Lower limb ulceration is a common, debilitating and costly condition that accounts for over one third of chronic wounds in the UK. The most common underlying causes of leg and foot ulceration are venous insufficiency, arterial insufficiency, lymphoedema and diabetic neuropathy. More than half of leg ulcers do not have a recorded diagnosis and are unlikely to receive appropriate care. Poor care can cost up to ten times as much as appropriate care. The Legs Matter campaign aims to change this situation through a public health campaign supported by a website: http://legsmatter.org. The website provides clearly written, easily accessible information for patients, the public and generalist healthcare professionals along with signposts to reputable sources of information. In this way, the campaign aims to raise awareness that leg and foot conditions can be improved with the right care.
Compression is the key to management of lymphoedema and multilayer bandaging has been considered the gold standard. This article looks at adjustable Velcro compression devices as an alternative to multilayer bandaging. The author finds that the devices enable patients to maintain the required pressure in between consultations with healthcare professionals. They also allow for changes in limb volume and can help with concordance, as well as cutting down on the time clinicians need to spend with patients as the devices promote self-management.
This article is the second in a two-part series on managing common lower limb problems encountered in primary care. The first article in the series (Brown, 2017) discussed the causes of oedema and its relation to underlying conditions, such as venous disease, lymphoedema and lipoedema. This article investigates skin care, the management of ‘wet legs’ and the different types of compression therapy available to non-specialist community nurses.
This article focuses on the work of a team of community nurses running a primary care drop-in centre. As well as a full range of clinic services, the team sees a lot of leg ulcer patients for compression bandaging. A common problem with traditional compression bandaging is the amount of time that community nurses have to spend on the procedure, as well as the dangers of maintaining pressure and bandage slippage between dressing appointments, which can result in discomfort for patients and even skin damage in some cases. This also has implications for patient concordance. This article looks at a review by the team of a new compression system (juxtacures®; medi UK), which offers measurable and adjustable compression and a greater involvement by patients in their own care, which in turn can minimise the time nurses need to spend on dressing changes.
By reading the article, you can learn all about the key principles of subjects that are vital to your role as a community nurse. Once you have read the article, visit www.jcn.co.uk/learning-zone/ to evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate, which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning.
Compression therapy can play a vital role in improving the quality of life for those with chronic venous insufficiency, chronic oedema and lymphoedema (Lymphoedema Framework, 2006; World Union of Wound Healing Societies [WUWHS], 2008). In particular, compression bandaging can facilitate wound healing and oedema reduction in the treatment phase of management, before further healing and maintenance with compression hosiery.
This article provides an overview of lymphoedema and its management. It includes information on the definition of lymphoedema, anatomy (lymphatics), lymphoedema staging, complications and the psychosocial impact. This leads onto a discussion of the management methods that can be delivered by community staff and practice nurses who have received appropriate training. Involving patients and their family/carers in all aspects of the management plan can help them to cope with this lifelong condition and promote concordance with treatment.
Millions of people across the world are affected by lymphoedema. Physical treatments commonly combine skin care, compression therapy, exercise and manual lymphatic drainage. Increasingly, surgery has been recognised as providing benefits for some individuals with lymphoedema, although the evidence is still limited. This article overviews lymphoedema types and treatments, discusses different surgical approaches for people with lymphoedema, and the implications for community nurses.
Dr Anne Williams Nurse Consultant/ Researcher, Esk Lymphology, Midlothian
Article accepted for publication: January 2012
Anne Williams explores the issue of cancer survivorship from the perspective of women who have undergone breast cancer treatment. The article examines three specific aspects relevant to breast cancer and its treatment: fatigue; psychological distress; and lymphoedema. It considers the implications for health professionals such as community nurses in supporting women who are living with and beyond breast cancer.
Anne F Williams, Macmillan Teaching Fellow, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN
Article accepted for publication: October 2011
Rosemary Pudner considers the issues involved when managing a patient with a leg ulcer.
Rosemary Pudner discusses the special needs of patients who have a fungating or malignant wound.
