Chapter 27-30

Diabetic Foot Care

Diabetic patients need special attention to foot care due to decreased sensation and circulation, which can delay wound healing. Proper care includes inspecting feet daily, washing with warm water and mild soap, drying thoroughly, applying lotion (not between toes), wearing clean socks, wearing well-fitting shoes, trimming toenails straight across, and never walking barefoot.

Bathing

Bathing cleanses the skin, removes bacteria, and promotes circulation. Nurses assist with bathing based on patient needs, providing either a complete bed bath or a partial bed bath.

Complete Bed Bath

The nurse bathes the entire body of a patient unable to bathe themselves.

Partial Bed Bath

The nurse bathes only parts of the body that the patient cannot reach or are soiled.

Changing an Occupied/Unoccupied Bed

Changing bed linens provides comfort and cleanliness. An occupied bed change is performed for patients unable to get out of bed, while an unoccupied bed change is done when the bed is empty.

Oral Care

Oral care prevents infection, promotes fresh breath, and improves the patient's sense of well-being. It involves daily cleaning of dentures and assisting patients with oral hygiene as needed.

Perineal Care

Perineal care helps to prevent infection and maintain skin integrity, especially in incontinent patients or those who have had surgery in the perineal area. Nurses use a gentle cleanser and warm water to clean this area.

Range of Motion (ROM)

ROM exercises maintain joint flexibility and prevent contractures. Active ROM is performed by the patient, while passive ROM is performed by the nurse.

Use of TED and SCD

TED hose (compression stockings) and SCDs (sequential compression devices) promote blood flow and prevent deep vein thrombosis (DVT).

Signs of DVT

Signs of DVT include pain, swelling, redness, and warmth in the affected leg. Early recognition is crucial to prevent complications such as pulmonary embolism (PE).

Foot Drop

Foot drop is the inability to dorsiflex the foot. Interventions include using a footboard, high-top tennis shoes, or a splint.

Contractures

Contractures involve a shortening of muscles or tendons, leading to joint deformity and rigidity. ROM exercises, proper positioning, and splints help prevent them.

Ambulation

Ambulation, or walking, improves circulation and muscle strength. Nurses assist by using gait belts and providing support during walking.

Controlled Fall

If a patient begins to fall, the nurse should assist them to the floor in a controlled manner to avoid injury.

Use of Mobility Devices

Trapeze bars, trochanter rolls, hand rolls, and sliding boards assist with patient mobility, transfers, and preventing contractures.

Complications of Immobility

Immobilization can lead to musculoskeletal issues (muscle atrophy, joint contractures, osteoporosis), skin problems (pressure ulcers), and cardiovascular/respiratory issues (DVT, pneumonia, atelectasis).

Positions

Common patient positions include supine, prone, lateral, Sims', and Fowler's, all of which promote comfort and prevent complications.

Use of Crutches, Canes, and Walkers

Crutches are used when patients can't bear weight on one or both legs. Canes provide balance and support, while walkers offer the most support for unsteady patients.

Wound Care

Wound care involves cleaning and managing wounds to promote healing and prevent infection. This includes cleaning incisions with sterile solutions and applying sterile dressings.

Wet-to-Dry Dressing

A wet-to-dry dressing debrides a wound by adhering to dead tissue and pulling it away when the dressing is removed.

Drains

Drains remove fluid or air from a wound. Nurses monitor the type and amount of drainage.

Complications of Surgical Wounds

Surgical wounds may be complicated by infection, dehiscence (separation of wound edges), or evisceration (protrusion of organs).

Pressure Ulcers

Pressure ulcers, or bedsores, are caused by prolonged pressure. They are staged from I (reddened skin) to IV (full-thickness loss with exposed bone or muscle).

Friction and Shear

Friction is the rubbing of two surfaces together, while shear occurs when surfaces slide against each other, both contributing to pressure ulcer formation.

Cultural/Religious Considerations

Nurses should be aware of cultural and religious food restrictions when planning patient care, as certain foods may be prohibited.

Food Sources of Nutrients

Nurses need to understand food sources of essential nutrients like carbohydrates, proteins, fats, vitamins, and minerals to provide proper care.

Special Diets

Special diets include clear liquid, full liquid, soft, diabetic, and renal diets, each tailored to specific medical needs or conditions.

BMI

Body Mass Index (BMI) is a measure of body fat based on height and weight, used to classify individuals as underweight, normal weight, overweight, or obese.