Lower Limb and Leg Ulcer Assessment and Management

Lower Limb and Leg Ulcer Assessment and Management
 
Lower Limb and Leg Ulcer Assessment and Management is an indispensable resource for practitioners in primary and secondary care, offering a practical and accessible guide to treating and managing leg ulcers.
 
This comprehensive text challenges the misconception that leg ulcers are invariably 'chronic'. In practice, proactive management will prevent the harm associated with sub-optimal management. Insights are provided into lower limb assessment, early intervention for ulcer prevention, ulcer types and their causes, along with the influence that swelling and biomechanical changes have on the lower limb. The authors draw on international best practice guidance on lymphoedema, wound pain, wound bed preparation, compression therapy, psychological impact, and evidence-based care to enhance leg ulcer management.
 
Each chapter aims to facilitate reader comprehension and promote productive patient discussions, empowering healthcare professionals to collaborate with patients and improve leg ulcer management rapidly and effectively.
 
This multi-disciplinary resource covers:
* Normal venous, arterial, and lymphatic function in the lower leg
* Leg ulceration due to venous hypertension, peripheral arterial disease, and lymphoedema
* Leg ulcers of unusual aetiology, addressing autoimmune and inflammatory disorders such as pyoderma gangrenosum, rheumatoid arthritis, scleroderma, sickle cell, and more
* Musculoskeletal changes in the lower limb, assessment, and management to enhance mobility and calf-muscle function
* Clinical management, with topics like wound management, stages of wound healing, exudate management, holistic assessment including vascular assessment, compression therapy, and Laplace's law
* Pain management with an emphasis on understanding the complexities and features that exacerbate or diminish the pain response
* The personalisation of care, understanding of social determinants of health, and the role of supportive self-management in lifelong management
 
For professionals seeking evidence-informed approaches to delivering exceptional care, Lower Limb and Leg Ulcer Assessment and Management is an essential companion on the journey to understanding and managing leg ulcers effectively.

List of contents

List of Contributors xiii
 
Foreword xv
 
Preface xvii
 
Acknowledgements xx
 
Introduction 1
Alison Hopkins and Joseph Montgomery
 
The Wound Care Burden 1
 
The Cost of Sub-Optimal Wound Care 3
 
Classification of Dressing Products 4
 
Dressing Product Analysis 6
 
Online Non Prescription Services 7
 
Conclusion 9
 
References 9
 
Chapter 1 Aetiology 11
Aby Mitchell
 
Normal Venous Function 11
 
Veins in Action 16
 
Blood Pressure in Veins and Capillaries 17
 
Venous Disease 18
 
Pathophysiology of Chronic Venous Disease 19
 
Theories of Tissue Damage 21
 
Chronic Venous Insufficiency 23
 
Risk Factors for Venous Insufficiency 24
 
Arterial Disease 24
 
The Skin 33
 
Wound Healing 35
 
Phases of Wound Healing 36
 
Conclusion 39
 
References 39
 
Chapter 2 Lymphoedema and Chronic Swelling 43
Caitriona O'Neill and Rhodri Harris
 
Function of the Lymphatic System 43
 
Prevalence and Key Facts 48
 
Causes of and Risk Factors 52
 
Assessment, Diagnosis and Staging 55
 
Management Challenges 66
 
Lymphovenous Disease 68
 
Treatment 74
 
Compression Therapy and Assessment Considerations 76
 
Adjunct Treatment Modalities 79
 
Surgery 82
 
Palliative Care 83
 
Lipoedema 87
 
Summary 97
 
References 97
 
Chapter 3 Atypical Causes of Leg Ulceration 106
Sarah Bradbury and Kirsten Mahoney
 
Inflammatory/Autoimmune Disorders 107
 
Metabolic Disorders 134
 
Malignant/Neoplastic Wounds 145
 
Drug- Induced Leg Ulcers 155
 
Erosive Pustular Dermatosis 161
 
Infective Conditions 172
 
Conclusion 176
 
References 177
 
Chapter 4 Musculoskeletal Factors in Leg Ulcers: Assessment and Management 188
Rona Frances Campbell
 
Risk Factors 190
 
Lower Limb Veno-Muscular Pumps 192
 
Ankle Joint Assessment 196
 
Holistic History Taking Relating to Factors that Influence Biomechanical Lower Limb Function 198
 
Management 205
 
Reducing Falls Risk 216
 
Allied Health Professionals as Part of the Multidisciplinary Team 218
 
Conclusion 218
 
References 219
 
Chapter 5 Assessment of Leg Ulceration 226
Karen Staines and Aby Mitchell
 
Assessment 227
 
History Taking 227
 
Examination 238
 
Arterial Disease 248
 
Wound Assessment 252
 
Skin Assessment 263
 
Diagnostic Assessment 265
 
How to Perform a Handheld Doppler 268
 
Red Flags for the Urgent Treatment of Patients with Venous Leg Ulcers 276
 
Reassessment and Recurrence 276
 
Conclusion 276
 
References 277
 
Chapter 6 Holistic Management of Pain 285
Fran Worboys and Alison Hopkins
 
The Pain Experience 285
 
Theories of Pain 287
 
Causes of Pain 292
 
Types of Pain 293
 
Pain Cycles: Never- Ending Pain 295
 
Impact of Pain on People's Lives 296
 
Causes of Pain 296
 
Pain Management Solutions: Assessment 298
 
Managing Pain 303
 
Conclusion 312
 
References 312
 
Chapter 7 Personalised Care in Leg Ulceration 318
Alison Hopkins and Charlotte Smith
 
The Wider or Social Determinants of Health 319
 
Wider Determinants of Engagement with Treatment 324
 
Making Effective Change 326
 
What Influences Practitioners

About the author

Aby Mitchell, Senior Lecturer in Nurse Education, Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London. Aby's clinical experience spans across burns and plastics, primary care, and physical health in community mental health. Aby is a registered specialist practitioner in district nursing and has an MSc in Advanced Practice (healthcare education). Aby is committed to improving patient care through nurse education. Georgina Ritchie, Executive Director and Director of Education at Accelerate. Georgina brings over two decades of experience in clinical practice and education. Her journey from military nursing in the British Army to leadership roles in the NHS and academia has honed her expertise in community and district nursing. Georgina is a registered community specialist practitioner and a V300 non-medical prescriber, holding an MEd, with a passion for empowering confident clinical practice through education. Alison Hopkins MBE, Executive Director and CEO at Accelerate. With over three decades of experience in wound care, Alison established the leg ulcer service at Tower Hamlet's District Nursing Service in 1989, beginning a life-long passion for compression therapy and community transformation. In 2019 Alison was awarded an MBE for services to nursing and wound care and holds an MSc in Psychology and Health. In addition to overseeing Accelerate, she continues to contribute to academic journals, and speak at conferences, always seeking to challenge the status quo so that excellent wound and lymphoedema care becomes the norm.

Summary

Lower Limb and Leg Ulcer Assessment and Management

Lower Limb and Leg Ulcer Assessment and Management is an indispensable resource for practitioners in primary and secondary care, offering a practical and accessible guide to treating and managing leg ulcers.

This comprehensive text challenges the misconception that leg ulcers are invariably 'chronic'. In practice, proactive management will prevent the harm associated with sub-optimal management. Insights are provided into lower limb assessment, early intervention for ulcer prevention, ulcer types and their causes, along with the influence that swelling and biomechanical changes have on the lower limb. The authors draw on international best practice guidance on lymphoedema, wound pain, wound bed preparation, compression therapy, psychological impact, and evidence-based care to enhance leg ulcer management.

Each chapter aims to facilitate reader comprehension and promote productive patient discussions, empowering healthcare professionals to collaborate with patients and improve leg ulcer management rapidly and effectively.

This multi-disciplinary resource covers:
* Normal venous, arterial, and lymphatic function in the lower leg
* Leg ulceration due to venous hypertension, peripheral arterial disease, and lymphoedema
* Leg ulcers of unusual aetiology, addressing autoimmune and inflammatory disorders such as pyoderma gangrenosum, rheumatoid arthritis, scleroderma, sickle cell, and more
* Musculoskeletal changes in the lower limb, assessment, and management to enhance mobility and calf-muscle function
* Clinical management, with topics like wound management, stages of wound healing, exudate management, holistic assessment including vascular assessment, compression therapy, and Laplace's law
* Pain management with an emphasis on understanding the complexities and features that exacerbate or diminish the pain response
* The personalisation of care, understanding of social determinants of health, and the role of supportive self-management in lifelong management

For professionals seeking evidence-informed approaches to delivering exceptional care, Lower Limb and Leg Ulcer Assessment and Management is an essential companion on the journey to understanding and managing leg ulcers effectively.

Product details

• Authors: Aby (King''''s College London) Ritchie Mitchell, Aby Ritchie Mitchell
• Assisted by: Alison Hopkins (Editor), Hopkins Alison (Editor), Aby Mitchell (Editor), Georgina Ritchie (Editor)
• Publisher: Wiley, John and Sons Ltd
• Languages: English
• Product format: Paperback / Softback
• Released: 01.05.2024
• EAN: 9781119908210
• ISBN: 978-1-119-90821-0
• No. of pages: 496
• Subjects: Natural sciences, medicine, IT, technology > Medicine > General; Krankenpflege, Medizinische Grundversorgung, Nursing, Community nursing, Gemeindekrankenpflege, Medizinische Grundversorgung, Praxis, Primary Care Nursing & Practice Nursing, Nursing Special Topics, Spezialthemen Krankenpflege