| Your nursing interventions should focus on providing | | | | foul-smelling, purulent drainage. Obtain a culture of |
| foot care, monitoring your patient's response to the | | | | any open or draining lesion, and begin antibiotic |
| prescribed drugs and promoting circulation after | | | | therapy as prescribed. If your patient is taking |
| surgery. | | | | antibiotics, make sure she drinks at least eight |
| Foot Care | | | | 8-ounce glasses of fluid every day, and assess her |
| The primary goal of nursing care in patients with | | | | renal function daily. Dress an infected wound with a |
| diabetes and peripheral vascular disease is to help | | | | wet-to-dry dressing and change it several times a |
| reduce the risk of foot and leg amputations. | | | | day to achieve mechanical debridement. (Remember |
| Therefore, protect the patient's legs and feet from | | | | that the dressing helps lift off dead surface skin, |
| even minor traumas, which can lead to infection, | | | | which promotes new tissue growth.) If the wound |
| ulcers, and ultimately loss of function. | | | | isn't infected, dress it with an occlusive dressing that |
| Thoroughly assess your patient's legs and feet for | | | | retains moisture and enhances cell migration and |
| signs of impaired skin integrity, such as pressure | | | | healing. |
| areas or skin tears. If your patient has peripheral or | | | | Drug Response |
| autonomic neuropathy, she may have decreased | | | | If your patient is taking pentoxifylline, check for |
| sensations of touch, pain, or temperature, so | | | | headaches, dizziness, nausea, or vomiting. Monitor her |
| examine her legs and feet routinely for signs of | | | | WBC count for signs of neutropenia. If she's taking |
| breakdown. Check her pedal pulses, foot | | | | ticlopidine, closely monitor her complete blood cell |
| temperature, capillary refill, and skin color. Also, | | | | count and WBC differential for adverse effects, such |
| assess her for changes in feeling, such as numbness | | | | as neutropenia. Also, evaluate her liver function tests |
| or tingling. | | | | for elevated alanine aminotransferase and aspartate |
| Provide your patient with meticulous foot care. To | | | | aminotransferase levels, which indicate liver |
| prevent pressure on her legs and feet, make sure | | | | dysfunction. |
| she changes position every 2 hours and performs | | | | Postoperative Circulation |
| range-of-motion exercises, if possible. Wash her feet | | | | If your patient has a bypass graft, your primary goal |
| with warm water and mild soap, and dry them well, | | | | after surgery is to promote and maintain circulation |
| particularly between the toes. Inspect her feet and | | | | through the new grafts. So monitor the |
| apply moisturizing cream every day but not between | | | | neurovascular status of her feet and legs. |
| her toes. Use protective padding, foot cradles, or an | | | | Immediately report signs or symptoms of graft |
| alternating-pressure mattress to reduce the risk of | | | | occlusion, such as severe pain, loss of pulses, cold |
| pressure injuries. To prevent constriction and impaired | | | | hands or feet, or new complaints of numbness or |
| circulation, don't use elastic antiembolism stockings. | | | | tingling. |
| Although your patient's activity may be restricted, | | | | Position your patient so that her knees aren't flexed, |
| make sure she wears appropriate footwear, | | | | which might impair her circulation and compromise the |
| even for short distances. Shoes or slippers that don't | | | | potency of the graft. Also, make sure she doesn't sit |
| fit properly can cause further injury and lengthen her | | | | in one position for a long period. Elevate the affected |
| hospital stay. | | | | leg to reduce edema. Instruct her not to cross her |
| Monitor your patient for signs and symptoms of | | | | legs and to avoid keeping the affected leg in a |
| wound infection, including redness, swelling, or | | | | dependent position for a prolonged period. |