Nursing Care Plan for Diabetic Foot

Nursing Care Plan for Diabetic Foot

Patient Profile

• Age: 47 years
• Gender: Female
• Diagnosis: Diabetic foot (complications may include ulceration, infection, neuropathy, or poor circulation)

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1. Nursing Diagnosis: Impaired Skin Integrity Related to Poor Circulation, Neuropathy, and Ulceration

Assessment Data:

• Presence of foot ulcer(s) or open wound.
• Signs of infection (redness, warmth, swelling, purulent drainage).
• Decreased sensation in the feet due to peripheral neuropathy.
• Poor circulation (cool extremities, weak pedal pulses).

Goals/Outcomes:

• The patient will demonstrate improved skin integrity by healing of the ulcer within 6–8 weeks.
• The patient will verbalize understanding of measures to prevent further skin breakdown.

Interventions:

1. Wound Care:
   • Clean the wound with sterile saline or prescribed antiseptic solutions.
   • Apply appropriate dressings (e.g., hydrocolloid, alginate, or foam dressings as per wound characteristics).
   • Monitor for signs of infection daily (redness, swelling, increased drainage, odor).
   • Collaborate with a wound care specialist for advanced therapies if needed.
2. Offloading Pressure:
   • Encourage the use of offloading devices (e.g., total contact cast, therapeutic shoes, or crutches) to reduce pressure on the affected area.
   • Advise complete rest of the affected foot if necessary.
3. Circulation Monitoring:
   • Assess pedal pulses and capillary refill regularly.
   • Elevate the foot slightly to improve venous return without compromising arterial flow.
4. Infection Control:
   • Administer prescribed antibiotics as ordered.
   • Maintain strict aseptic technique during wound care.
5. Patient Education:
   • Teach proper foot hygiene (daily washing, drying between toes, moisturizing).
   • Instruct on inspecting feet daily for cuts, blisters, or redness.
   • Emphasize avoiding barefoot walking and wearing properly fitting shoes.

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2. Nursing Diagnosis: Risk for Infection Related to Open Wound and Poor Glycemic Control

Assessment Data:

• Elevated blood glucose levels.
• Presence of an open wound or ulcer.
• Signs of systemic infection (fever, chills, elevated white blood cell count).

Goals/Outcomes:

• The patient will remain free from signs and symptoms of infection.
• The patient will maintain optimal glycemic control (HbA1c <7%).

Interventions:

1. Glycemic Control:
   • Monitor blood glucose levels regularly (pre-meal and post-meal).
   • Administer insulin or oral hypoglycemic agents as prescribed.
   • Collaborate with a dietitian to develop a balanced meal plan.
2. Antibiotic Therapy:
   • Administer prescribed antibiotics as ordered.
   • Monitor for therapeutic response and side effects.
3. Hygiene Practices:
   • Instruct on hand hygiene before and after touching the wound.
   • Avoid using harsh chemicals or irritants on the skin.
4. Systemic Monitoring:
   • Monitor temperature and white blood cell count for signs of systemic infection.
   • Report any worsening symptoms to the healthcare provider immediately.

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3. Nursing Diagnosis: Risk for Peripheral Neurovascular Dysfunction Related to Diabetes Mellitus

Assessment Data:

• Decreased sensation in the feet (tested with monofilament or tuning fork).
• Cool extremities, weak or absent pedal pulses.
• History of prolonged diabetes.

Goals/Outcomes:

• The patient will maintain adequate peripheral circulation.
• The patient will report reduced neuropathic symptoms.

Interventions:

1. Neuropathy Management:
   • Administer prescribed medications for neuropathic pain (e.g., pregabalin, duloxetine).
   • Educate on avoiding extremes of temperature to prevent burns or frostbite.
2. Circulatory Support:
   • Encourage regular exercise to improve circulation (e.g., walking or swimming).
   • Advise against smoking, as it impairs circulation.
3. Foot Protection:
   • Recommend wearing well-fitted, cushioned footwear.
   • Advise against tight socks or restrictive clothing.
4. Patient Education:
   • Teach how to perform daily foot inspections.
   • Discuss the importance of regular follow-up with a podiatrist.

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4. Nursing Diagnosis: Deficient Knowledge Related to Diabetes Management and Foot Care

Assessment Data:

• Patient expresses uncertainty about managing diabetes.
• Lack of awareness about preventive foot care practices.

Goals/Outcomes:

• The patient will verbalize understanding of diabetes management and foot care practices.
• The patient will demonstrate correct techniques for foot inspection and care.

Interventions:

1. Diabetes Education:
   • Provide information on the importance of maintaining target blood glucose levels.
   • Explain the relationship between hyperglycemia and diabetic complications.
2. Foot Care Training:
   • Demonstrate proper foot hygiene and inspection techniques.
   • Provide written materials or visual aids for reinforcement.
3. Nutritional Guidance:
   • Collaborate with a dietitian to create a personalized meal plan.
   • Discuss portion control and carbohydrate counting.
4. Follow-Up Care:
   • Schedule regular appointments with the primary care provider, endocrinologist, and podiatrist.
   • Reinforce the importance of adherence to treatment plans.

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5. Nursing Diagnosis: Anxiety Related to Fear of Amputation or Disability

Assessment Data:

• Verbal expressions of fear or anxiety about the future.
• Signs of stress (restlessness, insomnia, irritability).

Goals/Outcomes:

• The patient will verbalize reduced anxiety.
• The patient will demonstrate coping strategies to manage stress.

Interventions:

1. Emotional Support:
   • Listen actively to the patient’s concerns and validate their feelings.
   • Reassure the patient that early intervention can prevent severe complications.
2. Stress Management:
   • Teach relaxation techniques (deep breathing, guided imagery).
   • Encourage participation in support groups for individuals with diabetes.
3. Patient Empowerment:
   • Highlight the patient’s role in managing their condition through lifestyle changes.
   • Celebrate small victories (e.g., improved wound healing, better glucose control).

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Evaluation

• The patient demonstrates improved wound healing and intact skin integrity.
• Blood glucose levels are within the target range.
• The patient reports reduced anxiety and improved knowledge of diabetes and foot care.
• Follow-up appointments are scheduled and attended.

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Conclusion

This nursing care plan addresses the multifaceted needs of a patient with a diabetic foot. Early intervention, patient education, and interdisciplinary collaboration are key to preventing complications and improving outcomes. Regular reassessment and adjustment of the care plan ensure that the patient’s evolving needs are met effectively.