Wound care assessment
SN instructed patient about how the thyroid hormone helps regulate metabolism. When this hormone is abnormally low the energy production decreases, disrupting many vital functions. This can include skin issues such as: Coldness in the fingers and feet with pale and dry coarse skin, eczema, a yellowish hue to the skin, sparse and brittle hair, which comes out in handfuls, loss of hair in the outer third of eyebrows, slow growing, ridged and brittle nails, edema in face, eyelids, hands and feet, and delayed wound healing. Some of these things can be avoided if you are taking your replacement medication daily as ordered and are getting regular blood work to assure the medication is at the correct dose.
SN explained that the Chronic venous insufficiency ( CVI ) can’t be cured, but you can control leg swelling to reduce the likelihood of ulcers ( sores ). Recognizing the symptoms Be aware of the following: If you stand or sit with your feet down for long periods, your legs may ache or feel heavy. Swollen ankles are possibly the most common symptom of Chronic venous insufficiency ( CVI ). As swelling increases, the skin over your ankles may show red spots or a brownish tinge. The skin may feel leathery or scaly, and may start to itch. If swelling is not controlled, an ulcer ( open wound ) may form. What you can do Reduce your risk of developing ulcers by doing the following: Increase blood flow back to your heart by elevating your legs, exercising daily, and wearing elastic stockings. Boost blood flow in your legs by losing excess weight. If you must stand or sit in one place for a period of time, keep your blood moving by wiggling your toes, shifting your body position, and rising up on the balls of your feet. Pt verbalizes understanding.
SN instructed patient/cg regarding diet modification promoting wound healing: increase protein in your diet. Food reach in protein: eggs, meat, cheese, milk, fish, peanut butter, legumes. Drink at least 8 glasses of water every day. Eat food reach in vitamin C ( citrus fruits and juices, strawberries, tomatoes, broccoli, potatoes) and zinc such as fortified cereals, red meat, and seafood. Patient Verbalize 80% understanding: Requires more instructions.
Patient instructed on the importance of drinking 6-8 glasses of water per day. Hydration is important for wound healing, healthy skin, digestion, healthy kidneys, and electrolyte balance. Instructed on the increased risk for dehydration during the summer months.
Instructed in measures important in foot care of the diabetic: wear shoes that support and fit properly, wear socks that are clean and fit properly, avoid going barefooted, etc.
Instructed in the importance of proper foot care, including the wearing of properly fitting shoes and socks, correct trimming of the toe nails, and avoidance of injury to the legs and feet.
Patient was instructed about foot care, trying non-impact exercise such as swimming, cycling, yoga, and tai chi are increasingly popular ways to exercise - with minimal impact on the feet. Talk with the doctor before starting an exercise program. Further teaching is needed.
Patient was instructed on foot care: a podiatrist can also fit patient with shoe inserts called orthotics to support the feet if have diabetic nerve pain or the muscles have become weak from nerve damage. If pain or weakness is so severe that it's too painful or even impossible to walk, a foot brace or orthopedic shoes might help. Further teaching is needed.
If your big toe slants sharply in toward your other toes, with a big bump on the knuckle of your big toe, you've got a classic bunion. Corns are spots of thick, rough skin, where the tissue builds up on toes constantly barraged by too much rubbing or pressure. A buckled-under toe, called a hammertoe, can result from muscle weakness caused by diabetic nerve damage. All of these make it hard to fit shoes comfortably. But a good podiatrist can help you fix these problems and take better care of your feet.
Patient was instructed on the importance of a good skin care which can prevent most pressure sores (bedsores) which develop in people who have already skin damage, who are mentally confused, who are bed bound or cannot turn side to side.