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General
SN 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. SN also instructed on side effects of most medications taking that could possibly cause dizziness and to report it so that it can be addressed by physician. Patient and caregiver voiced understanding of all instructions given.
Patient instructed on fall safety precautions to include: locking w/c before transfers, use assistive device for mobility at all times, make sure walkways are free of clutter, & well lit, do not walk around barefoot or in socks, avoid using rugs, use non slip rug in bath tub & use shower chair for bathing.
SN instructed patient that people with heart and/or lung failure can benefit from energy conservation techniques like pace activities and spread them throughout the day/week, plan the day in advance so that you won’t feel rushed, break up tasks into small steps and rest in between, sit down instead of standing for most any activity, and work with arms below the shoulders as overhead activities are more taxing.
SN instructed the reason it is important to help or use proper turning techniques to prevent friction and shearing of skin. Friction usually, but not always, accompanies shear. Friction is the force of rubbing two surfaces against one another. Shear is the result of gravity pushing down on the patient's body and the resistance between the patient and the chair or bed. When combined with gravity/force (pressure), friction causes shear, and the outcome can be more devastating than pressure alone.
Sn instructed patient in walker safety. When you stand wait one minute before attempting to walk. Do not take a step until all 4 legs of the walker are level on the ground. Do not place the walker too far ahead of you. Keep the walker’s back legs even with your toes. Always look forward at your path, don’t look down at your feet. To get up from a seat, do not pull up on your walker. Push up from your seat. Do not lean forward over your walker. Work at keeping good posture. Be careful when you walk from a tile or hardwood floor to a carpeted floor. Do not use your walker on stairs or on an escalator. Check the rubber tips on the legs of your walker often. Replace the tips when they become worn. Patient verbalized understanding of teaching.
SN instructed patient/ CG about thickened liquids. SN explained that thickened liquids are used to treat patients with Dysphagia. Thick liquids decrease aspiration. Thick liquids may give the patient more time to perform additional swallows or other swallowing strategies. Thickened liquids slow down the bolus flow to compensate for a delayed swallow and reduced airway closure.
Instructed patient in lifestyle and home remedies that may help decrease edema and keep it from coming back. Before trying any self-care techniques, talk to your doctor about which ones are right for you. Compression, if one of your limbs is affected by edema, your doctor may recommend you wear compression stockings, sleeves or gloves, usually worn after your swelling has gone down, to prevent further swelling from occurring. These garments keep pressure on your limbs to prevent fluid from collecting in the tissue. Patient verbalized understanding.
SN instructed the patient on good diabetic foot care and assessment as follows: using a handheld mirror if needed assess feet daily to include in between toes. Never cut toenails or file down calluses. Only a podiatrist should do this. Report any blisters, cracks, wounds or any other concerns to your podiatrist immediately. Wash and lotion feet very well daily. Do not lotion between toes as this may cause maceration and cause skin breakdown. Recommended wearing diabetic socks. Always wear good fitting shoes. Preferably tailor-made for the patient. Never walk around barefoot.