Wound care assessment
SN instructed that keeping your regular cast dry is very important! There are no devices that are 100% effective in keeping any cast dry. Sponge baths are the safest way to keep the cast dry. If you have to take a bath or shower, please follow these instructions: place a towel or washcloth around the upper portion of the cast. Cover the entire cast with 2 plastic bags ( use two in case one has a leak, secure the bag at the top with tape or a rubber band, if the cast gets moist, dry the top or bottom of the cast using a blow dryer. Use only the cool or low setting, if the cast is soaked all the way through, it needs to be changed ( call doctor office )
RN performed supervision with HHA present and reviewed that the HHA Care Plan is followed as ordered. Patient is satisfied with rendered services. RN instructed patient and caregiver on strategies that can significantly help decrease the risk of a fall such as: skid - proof mats or strips in the shower and bathtub, removal of furniture that can slip away if grabbed accidentally for support, supportive non - slip footwear and not walking in stocking feet. RN also explained that side effects of most medications taking can cause dizziness and advised to immediately report the occurrence of dizziness so that it can be addressed by physician. Patient and caregiver voiced understanding of all instructions given.
SN instructed patient about tracheotomy care dressing changes promote skin integrity and help prevent infection at the stoma site and
in the respiratory system. The patient should be instructed at least once per shift, apply a new dressing to the stoma site to absorb secretions and insulate the skin
. After applying a skin barrier, apply either a split - drain or a foam dressing. Change a wet dressing immediately.
SN instructed patient that eliquis could cause bruising, internal bleeding, increased bleeding time so if any falls, severe cuts or unexplained pain or pain pressure call 911 anytime you think you may need emergency care. For example, call if: You cough up blood, you vomit blood or what looks like coffee grounds, you pass maroon or very bloody stools. Patient was able to be taught back.
SN instruct the patient the following symptoms could be signs of a heart attack: chest discomfort, discomfort in one or both arms, back, neck, jaw, stomach, shortness of breath, cold sweat, nausea, or dizziness. Call 911 for emergent care if you experience any of these s / s ( symptoms / signs ).
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.
SN instructed patient that fluid restrictions are usually necessary when dialysis is initiated, especially if dialysis only occurs three days a week and if urine production is decreased. Build up of fluid can lead to shortness of breath, swelling, and high blood pressure. There is a limit to the amount of fluid that can be safely removed during dialysis. If fluid limits are exceeded and extra water must be removed, negative effects such as muscle cramping, low blood pressure leading to nausea, weakness, dizziness, and possibly extra dialysis sessions to remove the fluid.
SN instructed patient / caregiver about a few simple precautions that can be taken to create a safe home environment when using oxygen. Oxygen canisters should be kept at least 5 - 10 feet away from gas stoves, lighted fireplaces, wood stoves, candles or other sources of open flames. Do not use electric razors while using oxygen ( These are a possible source of sparks ). Do not use oil, grease or petroleum - based products on the equipment. Do not use it near you while you use oxygen. These materials are highly flammable and will burn readily with the presence of oxygen. Avoid petroleum - based lotions or creams, like Vaseline, on your face or upper chest. Check the ingredients of such products before purchase. If a skin moisturizer is needed, consider using cocoa butter, aloe vera or other similar products. For lubrication or rehydration of dry nasal passages, use water - based products. Your pharmacist or care provider can suggest these.
SN instructed patient on ways to avoid acute exacerbations of chronic obstructive pulmonary disease ( COPD ) by recognizing early warning signs and then taking action to stop them in their tracks. The best way to do this is to work with your health care provider on an action plan so you know what to do to treat an exacerbation before it becomes serious. SN instructed on early warning signs of an acute exacerbation: Wheezing or more wheezing than what’s normal for you, coughing more than usual, shortness of breath that is worse than usual, an increase in the amount of mucus, change in the color of your mucus to yellow, green, tan, or bloody, shallow or rapid breathing, more than what’s normal for you, fever, confusion or excessive sleepiness, and swelling in your feet or ankles. Patient nods head in understanding. Sn will continue to monitor.
SN explained that the problems with the veins in the legs may lead to chronic venous insufficiency ( CVI ). CVI means that there is a long-term problem with the veins not being able to pump blood back to your heart. When this happens, blood stays in the legs and causes swelling and aching. Two problems that may lead to chronic venous insufficiency are: Damaged valves. Valves keep blood flowing from the legs through the blood vessels and back to the heart. When the valves are damaged, blood does not flow as well. Deep vein thrombosis ( DVT ). Blood clots may form in the deep veins of the legs. This may cause pain, redness, and swelling in the legs. It may also block the flow of blood back to the heart. Seek immediate medical care if you have these symptoms. A blood clot in the leg can also break off and travel to the lungs. This is called pulmonary embolism ( PE ). In the lungs, the clot can cut off the flow of blood. This may cause chest pain, trouble breathing, sweating, a fast heartbeat, coughing (may cough up blood), and fainting. It is a medical emergency and may cause death. Call 911 if you have these symptoms. Healthcare providers call the two conditions,Deep vein thrombosis ( DVT ) and pulmonary embolism ( PE ), venous thromboembolism ( VTE ).