Chronic oedema is a common condition which is increasing in prevalence, yet is still often under-recognised and mismanaged in community settings. Any oedema is a sign that the venous and lymphatic systems are not working properly. Without early identification and intervention, the condition can worsen, resulting in the need for complex care. Using a case history, this article highlights the inappropriate and ineffective use of medicinal management of a patient with lymphorrhoea (i.e. wet, ‘leaky’ legs). As a result of health assessment and a review of management and medication, deprescribing was effectively implemented in this case. The patient was provided with compression hosiery and education, and supported by a Healthy Legs clinic in the South Eastern Health and Social Care Trust, with positive outcomes for the patient, treatment room and GP. The case demonstrates how good practice uses health assessment and symptom analysis to determine diagnosis and appropriate treatment options. It also poses the question: is pharmacology always the answer?
Chronic oedema is a common condition which is increasing in prevalence, yet is still often under-recognised and mismanaged in community settings. Any oedema is a sign that the venous and lymphatic systems are not working properly. Without early identification and intervention, the condition can worsen, resulting in the need for complex care. Using a case history, this article highlights the inappropriate and ineffective use of medicinal management of a patient with lymphorrhoea (i.e. wet, ‘leaky’ legs). As a result of health assessment and a review of management and medication, deprescribing was effectively implemented in this case. The patient was provided with compression hosiery and education, and supported by a Healthy Legs clinic in the South Eastern Health and Social Care Trust, with positive outcomes for the patient, treatment room and GP. The case demonstrates how good practice uses health assessment and symptom analysis to determine diagnosis and appropriate treatment options. It also poses the question: is pharmacology always the answer?
The second in this four-part series exploring leg ulcer management and understanding compression therapy examines the role of assessment as the basis for optimal clinical practice. The authors explore how the findings of thorough assessment can influence treatment choice. Adopting an holistic, person-centred approach to assessment, which includes taking an ankle brachial pressure index (ABPI) reading and involves the patient in decision-making will help nurses to make effective clinical decisions and plan care in partnership with patients. This article discusses a three-stage assessment and clinical decision-making process, which involves looking at the whole person, assessing the leg and the wound. The next article in the series will examine compression hosiery and adjustable wraps for the management of the lower limb.
Using applied wound management as an assessment tool Simon Barrett describes how district nurses could enhance their practice. Simon Barrett RGN, BSc Nursing is a Tissue Viability Nurse Specialist for East Yorkshire PCT. Article accepted for publication: February 2005
Antoinette Whitrick writes about how a secondment opportunity from District Nursing developed into a valued community service.
Antoinette Whitrick. BSc(Hons). RGN. Dip DN. PG.Cert in Health and Social Care Management - is Specialist Nurse Physical Disabilities for the East Riding of Yorkshire Primary Trust
Article accepted for publication: March 2007
Ann Winder gives a guide to the appropriate use of intermittent catheterisation.
Ann Winder RGN, Head of Continence Services & Professional Lead – Specialist Adult Services, Hertfordshire
Article accepted for publication: January 2008
Edwin Tapiwa Chamanga discusses the use of the Waterlow assessment tool in wound management
Edwin Tapiwa Chamanga RGN, BSc (Hons), (BSc Hons) Specialist Community Practice (District Nursing), currently reading for an MSc Skin integrity skills and treatments is a Tissue Viability Nurse Specialist, City and Hackney Primary Care Trust, London
Article accepted for publication: September 2009
Acknowledgement: The author would like to acknowledge the contribution of Mr. Prince Sunkwa-Mills, a student in MSc Health Informatics, who assisted in some of the research for this article.
