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- Treat the cause of the problem. Refer for medical and vascular evaluation. If the patient is diabetic, disease control is primary. Surgical consultation may be required for debridement and possible revascularization. When the ulcer is caused by pressure from a shoe, refer patient to orthotics for non-weight bearing devices.
- Support moist wound healing. If perfusion is poor, the wound bed may dry out quickly. Cautious use of moisture-retentive dressings and close monitoring is recommended. If gangrene is present, it is recommended to keep the wound dry to avoid further bacterial growth. Wounds between the toes may benefit from cotton or sheepskin placed between the toes to absorb fluid and protect intact skin. Following revascularization, moist wound healing techniques may be resumed.
- Prevent infection.
- Ambulate as tolerated.
- Control edema, if present.
- Aggressively treat infection. Consult with physician to determine the need for antibiotic therapy, debridement, cleansing, and dressing approach.
- Debride. This is based upon the condition of the patient and wound. Debridement may be contraindicated in neuropathic wounds with arterial disease. Consult a wound care specialist in these situations. Methods of debridement include autolytic, mechanical, sharp, and enzymatic.
- Perform daily skin inspection and care. Inspect for cracks, bruises, or injury to the skin. Cleanse and moisturize the skin. Protect feet from injury. Avoid foot soaks. Check temperature of the water with a forearm or hand before bathing. Proper nail care is critical.
- Provide adequate nutritional intake.
- Manage pain. If pain is present, it may help to position legs and feet in a dependent position.
- Provide education to patient, family, and caregiver. Education plans should include the following: compliance with medications, control of diabetes (if applicable), smoking cessation, avoidance of exposure to trauma (e.g., friction, pressure, extremes in temperature, constrictive clothing, and going barefoot).
- Document assessments and interventions.
- Reassess at regular intervals per agency protocol.
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