wound vac
Instructed patient all bed-bound and chair-bound persons, or those whose ability to reposition is impaired, to be at risk for pressure ulcers.
Instructed patient consider nutritional supplementation/support for nutritionally consistent with overall goals of care.
Instructed patient reposition bed-bound persons at least every two hours and chair-bound persons every hour consistent with overall goals of care.
Instructed caregiver reduce friction by making sure when lifting a patient in bed that they are lifted, not dragged during repositioning, prevent ulcers from occurring and can also help them from getting worse .
Make sure the skin remains clean and dry. Examine the skin daily. Inspect pressure areas gently. Make sure the bed linens remain dry and free of wrinkles. Pat the skin dry, do not rub
SN instructed patient the skin around a fistula needs to be clean, dry, and grease-less for effective pouch adherence. Enterocutaneous fistulas (ECFs) can cause contents of the intestines or stomach to leak through a wound or opening in the skin. It also can cause: Dehydration, Diarrhea, and Malnutrition.
Instructed patient Enterocutaneous fistulas (ECFs) can cause contents of the intestines or stomach to leak through a wound or opening in the skin. It also can cause: Dehydration, Diarrhea, and Malnutrition. Adequate protein and calories must be provided to maximize healing and minimize complications.
Instructed patient about external fistulas cause discharge through the skin. They are accompanied by other symptoms, including: abdominal pain, painful bowel obstruction, fever, elevated white blood cell count. Prevent skin maceration and breakdown from corrosive effluent and wound infection. Patient comfort, accurate measurement of effluents, patient mobility protect skin from damage from effluent, containment of effluent, odor control.
SN completed assessment done on all body systems and noted patient with elevated blood pressure during visit. SN completed treatment during visit and noted no drainage on old tx, wound callused and new area found to left medial top of foot remains intact with no drainage noted. SN noted patient complaint of pain to bilateral lower extremities with +2 edema noted. SN educated primary caregiver on the importance of elevation of bilateral lower extremities as well as pain management for patient.
Instructed caregiver the patient are at high risk if the patient have or do the following: Neuropathy, Poor circulation, A foot deformity (e.g., bunion, hammer toe), Wear inappropriate shoes, Uncontrolled blood sugar, History of a previous foot ulceration.