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Nursing Care Plan For Diabetic Foot Ulcer Ppt

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Home Care Nursing: Diabetic Foot Care

NCP 26 Nursing care plan on Diabetic Foot Ulcers/ Diabetes Mellitus Complications/Cellulitis of

October 30, 2016 by Kat Livaskani

In 2012 American Diabetes Association data showed that 29.1 million Americans or 9.3% of the population had diabetes. This figure includes 11.8 million seniors. Seniors often experience many health issues which frequently lead to hospitalization. In fact, additional research done by the ADA found that patients with diabetes were most commonly admitted to the hospital for comorbidities, resulting in diabetic care largely being overlooked. At discharge, these patients are often referred for home care services based on their other health concerns referrals for diabetes care only are rare. But a diabetes diagnosis can lead to many complications and greatly contributes to health care expenses. After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes. Diabetes comes with several complications and is often not treated as seriously as it should be. While a nurse may be in the home of a patient because of a different health issue, it is important to also perform appropriate diabetic care to avoid further complications.

Signs And Symptoms Of Pressure Ulcer

The general clinical manifestations of pressure ulcers include:

  • Unusual skin color or texture discrepancies
  • Erythema or redness
  • Edema or swelling in the affected area or limb
  • Discharges foul in odor, can be fluid or pus-filled
  • Warm or cold to touch An area of the affected region that feels different to touch than surrounding areas
  • Tenderness and pain on site

Nursing Care Plan And Diagnosis For Diabetes

This nursing care plan is for patients who have diabetes. Diabetes is where the body is unable to control blood sugar levels due to either the body not being able to produce enough insulin or because the body is resistant to insulin. A normal blood sugar level ranges between 70-150.

Anything below 70 is considered hypoglycemia and anything above 150 is considered hyperglycemia. In this care plan we will be talking about hyperglycemia. In patients who have a high blood sugar the classic three Ps will present such as polyuria, polydipsia, and polyphagia.

Uncontrolled diabetes is mostly common caused by patient knowledge deficient of not knowing how to manage their diabetes properly. Many patients lack the knowledge about diet regimes, how to give insulin properly, sliding scale dosages, common signs and symptoms of high blood sugar, dosing insulin when sick, and how insulin works.

It is the nurses responsibility to educate the patient about diabetes. Some doctors will educate the patient but many times this falls to the nurse. Remember that uncontrolled diabetes can lead to blindness, peripheral vascular disease, and heart problems.

Below is a nursing care plan with diagnosis and nursing interventions/goals for patients with diabetes.

What are nursing care plans? How do you develop a nursing care plan? What nursing care plan book do you recommend helping you develop a nursing care plan?

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Prevention With Home Care Nursing

Diabetic foot problems are largely preventable with proper diabetes management, including diet, exercise, and carefully monitoring blood sugars. This is where a visiting nurse can assist in preventing these complications. It is important that diabetes management be identified as a concern for the visiting nurse so that maintenance is included in the patients plan of care. A diabetes diagnosis is often put on the back burner of elderly care as the focus is placed on other comorbidities. The homecare nurse can address the issues that can help prevent diabetic foot complications while treating the patient for other health issues.

To start, the home care nurse should assess how well the patient is managing the disease in order to try to prevent foot problems from occurring from the start. Make sure the patient is adhering to a balanced diet, getting enough exercise, and adequately monitoring their blood sugars. Education is key to prevention and wellness. Review diet and exercise requirements and make sure the patient knows how to use their glucometer.The following is a list of interventions that should be performed by the nurse or caregiver to prevent and monitor for diabetic foot complications. The patient should also be taught how to do these tasks whenever possible and encouraged to perform them regularly.

Health Education As A Form Of Prevention

Nursing Interventions For Diabetes Mellitus

Therefore, from health education, the patient can understand the reasons why the wound healing process is slow, the reasons for the main complications and especially the knowledge related to risk prevention. Nurses should be able to recognize the needs of the patient and thus contribute to accurate and safe nursing diagnoses related to the wound in its stage.

Scain Franzen Hirakata report that nurses have been maintaining efforts to perform health education with patients, becoming persistent and insistent to continue the educational process in patients with diabetic feet, use creativity with the development of educational technologies such as folders, videos, as well as being available to ask questions about some abnormal condition with the patient from social media technologies such as Whatsapp/phone.

Camillo et al. mentions that the concept of health education goes beyond bringing data or even removing doubts that arise, the authors consider health education a systematic, continuous and permanent process, aiming at the formation and development of critical awareness of the citizen, through the search for collective solutions to the problems experienced and their real participation in the exercise of social control.

Therefore, health education, continuing education and continuing education are forms of care that nurses use to improve the clinical picture of patients with diabetic feet.

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The Nurse Mediator For Self

Speaking of self-care refers to any and all action derived from the daily act of the human being. As for the self-care Arruda et al. report that patients with diabetic foot tend to generate a great economic, social, cultural, emotional and biological impact, which favors a greater dependence on others to help in daily life activities and an impact on their self-care and quality of life.

Scain Franzen and Hirakata report that the patient should be aware of the performance of his own activities and that self-care should be continuous, one of the ways to perform self-care cited by the authors were: Hygiene of the feet choice of appropriate footwear avoid walking barefoot and others.

Vargas et al. brings as self-care the maintenance of glycemic control, the proactive participation of patients in the performance of foot examinations, therapy, absolute restriction to the use of tobacco and beverages, nutrition, physical exercise, physical activity and other forms that contemplate the study previously referenced.

A way to achieve that the patient can aim for self-care is cited by the authors Silva Santo and Chibante as the strengthening of bonds between the patient and health professional. This strengthening favors the safety and credibility of the patient performing self-care to the feet in a continuous and systematic way, the lower the chances of risk of complications.

Diagnosis Of Diabetic Foot Ulcer

  • Medical History. The healthcare provider will determine when the foot ulcer has been noticed and if there are any additional illnesses that could raise the chance of developing foot ulcers, such as peripheral neuropathy or lower extremity arterial disease.
  • Physical Assessment. The foot, toes, and toenails will be checked by the healthcare provider to look for any blisters, wounds, scratches, or ingrown toenails that could cause more ulcers. By sensing the pulse, the healthcare provider also gauges the rate of blood flow in the foot.
  • Wagner Ulcer Classification System. The healthcare provider will most likely rate the ulcerâs severity from 0 to 5 using this system

0: no exposed sores

1: a surface ulcer that has not reached deeper levels

2: deeper ulcer reaching tendons, bones and joint capsule

3: deeper tissues affected with abscess, tendonitis and osteomyelitis

4: gangrene in the heel

5: widespread involvement of the entire foot in gangrene

  • X-ray. To check changes in the alignment of the bones in the foot, which might contribute to an ulcer, the healthcare provider will order an X-ray imaging. X-rays can also show a reduction in bone mass, which may be brought on by hormonal disturbances caused by diabetes.
  • MRI. If the healthcare provider requires further information about the degree of ulcer damage, this test is suggested. Inflammation, which can be an indication of an infection, can also be seen on MRI images.

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Diabetes can be managed through oral medications. In addition to insulin, metformin, which is a sugar-reducing agent, is also a common treatment for diabetes. It is considered a first-line therapy for diabetes treatment and is often added to insulin. It is important to know the risks of taking diabetes medications. Some drugs can be addictive, so you must consult your doctor before taking any medication. Your physician can prescribe you an appropriate treatment plan based on your medical history.

Your doctor will prescribe medication and check your blood glucose levels on a regular basis. Your A1c level will be checked every six months and your cholesterol levels will be tested regularly. Your doctor will also look for any signs of retinopathy, which is damage to the nerves in the eye caused by diabetes. You will also be examined for any foot problems. It is important to see a foot specialist regularly. Your feet should be thoroughly inspected for damage to the nerves.

While the first two types of insulin are the most common treatments, diabetes can be treated in a variety of ways. Your doctor may prescribe medications to control high blood pressure, which can protect the kidneys. Other types of medication include aspirin and other types of anti-platelet drugs. If your doctor is concerned about your blood sugar level, you may need to try a different medication. Some medications can cause side effects. Your treatment will depend on what type of insulin you need.

Nursing Care Plan For Diabetic Foot Ulcer 3

Assessment and Management of Foot Ulcers for People with Diabetes

Nursing Diagnosis: Risk for Ineffective Health Maintenance related to impaired functional status related to diabetic foot ulcer.

Desired Outcomes:

  • The patient and family will express the ability to cope effectively with the current situation, provide support and monitoring as indicated.
  • The patient will demonstrate knowledge on self-care measures related to diabetic foot ulcer.

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Pressure Ulcer Nursing Care Plans

A pressure ulcer is a localized skin injury where tissues are compressed between bony prominences and hard surfaces such as a mattress. They are caused by pressure in combination with friction, shearing forces, and moisture. The pressure compresses small blood vessels and leads to impaired tissue perfusion. The reduction of blood flow causes tissue hypoxia leading to cellular death.

Nursing Care Plan For Diabetic Foot Ulcer 5

Nursing Diagnosis: Impaired Physical Mobility related to pain and discomfort secondary to diabetic foot ulcer, as evidenced by expression of pain when mobilizing, refusal to move and limited range of motion.

Desired Outcomes:

  • The patient will perform physical activities independently.
  • The patient will demonstrate measures to increase mobility.

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Nursing Care Plan For Diabetic Foot Ulcer 4

Nursing Diagnosis: Acute Pain related to skin disruption secondary to diabetic foot ulcer, as evidenced by guarding behavior, facial grimace, and patientâs expression of pain with a rate of 8 on a scale of 1-10.

Desired Outcomes:

  • The patient will report pain reduced to a 4/10 or less.
  • The patient will demonstrate the use of appropriate diversional activities and relaxation skills.
  • The patient will use pharmacological and nonpharmacological pain-relief methods.
  • The patient will display an improvement in mood and coping.

Causes And Risk Factors Of Pressure Ulcer

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Pressure ulcers are caused by relentless pressure against the skin, thereby limiting blood flow to the skin and its surrounding tissues.

Inactivity and limited movement, particularly on bed-ridden patients, makes the skin vulnerable for the development of pressure ulcers.

There are three contributing factors for its development, and they are:

  • Pressure. Constant pressure on any part, specifically on the skin of the bony prominences of the body, will lessen the blood supply to the tissues. This lack of blood supply will deprive the tissues of needed nutrition from the circulation, and in turn, will cause damage and injury to the body.
  • Friction. Friction happens when the skin is rubbed against clothing, making the skin more fragile and vulnerable to injury. This is especially true if the skin is moist.
  • Shear. Shear occurs when two surfaces move away from opposite directions. This action complicates the damage incurred from pressure ulcers.
  • The risk factors of pressure ulcers are the following:

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    Nursing Care Plan For Pressure Ulcer 1

    Nursing Diagnosis: Impaired Skin Integrity related to skin breakdown secondary to pressure ulcer, as evidenced by pressure sore on the sacrum, discharge from the sores for a couple of days, pain and soreness

    Desired Outcome: The patient will have optimal skin integrity by following treatment regimen for decubitus ulcers.

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    Type 2 diabetes causes the body to become resistant to the hormone insulin. This hormone unlocks cells. There are two types of diabetes: type 1 and type 2. While both types of the disease can cause problems, you can minimize the impact by following healthy eating and being physically active. The sooner you know more about diabetes, the better prepared you will be to deal with it. Once you know more about the disease, youll be better prepared for treatment.

    Type 2 diabetes is a chronic condition that causes the body to produce too much insulin. It is also known as type 2 diabetes. If you have type 1, you can control your blood glucose levels by eating a balanced diet. If you have type 2 diabetes, you can even prevent it by adopting healthy lifestyle habits and modifying your diet. Its important to seek information that can help you be your own health advocate. There are many different types of diabetes, so its important to learn as much as you can about the condition.

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    Diabetes a known disease to everyone. If you are a diabetic patient & also have a wound then you are the person who know the sufferings. Here, we discussed about the care regarding diabetes. Following these, your sufferings will reduce. Thanks

    Diabetes a known disease to everyone. If you are a diabetic patient & also have a wound then you are the person who know the sufferings. Here, we discussed about the care regarding diabetes. Following these, your sufferings will reduce. Thanks

    Causes Of Diabetic Foot Ulcer

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    • Diabetes. The nerves and blood vessels can become damaged by excessive blood sugar levels. That reduces blood flow, which makes it more difficult for cuts and sores to heal particularly in the hands, feet, and limbs.
    • Poor circulation. It causes an inefficient blood flow to the feet and ulcers may be more difficult to heal if there is poor circulation.
    • High blood sugar level or hyperglycemia. Blood sugar control is essential because high glucose levels might hinder the healing of an infected foot ulcer. People with type 2 diabetes and other illnesses frequently struggle to combat ulcer-related infections.
    • Nerve damage. The long-term impact of nerve damage is a lack of sensation in the feet. Nerve damage can cause tingling and pain, it also causes painless ulcer-causing sores and lowers the sensitivity to foot pain.
    • Irritated or wounded feet. Drainage from the affected area and occasionally a pronounced bulge that is not necessarily painful are indications of an ulcer.
    • Obesity.Obese people with diabetes may be especially at risk for developing peripheral neuropathy, peripheral arterial disease, and becoming unable to care for themselves.
    • Flat foot. Diabetic patients with flat foot impose uneven tension on the foot which causes tissue inflammation in high-risk foot areas.

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    Its important to maintain a healthy body weight. You should also make sure that you drink plenty of water, and limit your intake of sugary drinks. In addition, make sure that you get regular exercise. You should also avoid alcoholic beverages. Lastly, you should avoid alcohol. These beverages contain high amounts of sugar. If you dont drink enough, youre not doing anything to prevent diabetes. Besides, drinking alcohol can be harmful to your health.

    The most important thing to do is to follow the recommended diet. Eat more healthy foods that have low amounts of fat and high amounts of fiber. The best way to lose weight is to lose 7 percent of your body weight. If youre overweight, you should try to lose 14 pounds to reduce your risk of developing type 2 diabetes. However, you should not attempt to lose weight while pregnant. Talk to your doctor about what kind of weight is safe for you.

    Besides high blood glucose, diabetes can also affect the nerves and skin. It may affect your sexual response and your nervous system. It can also affect your fertility. Women with diabetes are more likely to miscarry or have a baby with a birth defect. It can cause a person to have difficulty hearing and sleep. If the condition is left untreated, it can lead to type 1 diabetes and can even lead to amputation.

    Diabetic Foot Evaluation Techniques

    The technical-scientific knowledge acquired during the phases of nursing education and in the context of continuing and permanent education are relevant factors for the treatment of diabetic foot, therefore, it is up to the nurse to seek knowledge to perform safe evaluation techniques for patients with diabetes as a method of prevention and to patients with diabetic foot as prevention measures for complications.

    Arruda et al. states that the physical examination of diabetic feet are procedures performed by nurses in order to avoid possible complications such as: development of ulcers and amputations of the lower limbs. Therefore, the ignorance of this technique induces the higher rates of complications. The authors point out at another time that in addition to the technique not being used due to lack of knowledge of the nurse, the working conditions also influence the non-performance of the evaluation technique, these conditions are referred to by the authors as inadequate infrastructure and demand for excessive care.

    Vargas et al. brings in its study a similar context to the previously mentioned study and adds that nurses need more training regarding evaluation techniques related to diabetic foot, nurses also report that management does not offer materials to perform these techniques and talk about excessive demands.

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