Marvin, a 42 year old factory worker, comes to his physician complaining of an open sore...

Marvin, a 42 year old factory worker, comes to his physician complaining of an open sore on his left shin that does not seem to be healing. As the doctor unwrapped the bandage the patient had applied, a strong odor was detected. She identified the wound as an infected venous stasis ulcer. She noticed that the lower leg was edematous and the skin of the foot and ankle was somewhat discolored. Portions of the saphenous vein were visibly distended and tortuous. An oral history revealed that the patient stood at a workbench all day on the job. She explained to the patient that his varicose veins were caused by valvular incompetence in his veins. This had progressed to the chronic venous insufficiency he was now suffering from. After the infection was controlled with antibiotics, the patient was advised to wear elastic stockings, sit down at work whenever possible and to perform toe raises every 5 minutes if he did have to stand up for extended periods. 1. What is the likely cause of the patient’s valvular incompetence? 2. Why does valvular incompetence lead to varicose veins and chronic venous insufficiency? 3. Why does venous insufficiency result in edema and venous stasis ulcer formation? 4. What is the likely reason that the ulcer became infected? 5. What is the rationale for the advice about stockings, seated posture and leg raises?

Expert Solution

1) The likely cause of venous insufficiency is varicose veins.

2) When forward flow through the veins is obstructed — such as in the case of a blood clot — blood builds up below the clot, which can lead to venous insufficiency.

3) The increase in pressure stretches the vein walls, allowing proteins in the blood and blood cells to leach into the subcutaneous tissues, resulting in edema.

In venous insufficiency, the valves are damaged, and blood backs up and pools in the vein. Fluid may leak out of the vein and into the surrounding tissue. This can lead to a breakdown of the tissue and an ulcer. Veins that become blocked also may cause fluid to pool, leading to these ulcers.

4) Ulcers become infected because of bacterial contamination .

5) Compression stockings are specially designed to apply pressure to your lower legs and helps to maintain blood flow and reduce discomfort and swelling. Exercise also improves blood flow and decreases discomfort and swelling.

Nightingale answered 1 year ago

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