Cardiac Question #50

Question

The nurse is caring for a client with an open lower extremity leg ulcer. The wound margins are irregular, wound bed is red, and is draining moderate amounts of thick exudate. The nurse documents which type of ulcer?

Answers

  1. Arterial ulcer
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  2. Venous ulcer
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  3. Edema ulcer
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  4. Wound ulcer
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Overview

Explanation

Venous ulcers are caused from venous insufficiency. The condition is caused by a problem with blood return not blood flow. The blood pools in the lower leg because it cannot get back to the heart. Venous ulcers usually have irregular wound margins, weepy edema from pooling and may have a purple/brown color called hemosiderin staining from pushing cells out of the capillaries (that release iron). Drainage is usually moderate to heavy. The description in the question does not represent arterial ulcer, which are opposite from venous ulcers. Blood return is not the issue, but flow is the big problem as blood cannot go to the area. As a result, water and nutrients cannot be transported and the area will have little exudate, pale, cool to touch, and cyanotic form lack of oxygen. The area may also be hairless. Arterial ulcers may have necrotic tissue or pale tissue (because of lack of blood), may be round with “punched out” look and may occur on outer malleoulus and toes.

Learning Outcomes

Test Taking Tip

Video Rationale