Diabetic Foot Care Teaching Plan
SECTION I: Introduction/Assessment Data Patient Demographic Information and History Initials:DTAge:54Sex:M Date of admission:9/18/2006Date of Surgery, if applicable:9/25/2006 Date assigned to Patient:9/28/2006 1. Primary medical diagnosis: Diabetes Mellitus Type II 2. Reason for admission—Briefly describe signs, symptoms, and events that led to thishospitalization. Presented to ED with SOB, vomiting, chest pressure, anorexia, and an infected, slow-healing foot wound. Blood glucose was 579 mg/dL and BUN was 21. Was admitted with exacerbation of unmanaged diabetes mellitus, diabetic ketoacidosis, and gastritis r/t excess aspirin intake. . Significant Secondary Medical Diagnoses and Past Medical History (include past hospitalizations/surgeries) Medical hx: Essential HTN, hyperlipidemia, hypercholesterolemia, GERD, DVT, & neuralgia. Surgical debridement of foot wound on 9/25. 4. Medications: NameDoseFrequencyPurpose for taking Insulin glargine40 units qhsblood glucose management Novolin-Rsliding scaleac & hsblood glucose management Avandia4 mgbidblood glucose management Ampicillin3g q6htx of foot infection Ceftriaxone1 gq24htx of foot infection Aspirin81 mgqdprevention of MI Lipitor10 mgqhslower blood cholesterol Lovenox40 mgq24hprevent thromboses
Neurontin300 mgq12hrelieve neuralgia Metoprolol25 mgqdmanage HTN Valsartan 80 mgqdmanage HTN Pantoprazole40 mgq24hprevent acid reflux Tramadol 50 mgqdrelieve pain r/t foot wound Dilaudid 3 mgq4h prnrelieve pain r/t foot wound (Deglin et al. , 2005) 5. Prescribed diet:1800 calorie diabetic diet Educational Readiness Assessment 1. What is the patient’s current
What are the patient’s current health beliefs and practices? He believed that he could manage his diabetes by taking his daily dose of Avandia. He did not previously see the necessity of managing his diet, exercising, or monitoring blood glucose. 3. Are there any cultural, socioeconomic or lifestyle behaviors you need to consider? If so, please describe. The pt is African-American. He enjoys a high fat, high sugar diet. Although many stereotypes attribute this sort of diet to African-Americans, it is truly common amongst most cultures in the southern United States. Giving up certain foods may be seen as a large cultural sacrifice. . What is the patient’s educational level? Are there any deficits that you need to take into consideration in your planning? He is a high school graduate. He is cognitively capable of understanding all aspects of the plan. 5. Is he cognitively, emotionally, and physically ready to learn (assess his pain level, fatigue, mobility status, oxygenation, effects of anesthesia or analgesia, anxiety, grieving, depression)? Pain and fatigue will make long teaching sessions impossible. However, he displays readiness for enhanced learning and has already made efforts to learn more about managing his disease.
Teaching should be accomplished in brief, frequent sessions of no longer than 15 minutes each. 6. What is this patient’s support system? Are they able and interested in learning? Is the patient interested in having the support system learn about aspects of care to assist him? He is married. His wife has been to visit him daily during his hospitalization, but was not in attendance when I was with the pt. The pt. states that she is interested and will be assisting him with his care. SECTION II: TEACHING PLAN (In addition to this form, include brochures, pamphlets, and other supportive materials)
Topic for Teaching Plan and Reasons Indicated: Topic: Care of the diabetic foot. The pt. suffers from a slow healing wound in his left foot. The severity of the wound could have been prevented if the pt had knowledge of basic foot care and of the dangers associated with diabetic neuropathy and delayed wound healing. Goal/Time Frame of the Teaching plan: Baseline Behavioral and Assessment DataContent Outline (what is to be taught)Teaching Methods/Strategies (how is it to be taught) 1. T: 97. 2 P: 76 R: 16 BP: 97/63 O2: 99% Pain: 7, left foot 2. A&O to person, place, & time.
Cooperative & able to follow commands. Slightly fatigued. 3. Wound in left foot. 2. 5 cm long X 1 cm deep. No current sx of infection. Small amt. serosanguinous drainage on dressing change. 4. Blood glucose: 98. 5. Pedal pulse weak bilat. 6. 2+ edema in feet bilat. 7. Ready for enhanced learning. Time limitations r/t pain & fatigue. I. Pathophysiology of diabetic foot problems. II. Daily foot inspection. Check for blisters, cuts, scratches, foreign objects, & discoloration (Minor, 1992). III. Foot injury interventions. a. Cleanse breaks in skin with soap & water. Do not use alcohol, iodine, etc (Lewis et al. 2004). b. Call health care professional immediately if injury does occur (Minor, 1992). IV. Daily foot cleansing. a. Wash with mild soap in medium temperature water. b. Dry by patting feet, ensuring spaces between toes are completely dry. (Lewis et al. , 2004). V. Regular foot care. a. Apply lanolin to dry feet, but do NOT put any lotion between toes. b. Use mild powder for sweating, but do NOT powder shoes. c. Soak feet in warm water before cutting toenails & cut straight across (Minor, 1992). VI. Contraindicated items a. Commercial remedies for corn/ callous removal b.
Tight shoes c. Tight clothing d. Colored, non-cotton, or dirty socks e. Hot water bottles or heating pads Cold weather (Lewis et al. , 2004). 1. Explain the etiology of diabetic neuropathy and angiopathy in non-technical language. 2. Use visual aids to show what injuries requiring special attention will look like. 3. Demonstrate wound cleansing & explain necessity for immediate medical intervention. Assist pt in creating a list of phone numbers to call for emergency & non-emergency care. 4. Demonstrate a thorough foot cleansing, and have pt give a return demonstration. 5.
Demonstrate appropriate foot care & have pt. give return demonstration. 6. Provide a list of contraindicated items and explain the dangers of using each. Teaching Plan Outcomes Upon completion of the instructional sessions the pt will: 1. Describe the reasons that diabetics are more likely to develop foot problems. 2. Describe the types of foot injuries that will require attention. 3. Demonstrate appropriate wound cleansing, and identify whom he will call in the event of foot injury. 4. Demonstrate proper foot cleansing technique. 5. Demonstrate and verbalize appropriate foot care. 6.
Verbalize understanding of contraindicated items. SECTION III: Teaching Plan Evaluation 1. Were you able to educate the patient as you had planned? Why or why not? I was able to provide basic instruction in foot care. I provided a brochure and went over the finer points of foot inspection and cleansing. I was unable to use all visual aids or provide for return demonstrations due to time constraints. 2. What is your evaluation of the patient’s learning before and after the information was presented? I feel that he has a greater appreciation for the significance of taking care of his feet.
Prior to teaching, he did not understand how seriously diabetes could affect foot health. He is much more likely to take proper care of his feet in the future. 3. What is your evaluation of how you presented the material and any modifications that you would do for future patient teaching? I would like to have had more time for actual care demonstrations. In addition, I obtained some good ideas for teaching from my books after the clinical day was over that I would not have thought of on my own. However, I can use these ideas for future teaching. 4. What communication techniques did you use during your teaching?
I asked open-ended questions to identify the pt’s education level & teaching needs. I used specific terms to explain what types of care are needed. I took great care be nonjudgmental about previous medical non-compliance. 5. Was the environment you selected conducive to patient teaching? How could this be improved for future teaching? The hospital environment is not the optimal one for teaching. The busy atmosphere, beeping machines, shared room, and IV lines are distracting and obtrusive. Choosing a less busy time when nothing is infusing in the pt’s IV would be most advantageous for instruction.