Diabetic ulcers are quite chronic and painful, especially when they are in an elderly patient. As such, there is a need to develop a comprehensive care plan and a clear concept map.
Wounds affecting the diabetic foot are not mere ulcers, and consequently, their evaluation and treatment require a lot of experience (Boulton et al., 2018). Before coming to the doctor or nurse’s attention, patients often medicate themselves, aggravating the state of the lesions.
The first fundamental point for treating a diabetic ulcer consists of the analysis of the factors that caused it and their elimination. Clinical experience shows that patients come to healthcare professionals’ attention only after trying many products, often useless and harmful.
Wound assessment and care consider three fundamental factors:
blood circulation;
infection;
pressure relief.
A wound can heal only if the leg and foot are well supplied with blood: any local dressing is useless, as well as being harmful if the blood does not irrigate the limb, as ulceration can already be the effect of the chronic lack of blood (Nayeri et al., 2020). The infection causes a rapid worsening of the wound and exposes to the risk of amputation as the bacteria, spreading in-depth, infect the bones (osteomyelitis) and significantly reduce the therapeutic possibilities since the bone is not very accessible by antibiotics.
Concept Map
Care Plan
For each of the priority nursing diagnoses, establish three (3) goals. For each goal create three (3) nursing interventions.
| Prioritized Nursing Diagnoses | Goal | Nursing Interventions |
|---|---|---|
| Check for signs of powerlessness and fatigue | Assess the motor abilities | Eliminate chances of falling by providing a flat movement environment |
| Recommend proper walking aids other that a cane which increases risk of falling | ||
| Provision the patient with information on the importance of enough rest. | ||
| Assess Situation management and coping ability (Nayeri et al., 2020). | Counselling on importance of genuine expression and relaxation | |
| Provide therapy on how to handle the feeling of helplessness | ||
| Teach the daughter how to support her mother emotionally. | ||
| Check for signs of fatigue | Provide support | |
| Provide energy boosting diet | ||
| Proper room ventilation and oxidation | ||
| Assess Medication Knowledge | Gather the knowledge about medication dosages and frequency (Nayeri et al., 2020). | Explain that Lantus need to be used only once per day |
| Teach the patient on changing the injection spot and its importance | ||
| Teach the patient and caregiver on how to adjust dosage for different states of the illness | ||
| Assess how the patient treats hypoglycemia | Teach the patient on using carbohydrate snacks | |
| Teach the daughter on how to administer glucagon through Intramuscular injection in case Mrs. Y is unconscious. | ||
| Teach the patient on observing proper diet, rich in fiber but low on fats and sugars | ||
| Assess the knowledge about risk associated with incorrect medication (Nayeri et al., 2020). | Inform the patient on importance of observing correct dosage | |
| Inform the patient and caregivers the importance of injecting the needle perpendicular | ||
| Check for signs of impaired skin integrity | Assess how the patient walks | Discourage the patients from walking bare footed |
| Encourage supported walking and wearing of pace boots on ulcerated heels | ||
| Encourage using foot cradle | ||
| Assess the state of the skin around knees and feet | Provide preventive care medication | |
| Encourage wearing of white socks to boost visualization of the veins | ||
| Check for sensory level | Wash feet with warm water and soap | |
| Cut toe nails | ||
| Check for signs of erythema and trauma daily |
References
