skin
Others
Instructed patient Be sure to treat any skin redness or skin changes right away, when the problem is still small. Do not
allow the sore area to become larger or more irritated before asking your doctor about it.
SN instructed patient and caregiver that the key difference between a suspected deep tissue injury (sDTI) and an unstageable pressure ulcer is that sDTI involves intact skin, whereas an unstageable ulcer involves a breakdown into at least the subcutaneous tissue. An unstageable ulcer is covered with necrotic tissue, such as slough or eschar, formed from remnants of the collagen matrix of subcutaneous tissue. So it’s always a full-thickness ulcer either stage III or stage IV.
Patient was instructed on nerve damage as a complication of diabetes. Because of the lost sense of feeling in the extremities it is possible to not feel any discomfort in the feet, and it is also possible to develop sores that can turn into skin ulcers without being aware of it.
If your big toe slants sharply in toward your other toes, with a big bump on the knuckle of your big toe, you've got a classic bunion. Corns are spots of thick, rough skin, where the tissue builds up on toes constantly barraged by too much rubbing or pressure. A buckled-under toe, called a hammertoe, can result from muscle weakness caused by diabetic nerve damage. All of these make it hard to fit shoes comfortably. But a good podiatrist can help you fix these problems and take better care of your feet.
Patient was instructed on the importance of a good foot care. Calluses indicate that areas of the feet are receiving too much pressure. If the increased pressure continues, the skin may break down and it is possible to get a foot ulcer.
Patient was instructed about the feet care: always wear shoes or slippers. Always wear socks with the shoes, since leather, plastics, and manmade shoe materials can irritate your skin and quickly bring on blisters. While the Diabetic patient might prefer the look of hose, nylon knee-highs, or thin socks, may find that these doesn't give to the toes or heels enough protection. Wear thicker socks to pad the feet and cushion any calluses or sore spots. Further teaching is needed.
The patient was instructed in burns and its classification. The patient was advised that the curative process with new skin progress is expected in 6 weeks with mature healing within 6 to 12 months, depending on the extended of injury. The patient was taught to care of healed burns, avoiding exposure to direct sunlight, harsh detergent, fabric softeners etc., avoid contact with persons with infections especially upper respiratory infections. The patient was recommended to obtain medical supplies for dressing and any special assistive devices for home care management. The patient was encouraged in the importance of physiotherapy to assist in the exercise regimen and water exercises to maintain limb mobility.
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.
Instructed patient for the first 4-6 weeks after placement of a new PEG, bath water should not be so deep that the tube is
under the water. Shower water should fall on your back only. For a balloon, low profile, or older PEG tube you can take a
bath or shower as you normally do. Instructed patient call nurse or doctor if your body changes: your skin around tube has signs of infection: redness, warm to touch, firm to touch , tender.
SN assessed portacath insertion site every visit. SN instructed s/sx to report to SN / MD such as redness, pain, puffiness around port, drainage from insertion site, temperature above 100 degrees, shortness of breath and chest pain. Sn instructed on portacath care and protection of the skin over the port.