg-ulcers. Being a nurse, it is important to make the process of wound cleaning more gently and same matter must be applicable for Mrs A.

References

• Ashby, R. L., Gabe, R., Ali, S., Adderley, U., Bland, J. M., Cullum, N. A., ... & Stubbs, N. C. (2014). Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): a randomised controlled trial.
• Augustin, M., Brocatti, L. K., Rustenbach, S. J., Schäfer, I., & Herberger, K. (2014). Cost‐of‐illness of leg ulcers in the community. International wound journal
• Bohn, G. A., & Gass, K. (2014). Leg ulcer treatment outcomes with new ovine collagen extracellular matrix dressing: a retrospective case series.Advances in skin & wound care