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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 ).
Sn instructed patient on ways to prevent Urinary tract infection ( UTI ). If the patient is elderly be careful with cleaning, be sure that the perineal area is being cleansed properly. Women should always wipe themselves from the front to the back. If you are tending to perineal care, take steps to ensure that you always wipe your starting in front of the urethra and wiping towards the anus. Before wiping the area again, fold the rag to a clean section. The idea is that residue from the anus should never be dragged toward or against the urethra. Patients that wear adult diapers, or briefs, should be changed on a regular basis. They should be checked every two hours or so and they should never be allowed to sit in dirty briefs for prolonged periods. You should also wiped and cleansed after every brief change and bowel movement. Douches should never be used. The right drinks - what you drink can make a difference. Caffeinated drinks and alcohol can irritate the bladder and should be avoided as much as possible. Patient and caregiver verbalized understanding.
Tracheostomy care Instructed patient caregiver It is important to routinely clean the skin around the opening of the tracheostomy (stoma). This will help prevent skin irritation and the build-up of secretions.
Urostomy care Instructed patient When to Change the Pouch. Most urostomy pouches need to be changed 1 to 2 times a week. It is important to follow a schedule for changing your pouch. DO NOT wait until it leaks because urine leaks can harm your skin.
SN instructed patient and care giver that Silvadene is used with other treatments to help prevent and treat wound and skin infections. Silver sulfadiazine (silvadene) works by stopping the growth of bacteria. Silver sulfadiazine belongs to a class of drugs known as sulfa antibiotics. Possible SE may include: pain, burning, or itching of the treated skin. Skin and mucous membranes (such as the gums) may become blue/gray in color. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Instructed patient to cleanse feet daily, dry thoroughly especially in between toes. Examine feet daily for bruises/sores/blisters, if any noted, notify MD asap. (use a mirror if needed to visualize) Wear proper fitting shoes and wear slippers/shoes at all times, and exercise feet daily. Demonstrated feet exercises, verbalized understanding.
SN Instructed to the urostomy care: How to change the Urostomy bag: Prepare the new bag. Gather everything you need in the bathroom: plastic bags, toilet paper, paper towels or a soft washcloth, a clean cloth wipe, an additional skin barrier in the form of a paper towel (if desired) and a new bag.If the bag you use does not come with a skin barrier already made, take the measurements and now form the opening with scissors. Slowly remove the skin barrier lining. Put aside the skin barrier. Empty the used bag before removing it. To empty the bag, sit on the toilet or stand in front of it: Remove the used bag. To remove the used bag, sit on the toilet or stand in front of it. Carefully separate the skin from the skin barrier with one hand. To do this, start at the top edge of the skin barrier. With the other hand, slowly release the skin barrier from top to bottom. Seal the used bag tightly inside a plastic bag and dispose of it in the trash: Clean the area around the stoma. Use toilet paper to clean urine and mucus in the stoma or the skin around it. Clean the skin with warm water and a soft cloth wipe or a paper towel. Clean up to the stoma border. You can also do this while showering. Dry the skin without rubbing, using a clean towel; and Place the new bag. Use a folded paper towel or a piece of gauze to keep the stoma dry while placing the new pouch. Once you have changed the bag, wash your hands.
Instructed patient check for redness, swelling, any drainage or excess skin growing around the tube. A small amount of clear tan drainage can be normal. Call your care team with any concerns. Instructed patient remove old dressing (if dressing is being used). Look at the area where the tube enters the skin
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.