Arterial Ulcers
Posted on May 28, 2010 in Coding Education
by Ann Giles, RN, BSN, HCS-D, COS-C
Let's continue the wound discussion by focusing on arterial ulcers. These wounds will be found in patients with arterial disease. Because of the partial/total occlusions or calcification of the arteries, circulation to the extremities is impaired.
These patients have very unique characteristics.
* Their legs will be thin, pale and shiny.
* Due to the lack of perfusion to the hair follicles, their legs will also be hairless.
* They will usually have thick toenails which are susceptible to fungal infections.
* These patients also suffer from dependent rubor (extreme redness when in a dependent position) and elevation pallor (paleness when the extremity is raised).
Lack of perfusion can become so severe at times, it causes an arterial ulcer. Characteristics of arterial ulcers are pretty standard.
* They are sharp-edged, full-thickness wounds which often times have tendons or bone visible.
* Because of the lack of blood flow, necrotic tissue is a common occurrence with these wounds.
* These wounds will be dry and have very little exudate.
* They are also painful and are prone to infection.
* The most distinguishing characteristic of these wounds is their location. They will be located in "end of the line" locations, such as the toes. This is because the further away the body part is from the heart, the more diseased vessels the blood has to flow through to feed the tissue, increasing the risk of ulceration.
Now that the arterial ulcer has been correctly identified, let's talk treatment. The wounds have a poor prognosis of healing. Greater means such as surgical intervention for revascularization or hyperbaric treatments are needed for healing. As a home health nurse, your focus should be on pain control and infection prevention.
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