Issues like venous stasis ulcers, arterial lower extremity or arterial wound and diabetic ulcers do get a bit muddy because some patients may certainly have mixed etiologies. For instance, you notice the left leg, there is some edema in the left leg of a patient that left the nurse confused. Read this expert CMS OASIS article for more.
And so, the nurse wanted to call these venous stasis on her OASIS-C. You understand that one of the key components to attacking and treating venous stasis, and venous stasis ulcers is to compress. Compression is the key component. However this patient actually has lower extremity arterial disease wounds. If you begin to compress these legs you would cause harm because these are clearly arterial wounds.
So, just to refresh your memory and to sort of give you a couple of tricks to help you when you are out on the field, you would expect to see arterial wounds below the ankle. And this is what is going on with this patient. She's got wounds that are below the ankle. They are covered with dead tissues that are typical. She's got exquisite pain. You see the rubor to the bottom of her foot. When you pick her feet up, they pale out so these dependent rubor elevation or pallor.
Our expert cleared this in a home health aid training event that when you've got these thin, pale, shiny hairless legs wounds below the ankle, it's a safe bet that you are not looking at venous wounds. A lot of times too, this is going to require a call back to your physician's for clarification because you find that quite often they are not quite sure on what they are looking at either. So they're kind of counting on you to identify whether they're venous or arterial and then call them back with a suggested management plan.
In classic venous stasis, you've got scaly skin with stained – the hemosiderin stained skin. The hallmark of venous stasis ulcers is that they are located above the ankle in the gator area. So we expect to see these from the ankle to just below the knee.
There is most often edema. There's a history of edema. And then the wound should not have dead tissue in it. It might be full thickness but it's not going to be deep. And it's not particularly painful. It should drain a lot.
And a couple of things that you must ensure is that you understand is that compression is the important component of management of venous stasis as per home health guidelines. And one important thing when it comes to home care is that patients from the very first time you assess that patient, the very first time you begin to apply compression to that venous stasis ulcer, you need to begin to talk to your patient about lifetime compression because you're going to control the edema and you're going to get that wound healed.
But if you simply stop compression, discharge the patient, he's going to readmitted within a few weeks as the edema is going to very quickly. Blow that healed scar or that new scar off and he's going to be right back where he started. So part of your discharge plan should be to get him in lifetime compression.
And that looks different for different patients but that is an important component. And then compression is again just an important component. Even no matter, if your patient has skin graft over his wound, if they used even negative pressure devices, they've got to be compressed as per home health rules.
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