Venous Leg Ulcer Care Plan

This assignment presents a detailed care plan for a patient named Mrs. Mary Jones who is experiencing a venous leg ulcer. The plan includes assessments, diagnoses, planning strategies, interventions, and rationales for each step. The care plan specifically addresses the ulcer's treatment, preventative measures, and management of her accompanying hypertension.

MAINTAINING PROFESSIONAL HEALTHCARE
STANDARDS
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TABLE OF CONTENTS
Introduction..........................................................................................................................................3
Patient presentation and pathophysiology of condition.......................................................................3
Classification....................................................................................................................................3
Aetiology..........................................................................................................................................4
Epidemiology...................................................................................................................................4
Burden of the disease on economic facets........................................................................................5
Signs and Symptoms of leg ulcers...................................................................................................6
Diagnosis of venous leg ulcer..........................................................................................................6
Pathophysiology...............................................................................................................................7
Analysis of the underpinning knowledge and its application to the nursing process...........................7
Types of assessment.........................................................................................................................9
Methods of assessment data collection..........................................................................................10
Range of prevention and therapeutic interventions........................................................................11
Guidance from national and international bodies...........................................................................12
Conclusion..........................................................................................................................................12
References..........................................................................................................................................13
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INTRODUCTION
Leg ulcer is a long lasting (chronic) sore that is usually developed on the inside of the leg or
just above the ankle. The symptoms generally include pain, itching and steeling in the affected leg.
These are most common in older people and especially among women. They affect about 1 in every
1000 people in the UK at some stages in their lives (González, 2016). Venous leg ulcer become
more common in the age of 80s and without treatment it may become larger. The study is important
since that could aware old people regarding the development of venous ulcer in leg. People with
varicose veins also have a higher risk of developing venous leg ulcers.
The root of the problem is due to increased pressure of blood in the veins of the lower leg.
This also causes fluid to ooze out of the veins beneath the skin. This also causes swelling,
thickening and damage to the skin (Gould and et.al. 2016). The ulcer is dressed in a similar way to
any other wound and along with this, compression bandaging is also required. The bandages are
reapplied every week; thus extra efforts are required to put by the nurse. Understanding knowledge
use in everyday nursing practice is important so as to improve the educational preparation and
quality in health care. Information of the patients are required to be protected so that secrecy can be
maintained.
In order to deliver specific care to the patients (who have venous leg ulcer), suitable time
period is required to be considered so that the root cause of the problem can be eradicated. Venous
ulcers are often recurrent and it can prevail from weeks to many years and severe complications
include cellulitis, osteomyelitis and malignant change (Grover and et.al. 2016). The present research
study has been made with the purpose of analysing the need of promoting nursing knowledge for
venous leg ulcer. Regarding this, symptoms, causes and treatment of the ulcer is being discussed in
the current research report. Similarly, researcher has also discussed impact, pathophysiology and
complications of venous ulcer on human beings. Discussion has also been made on appropriate
nursing process that can be applied in the case of venous ulcer.
PATIENT PRESENTATION AND PATHOPHYSIOLOGY OF CONDITION
In the present research study, discussion has been made on Mrs Mary Jones who is 54 years
old and who works as a sales advisor. She has the issue of venous leg ulcer and she is getting
treatment from the community sector which is managed by district nurses. Stating about her
medical history, it has been identified that she has hypertension; thus lisinopril 5mg tablets is
prescribed for which she needs to take twice in a day.
Classification
Most of the ulcers are caused by artery disease or diabetes that occur on the foot rather than
on a leg. The categories of leg ulcer can be split into five categories which are mentioned in the
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below section. Arterial leg ulcers: It is caused by poor circulation of blood in the arteries. People who have
these ulcers have cardiac and cerebrovascular disease. Foot wounds are deep and sometimes
it create deep wounds on the toes which exposes tendons. These are usually located on bony
prominences and creates wounds in toes (Jull and et.al. 2016). They rarely bleed; however
they are highly painful. Diabetic leg ulcer: Diabetic leg ulcer is caused by high blood sugar which has a direct link
with diabetes. They usually occur on the foot and most commonly it creates pressure points
that are prone to blisters. It is typically caused by prolonged pressure on trauma to the foot
and regular diabetic foot exams could prevent the formation of neuropathic ulcers. Most of
the health care entities recommend wound debridement so that ulcers can be permanently
healed (Kirsner and et.al. 2016). Vasculitic leg ulcer: Vasculitic leg ulcer is associated with chronic inflammatory disorders
such as lupus and rheumatoid arthritis. Traumatic leg ulcer: This type of ulcer is usually developed when any injury happens to the
leg.
 Malignant leg ulcer: This type of ulcer is caused by a tumour of the skin of the leg which
keeps on increasing if the patient do not undertake prominent care for this ulcer (Pipe and
et.al. 2005).
For all the categories of ulcers, antibiotics can be used so to treat the infected area and also
to heal the wounds. Despite of the complications, chronic wound healing occurs a lot in older
people; however that does not have any impact on quality of life. Several types of care services are
required to be given to the patients so that they can overcome such problem.
Aetiology
It has been identified that ulceration generates in human leg due to vascular causes and that
is also based on multiple factors which develops ulcer in the body. This is caused by both arterial
and venous disease. Hypertension and atherosclerosis of the peripheral vessels also leads to arterial
disease which has a direct association with ischemic ulcers. Chronic venous insufficiency results in
venous hypertension and that further causes venous ulcers. Vasculitis or Takayasu disease are
associated with ulceration. It initially develops in the body due to arterial or ischemic type ulcers
which later on develops cutaneous disease (Ratliff and et.al. 2016). The other categories of such
disease are pyoderma gangrenosum or erythema nodosum. When ulcer do not respond prominently
with medical care, it potentially develops the need of malignancy. Cutaneous distortions may
include ulcerative basal cell carcinoma and it could also assist the health care practitioners to
deliver prominent therapeutic intervention. According to the historic aspects, neoplasia, chronic
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inflammation and vasculitis are the most common categories of ulcers that develops in human leg
due to hydroxyurea.
Epidemiology
The prevalence of vascular ulcer in general population is not known; however due to
increasing rate of obesity, vascular ulcers are also amending among people. This usually develops
since comorbidities seems to be there in patients who have issues related to obesity. In most of the
countries, venous ulcers are seen at a rate of 2.5% in patients who further needs to have long term
care services (Gabriel and et.al. 2016). This rate is believed to be much higher than the overall
prevalent population. The major cities of UK shows that chronic leg ulcer prevails in people with
around 1%. In this category, most are considered to be caused by venous disease rather than arterial
disease. According to a survey, it has been estimated that venous ulcers prevails over time to be
98% for both healed and non- healed ulcers in older patients.
Burden of the disease on economic facets
Treatment of venous leg ulcer is expensive as it includes several medication and therapies
which are cost effective. It also leads to economic burden on the health services in many countries
and so in UK as well. According to several research studies, the annual cost of CVI is estimated to
be more than 1 billion pounds in UK. Current treatment for CVI surgery, sclerotherapy and
compressive therapy which heals wounds in legs at the initial stage (The burden of chronic wounds
in the UK. 2014). However, currently practitioners are undertaking micronized purified flavonoid
fraction adjuvant therapy which shows significant impact on venous leg ulcer and at the same time,
it also reduces healing time of the ulcers.
On the contrary, effective treatment programs for venous leg ulcers could minimize the
economic impact of CVI on health services. It is most commonly caused by venous hypertension
that further results in valvular incompetence in the superficial, deep and perforating veins. It causes
swelling, restricts blood flows and damages the skin and other tissue that surrounds in the wounded
area. According to health statistics, it has been identified that there are 70,000-190,000 individuals
in the UK that have issues related to venous leg ulcer (The Social and Economic Burden of Venous
Leg Ulcers: Focus on the Role of Micronized Purified Flavonoid Fraction Adjuvant Therapy. 2003).
Prevalence of venous ulcer increases according to different ages and it especially develops among
old people. The same study also contends that 55% of patients faces this issue for more than a year.
Hence, the cost of treating patients (who have venous ulcer) requires extensive care and nursing
services. Further, it has also been identified that government has to spend around £168–198m per
year for patients suffering from venous ulcers. The example of such thing has been mentioned in the
below table:
Chronic wound treatment costs to the NHS
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Annual incidence Cost per patient Annual NHS cost
Venous leg ulcers 108,600 £1,500 - 1800 £168 – 198 millions
Foot ulcers 57,000 £5,200 £300 millions
Pressure ulcers 410,000 £4,300 – 6,400 £1.8 – 2.6 billions
TOTAL 575,600 £4,000 – 5,400 £2.3 – 3.1 billions
However, at the same time effective treatment programs for venous leg ulcers could reduce
the economic impact of CVI on health services. The treatment of venous leg ulcer with MPFF
therapy can reduce the overall cost aspects as compared to conventional therapies. Thus, under a
retrospective cost effective analysis, MPFF seems to be more feasible than conventional therapies
and it also consumes 45% less cost on such aspects (Tollow and Ogden, 2016). If several tangible
costs are included, then the ratio of effectiveness could likely be amend in the favour of MPFF.
Further, the increased price of drug would not affect the suitability of the therapy because it is more
feasible than to conventional therapies. Henceforth, it is clear that MPFF adjuvant therapy can be
used for the purpose of treating patients with venous leg ulcers as this is more effective and
potentially cost saving method.
Signs and Symptoms of leg ulcers
They are commonly found on the lower leg and ankle and as a sunken, it can asymmetrically
shaped wound in the leg. The edges of the ulcer are clearly defined from the surrounding skin and it
can create the skin intact but inflamed. The surroundings may be pigmented, hardened or calloused;
hence it can develop more pain the leg (Venous leg ulcer – Symptoms. 2015). Venous leg ulcers are
open and painful and it often sores in the skin that take more than a month to heal. As a sign of this
disease, a venous leg ulcer can be susceptible to bacterial infection; hence the disease can be
observed with the help of major symptoms such as worsening pain, unpleasant discharge coming
out from the ulcer, redness and swelling of the skin around the ulcer. At the same time, the person
get high temperature fever and the surrounding also gets hardened. Hence, the ulcer becomes more
painful and irritated.
Diagnosis of venous leg ulcer
In order to diagnose venous leg ulcer, the patient should immediately contact the nearby GP
as soon as the symptoms are observed. Physical examination is required to conduct so as to identify
the cause of the ulcer. At the same time, patient may have to undergo a test Doppler machine that
ascertains the blood supply in the leg (Diagnosis and Treatment of Venous Ulcers. 2010). In other
cases, patients can also refer to vascular specialists for conditions that affect blood vessels.
Moreover, the diagnosis also includes clinical observation where in the care practitioners conduct
tests likewise ankle- brachial index, venography, plethysmography and ultrasonography. This is
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based on colour duplex ultrasonography which shows clear picture of the ulcer along with the
causes.
On physical examination, these ulcers are generally irregular and shallow; thus granulation
tissue and fibrin often present in the base of the ulcer. A clinical severity score based technique can
also be used for assessing the chronic venous disorders (Management of chronic venous leg ulcers.
2010). Thus, under treatment, venous leg ulcer include conservative management, mechanical
treatment, surgical options and medications. In generalized context, the main aim of treatment is to
reduce edema and it also improves ulcer healing so as to prevent recurrence of the wound. Another
sources of treatment are also available which have varied effectiveness and limited access to use.
Inelastic compression therapy provides high working pressure at the time of ambulation and muscle
contraction but it does not have any resting pressure.
Pathophysiology
Venous hypertension
Deep vein thrombosis, superficial and deep vein insufficiencies, perforator insufficiency,
arteriovenous fistulas and calf muscle pump insufficiencies are the major causes that amends the
distal veins of the leg and at the same time it creates venous hypertension (Tollow and Ogden,
2016). The case of chronic vascular ulcers place a significant burden on the patient and also on the
health care system. Several guidelines have been developed for the purpose of reducing the causes
of venous leg ulcers.
Fibrin cuff theory
Fibrin revolves around capillary beds and that also leads to elevated intravascular pressure.
This also causes enlargement of endothelial pores which further results in amending fibrinogen
deposition in the interstitium. The fibrin cuff is also surrounded with the capillaries in the dermis
which decreases the rate of oxygen and also penetrates 20 fold. It also constrain dissemination of
oxygen and other nutrients in the body. At the same time, it further leads to tissue hypoxia that
causes impaired healing of wound.
Inflammatory trap theory
There are various factors that leads to growth in inflammatory cells and that also traps the
cells in the fibrin cuff. This promotes austere uncontrolled tenderness in surrounding tissue. The
procedure is useful for the purpose of preventing proper regeneration of wounds. Similarly,
leukocytes gets trapped in capillaries which releases proteolytic enzymes and oxygen metabolites;
thus this is the major cause of endothelial damage (Simka and Majewski, 2012). These injured
capillaries becomes more porous to several macromolecules; therefore along with the same, it
amends the degree of fibrin deposition. Obstruction by leukocytes also leads to ischemia and this
also amends tissue hypoxia and reperfusion damage.
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Dysregulation of several cytokines
Improper regulation of inflammatory cytokines develops more tumours because it is
integrated with the growth factors that has tumour necrosis factor -α (TNF-α), TGF-β and matrix
metalloproteinases. Hence, this leads to chronicity of the ulcers and as a consequence it creates
more issues in the leg.
ANALYSIS OF THE UNDERPINNING KNOWLEDGE AND ITS APPLICATION TO THE
NURSING PROCESS
In health care, Carper’s model play a crucial role in knowing the body of knowledge that
possess the discipline and that also refines the properties of knowledge structure. The model is also
useful for the purpose of analysing how different variables are related to each other and how they
function in the process of knowing (Managing the patient journey. 2013). The model is typically
useful in health care sector which helps the practitioners to classify the sources from which
knowledge and beliefs in professional practice can be derived. The typology accentuates chiefly on
four fundamental patterns of knowing such as empirical, personal, ethical and aesthetic.
Empirical knowing is related to factual descriptions, explanations and predictions of the
disease and it also refers to knowing about the expressed aspects can be shared with patients about
the disease. Ethic refers to involvement of moral obligations, values and desired beliefs that assists
in treating the patients in appropriate manner (Nherera and et.al. 2016). Personal knowing is other
dimension that assists the health care practitioners to deliver prominent services to the patients. It is
also significant for the purpose of developing effective relationship among nurse and patients.
Aesthetic knowing reflects that nurses should perceive the things in positive manner so that patients
can address their issues prominently. All these aspects in nursing are crucial for developing a
comprehensive clinical perspective.
Carper’s theory can be applied for Mrs Mary Jones so that she can address the outcomes of
the nursing process. As per empirical knowledge, it is essential for the district nurse to properly
identity the root cause of the problem so that specific solutions can be delivered to Mrs Mary Jones.
The pattern of knowing the information is something designated as nursing science which does not
exhibit systematic explanation of mature science (Fundamental Patterns of Knowing in Nursing.
2012). However, it could be argued that some of these structures have greater value since that gives
systematically explanation about identified occurrence. While most of the researchers depict that
this is the matter that needs to be adequately determined by valid research. For producing empirical
reality, explanatory concept can be utilized at the same time.
Nurses should also use moral obligations and values so that Mrs Jones can feel better while
getting services for venous leg ulcer. Empathy is also other aspect that needs to be considered for
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the health care practitioners as that shows the capacity of the nurses for experiencing other’s
feelings (Pipe and et.al. 2005). This plays essential role in treating Mrs Mary Jones in effective
manner. Skilled nurse becomes more competent in perceiving the problems of Mrs Jones because
they have more empathy with other; hence this can increase the knowledge and understanding level.
Ethical pattern of knowing in nursing is essential because it includes the understanding of diverse
philosophical aspects which further also specifies right and wrong values in the service provision.
Moral choices should be made according to the specific actions and additionally, this can develop
concrete situations (Cheung, 2009). However, on the other hand the knowledge of ethical codes will
not provide any sort of answer to moral questions which is involved in nursing. Further, it will also
not eliminate the requirement of having access to moral choices; but it can meet the requirements of
appropriate treatment.
Personal knowing is also essential in this case as through this, Mrs Jones would be able to
develop prominent relationships with the nurses and care practitioners for her own betterment
(Rasmussen and et.al. 2016). At the same time, personal knowledge is concerned with the knowing,
encountering and finding out the actual aspects of the matter; hence this could strive the nurse to
know the issue. Several aspects are involved in the realm of personal knowing which can be further
categorized into subjective and existential aspects. Thus, it can be said that it is concerned with the
sort of knowing the aspects that promotes wholeness and integrity in impersonal orientation.
This is also significant for the purpose of addressing the level of satisfaction from the
subsequent treatment and therapies. Aesthetic knowing is also vital for analysing the behaviour and
attitude of nurses towards Mrs Mary Jones. There should be proper communication at the time of
treating Mrs Mary Jones so that she can specify all the medication that she got from the treatment.
Further, it is also essential for the nurse to get consent from Mrs Jones as she has the right to be
informed about the treatment which she is getting (Ratliff and et.al. 2016). Nursing process for Mrs
Jones should be a collaborative exercise where in all the professionals should discuss each and
every aspect with the team members and patient as well. Unna boot, and moist bandage are the most
common forms that can be applied at the time of treating venous ulcer. The entire process of
applying the bandage is hardened; hence this increases the level of pain.
Types of assessment
 Mini Assessment: Mini assessment is a short record a patient that derives from instant visual
and physical assessment. Under this assessment, nurses ascertains patient’s airway,
breathing and circulation aspects. It also analyses mental status so that overall performance
can be identified (Simka and Majewski, 2012). With the help of such assessment, level of
consciousness and important symptoms of patient’s health problem can be recognised.
 Comprehensive Assessment: Comprehensive assessment includes details about patient’s in-
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depth health status. It also conducts physical examination so as to ascertain the risk factors.
It can be conducted at the time when patient enters in the care home and also when the
health care practitioner carry out physical examination of the health. Patient’s previous
health status are required to be examined in the same assessment so that new treatment and
service delivery can be provided (Shai and Maibach 2007).
 Target Assessment: Target assessment is also referred as a focused assessment in which
specific condition of the patient is identified through several medical processes. This
includes an assessment of a specific condition, problem along with the assessment for day
care.
Thus, according to the types of assessment, district nurse (working for Mrs Mary Jones) has
undertaken Target Assessment so as to find out the reasons that generates venous leg ulcer in the
lady. This has included the categories of services that are available for Mrs Jones. Looking towards
the condition of the lady, it can be said that Mrs Jones should consult range of practitioners so that
to get recovered as soon as possible. Moreover, the assessment could also help the practitioners to
meet their specific health goals. For more improvement, it is vital for the district nurses to treat
Mary Jones in prominent manner so that she can come out of the problem immediately.
Mrs Mary Jones is potentially facing several problems related to leg ulcer and from last few
months, her leg tissue is getting red, flaky and itchy (Norton and et.al., 2009). Further, unpleasant
and foul smelling discharge is also observed from the ulcer which is even more painful to suffer.
Thus, it can be said that the level of infection is increasing due to bacterial infection. Mrs Mary
Jones is also complaining of a green unpleasant discharge from the ulcer and most of the time, she
faces issues from high fever which is intolerable as well. Further, Mrs Jones is also complaining of
foot ulcers and this susceptibly leads to minor trauma a few times.
Hence, it can be said that as a part of the inpatient assessment, the district nurse of Mrs
Jones should obtain an oral health history including health practices and current state of oral health.
At the time of conducting this assessment, it is vital for the practitioners to be aware about the
aspects that affect the oral health of the patient (Negus and et.al., 2005). This comes under nutrition
care of the patient. As compared to conventional therapy, nurses and doctors should emphasize
more on MPFF therapy which is cost effective as well. It reduces healing time of the ulcer; hence
improves quality of life of patients. Along with Compression therapy, Mrs Jones is also prescribed
Pentoxifyline (Trental) as it is useful monotherapy. Thus, according to the medical history, it can be
said that either Mrs Jones should enhance the dose of lisinopril or she should take Aspirin (300mg)
per day with compression therapy.
Methods of assessment data collection
Subjective assessment of data collection is known as qualitative where in data is derived
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through sensory observation and also through overall impression of specific phenomenon. It tends
to work with fewer subjects which also decreases statistical significance of the data; however at the
same time it generates deeper understanding about the study. In the present case, subjective
assessment has been utilized for the purpose of identifying the condition of Mrs Mary Jones and
how effectively she is getting treated from the district nurses (The Difference Between Objective
and Subjective Data. 2013).
Objective assessment is yet another category where in data is collected through high tech
machines and in the present case, this assessment has been utilized for ascertaining medical
condition of Mrs Mary Jones (Nherera and et.al., 2016). District nurses have conducted survey and
it has been identified that Mrs Mary Jones needs more treatment for the purpose of getting
recovered as earlier she got different medication such as compression therapy and other medicines
as well.
Range of prevention and therapeutic interventions
Acute psychosis is a collective psychiatric emergency that might exist in health care
services. Mrs Mary Jones is one of the first episode; hence she is best treated by specialists’ multi-
disciplinary district nurses who are capable in psychosocial interventions. Wounds on the lower legs
usually develops and it causes problems in veins or arteries. Venous leg ulcers are regarded as open
lesions that occurs between the knee and ankle joint and as a consequence it develops venous
disease. The prevalence of venous leg ulcer is between 0.18% and 1% and over the age of 65, the
level of prevalence increases to 4% (Treatment Options for Leg Ulcers. 2013). The ulcer also
depicts the advanced form of chronic venous disorders such as varicose veins and
lipodermatosclerosis.
With appropriate treatment, venous leg ulcers heal within three to four months and treatment
should be carried out by a health care professional who is trained in compression therapy. This is
especially practiced by a district nurse and health care practitioners. Cleaning and dressing the
wounds properly could improve the health condition of the patients.
Cleaning and dressing the ulcer
The first step is to remove all the debris or dead tissue from the ulcer and that can be done
with the help of proper dressing. Simple as well as non sticky dressing could be used for the
purpose of dressing the ulcer. Further, in order to improve vein circulation in the legs, nurses should
apply a firm compression bandage over the affected area (Kirsner and et.al. 2016). These bandages
are usually designed to squash the leg and manage the circulation of blood. There are several elastic
stockings available at market that can be used to treat venous leg ulcers. However, compression
bandage should not be applied to an unhealthy ulcer as that can increase the frequency of pain.
Patients should try to keep active in walking so that swelling level can be reduced.
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Apart from these, there are several other effective aspects also that can improve the
condition. In the case of thrombophilic condition, several factors are depicted such as V Leiden
mutation, prothrombin mutations and hyperhomocysteinemia are also implicated at the same time.
The other presented hypothesis also suggested that endothelium is damaged by enhanced venous
pressure and leukocyte activation (Jull and et.al. 2016). At the same time, proteolytic enzymes and
free radicals are released with the help of this process and it also outflows the leaky vessel walls.
This results in damaging the surrounding tissue and leads to more injury and ulceration in the
specific part. Along with this, studies conducted on this sphere has also shown a direct relationship
amid obesity, chronic venous disease and popliteal venous compression. The particular syndrome
also explains the causes and ways through which venous generates in human body. Intra- abdominal
venous compression is another reason that increases the incidence of vascular ulcers in patients who
have issues related to obesity.
Therefore, according to the situation of Mrs Mary Jones, nurses should adopt therapeutic
and supportive intervention so that motivation can also work for her improvement. Earlier,
preventive measures were implemented so as to protect Mrs Mary Jones from venous leg ulcer.
Instead of adopting diverse measures for prevention, the patient got affected from the ulcer
(González, 2016). Hence, under supportive intervention, nurses and practitioners should provide
encouragement to the patient so that she can take care of her leg in effective manner. Supportive
intervention is also significant for the purpose of adopting less medication. Proper dressing as well
as cleaning is required so that green discharge that comes from the ulcer may not affect the
surrounding tissue.
Guidance from national and international bodies
In the above section, it has been discussed that Mrs Mary Jones is provided preventive
intervention under the guidelines given by NICE. As per the guidelines necrotic material or slough
within a wound margin acts as a source for bacterial proliferation; thus it should be removed by
debridement. Here it can be said that prevention intervention is supported by NICE guidelines;
hence district nurses have given local anaesthetic cream (EMLA) to reduce the pain of sharp
debridement in Mrs Mary Jones (Gabriel and et.al. 2016). Further, general care of the skin is also
taken so as to maintain skin integrity and risk of further ulceration. From the medical history, it has
been identified that Mrs Mary Jones is given treatment through Compression therapy as well which
aims to improve venous return and at the same time it also reduce venous hypertension. Hence, as
per the guidelines of NICE, compression includes healing of venous leg ulcer with seven RCTs.
CONCLUSION
Summing up the study, it has been identified that most of the venous leg ulcers heal within
three to four months if they are properly treated by a health care professional who is trained in
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compression therapy for leg ulcers. Nurses use a wide range of theoretical and practical knowledge
in their work. It is the means through which the whole purpose of caring for patients is achieved
because it underpins the practices of health care services. Prominent knowledge is required so that
appropriate level of care can be provided to the patients.
Nursing knowledge is dynamic, evolving and a relatively new profession; therefore prior
delivering any health care service, it is essential for the practitioners to focus on systematic nursing
process. The financial burden of venous ulcer is estimated to be 1 billion pound per year in the UK.
This impacts the economic stability of UK and as a result, overall economic aspects gets impeded.
Thus, from the above study it is clear that venous hypertension as well as leg ulcer both can be
overcome with the help of proper intervention. The district nurses are required to adhere the
following care plan for treating Mrs Mary Jones in adequate way.
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16

APPENDIX
Care plan for Mrs Mary Jones
Assessment Diagnosis Planning Intervention Rationale
Mrs Mary
Jones has
been facing
issue from
venous leg
ulcer and the
district nurses
have
identified that
she further
has
hypertension
as well.
Her problem
has been
identified
after
conducting
target
assessment
where in
specific focus
has been
given to
particular
case of Mrs
Mary Jones.
Mrs Mary Jones
has to undergo
with a test
conducted by
Doppler machine
for testing her
blood supply
level. After that,
physical
examination has
been carried out
like brachial
index,
venography,
plethysmography
and
ultrasonography
for getting detail
information
about the
ulceration.
In order to
treat the
patient,
proper
services are
required to be
given so that
the level of
ulceration can
be
minimized.
However, it
has also been
observed that
after every 8
hours, nurses
have changed
the dressing
under
treatment
regimen.
Diet chart
will be made
for her in
terms of
managing her
nutritional
aspects.
For the
present case,
preventive
and
supportive
intervention is
essential so
that Mrs Mary
Jones can get
recovered
from venous
leg ulcer and
hypertension
both the
issues.
Supportive as
well as the
preventive
intervention
has been
suggested for
Mrs Mary
Jones because
so that heart
problem may
not arise in
her.
However,
proper
cooperation
and support is
required so
that the case
can be
prominently
managed.
17