care-teeth
Others
SN teaching the patient / caregiver on S / S ( signs / symptoms) of wound infection to report to physician, such as increased temp >100.5, chills, increase in drainage, foul odor, redness, or unrelieved pain.
SN instructed patient / caregiver on service authorization, advance directives, rights and responsibilities, rights of the elderly and obtained necessary signatures. Instructed patient / caregiver on 24 hour nurse availability and provided / posted the agency telephone number. Also instructed that after hours, weekends and holidays an answering service will reach the nurse and he / she will return the patient / caregiver call and answer any questions or make a visit if needed. Patient and caregiver stated understanding. Patient and caregiver educated on diabetic diet, diabetic foot care, symptoms / signs ( s / s ) of depression, managing pain with medications, healthy skin, and pressure ulcer prevention. Leaflets left in home.
Instructed patient What are some of the benefits of the care wear PICC line cover. The PICC line cover is antimicrobial. It is machine washable and can be machine dried with the rest of the laundry. The PICC line cover has a unique mesh window that allows for air to get into the dressing which is required for the dressing to be fully functional.
Instructed patient about the skin around your stoma should look like it did before surgery. The best way to protect their skin is by: using a bag or pouch with the correct size opening, so waste does not leak, taking good care of the skin around your stoma.
Instructed patient assess bowel sounds in all 4 quadrants, assess effluent from ostomy. Empty pouch when 1/3-1/2 full, assess abdomen, report any abnormal findings immediately.
SN assessed portacath insertion site every visit. SN instructed s/sx to report to SN / MD such as redness, pain, puffiness around port, drainage from insertion site, temperature above 100 degrees, shortness of breath and chest pain. Sn instructed on portacath care and protection of the skin over the port.
Instructed patient When should I contact my healthcare provider. You drain less than 30 milliliters (2 tablespoons) in 24 hours. This may mean your drain can be removed. You suddenly stop draining fluid or think your JP drain is blocked. You have a fever higher than 101.5°F (38.6°C). You have increased pain, redness, or swelling around the drain site. If you have questions about your JP drain care contact your physician.
SN instructed patient and caregiver that the key difference between a suspected deep tissue injury (sDTI) and an unstageable pressure ulcer is that sDTI involves intact skin, whereas an unstageable ulcer involves a breakdown into at least the subcutaneous tissue. An unstageable ulcer is covered with necrotic tissue, such as slough or eschar, formed from remnants of the collagen matrix of subcutaneous tissue. So it’s always a full-thickness ulcer either stage III or stage IV.
SN advised patient to take temperature once a day before bedtime, check for bleeding, pus, hardness, swelling, odor and any color change. If any of these are present, please let your nurse or doctor know as soon as possible. Patient verbalized understanding of instructions given.
SN instructed patient and caregiver on preventing skin tears. In terms of prevention, protective arm sleeves are helpful. The use of paper or gentle release tapes is also a better alternative to nylon tape, when it comes to sensitive or aging skin. In addition, it is important to routinely moisturize dry skin with an appropriate moisturize barrier. As we age, hydrating dry skin helps to replenish missing skin and keep skin healthy and intact. Oral hydration is important as well. Patient and caregiver verbalize understanding instructions given.
