A nurse is caring for a client. Exhibits For each assessment finding, click to specify if the assessment finding is consistent with an arterial ulcer, a venous ulcer, or a diabetic ulcer. Each finding may support more than one disease process.

Assessment Findings Arterial ulcer Venous ulcer Diabetic ulcer +1 posterior tibial pulse ✓ ✓ Hair loss ✓ ✓ History of hypertension ✓ ✓ ✓ Pale wound bed ✓ ✓ Pain at ulcer site ✓ ✓ Defined edges ✓ ✓ Skin cool to touch of the affected extremity ✓ ✓ +1 posterior tibial pulse: A diminished pulse supports arterial insufficiency and is frequently seen in both arterial and diabetic ulcers due to vascular complications in diabetes. Venous ulcers usually have normal pulses unless complicated by edema. Hair loss: Loss of hair on the lower extremities is a classic sign of arterial insufficiency, but it is also common in diabetic neuropathy where circulation is impaired. Venous ulcers rarely show this sign. History of hypertension: Hypertension is a risk factor for arterial disease, venous insufficiency (due to increased venous pressure), and diabetes-related vascular complications, making it relevant to all three ulcer types. Pale wound bed: Pallor in the wound bed suggests poor oxygenation and perfusion, which is characteristic of arterial ulcers. Diabetic ulcers may also have poor granulation due to impaired healing. Venous ulcers are more often red and moist. Pain at ulcer site: Pain with walking that improves with rest suggests intermittent claudication and ischemia, consistent with arterial ulcers. Diabetic ulcers can also be painful, especially if infection or inflammation is present. Venous ulcers tend to cause more aching or heaviness rather than sharp pain. Defined edges: Ulcers with sharply demarcated, punched-out edges are typical of arterial and diabetic ulcers. Venous ulcers usually have irregular, shallow borders. Skin cool to touch of the affected extremity: Cool skin reflects decreased blood flow and is characteristic of arterial ulcers. It is also common in diabetic ulcers due to associated peripheral artery disease. Venous ulcers tend to have warm, swollen limbs due to fluid accumulation.