diabetic foot and leg care
diabetic foot and leg care
the special attention given to prevent the circulatory disorders and infections that frequently occur in the lower extremities of diabetic patients.
method The patient's legs and feet are examined daily for signs of dry, scaly, red, itching, or cracked skin; blisters; corns; calluses; abrasions; infection; blueness and swelling around varicosities; and thickened, discolored nails. The feet are bathed daily in tepid water with mild or superfatted soap and are dried gently but thoroughly with a soft towel. A lanolin-based lotion is then applied, although not between the toes; excess lotion is removed with a dry towel; vigorous rubbing and use of alcohol preparations are avoided because of drying and irritation of skin which can lead to skin breakdown. The toenails are cut straight across above the level of soft tissue after the feet are soaked for 3 to 5 minutes in tepid water. The feet are also soaked in tepid water for several minutes before hardened areas are treated by applying soft soap and rubbing the area with a washcloth. Calluses and corns are removed, and thickened, deformed nails are cut by a podiatrist. Commercial remedies for removing calluses and corns should not be used.
interventions The nurse provides foot and leg care while the diabetic patient is hospitalized. Before discharge the patient is instructed to examine and bathe the feet daily according to the recommended method, to report abnormalities, to keep the feet dry at all times, to wear cotton socks or stockings with cotton feet, and to place clean lamb's wool or cotton between the toes if they perspire. The patient is cautioned to avoid sustaining foot or leg trauma, walking barefoot, scratching insect bites, using a hot-water bottle or heating pad on the lower extremities, getting sunburned, wearing constricting garments, remaining in the same position for long periods, sitting at more than a right-angle bend, and crossing the knees. The diabetic individual is advised to alternate the wearing of two pairs of rubber-soled, well-fitted shoes wide enough to prevent pressure and rubbing; to air each pair of shoes between use; and to break in new shoes gradually. The patient is urged to walk to tolerance daily, to plan exercise periods after meals, to bend and straighten the knees and rotate the ankles occasionally when sitting, and, when standing, to shift weight from time to time and walk in place. Patients may be referred to a certified diabetic educator for initial instruction about care.
outcome criteria Meticulous care of the feet and legs can prevent serious complications, including local infection, skin ulcers, cellulitis, and gangrene.