Disease Step by Step Guide to better health Medication Nutrition Activity Leg Ulcers (Wound) Safety Tests & Treatments Psycho/Social Community STEP by STEP Guide created by Innovative Healthcare Solutions
Phone Numbers Agency: Agency s Phone: Doctor: Doctor s Phone: Emergency Phone: Pharmacy: Pharmacy s Phone: Other Phone Numbers Additional Resources Page Arterial Leg Ulcer 20,21 Diabetic Leg Ulcer 22,23 Venous Leg Ulcer 24,25 Exercise and Activity 26 Protect Wound, Promote Healing 27 Nutrition, Food Tips 28 Diet Log 29 Wound Care Dressing 30 Wound Care 31 Wound Care, Symptom, Activity Log 32 Medications 33 Leg Ulcers Step by Step Guide Stock No. WB1-101 Version 1002 Copyright 2005-2006 Innovative Healthcare Solutions All Rights Reserved. By law, no part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Innovative Healthcare Solutions
Together, you and your healthcare provider will use this booklet one step at a time as a guide to better health. This STEP by STEP Guide describes typical GOALS for each contact with your healthcare provider or for each step in your disease management program. You may not have scheduled contacts with your healthcare provider. If not, a few times a week, read and learn the content from one or more of the Steps in this booklet. Log your symptoms. Review the Goals in the Steps. Mark off the Goals you are able to meet. If you are unable to meet the Goals, call your healthcare provider. What is a Leg Ulcer (Wound)? A leg ulcer is a slow healing open sore. It is slow healing because of blood flow problems. There are different types of leg ulcers. The most common are arterial ulcers, diabetic ulcers and venous ulcers. This book helps you take care of your leg ulcer. Check the pages listed below for more information about caring for your type of ulcer. You have An arterial ulcer caused by blocked or restricted arteries, see pages 20 and 21 A diabetic neuropathy ulcer caused by restricted blood flow and reduced feeling to the legs and feet caused by diabetes, see pages 22 and 23 A venous ulcer caused by bad valves in your veins that can not pump blood and fluid back to the heart, see pages 24 and 25 Caring for a Leg Ulcer Your healthcare provider will guide you through this book a little at a time, step by step, helping you learn to care for or prevent wounds. Although many leg ulcers cannot be prevented, they can be managed with skin care, diet, exercise, treatments and positive health habits. You can do a lot to heal or prevent a leg ulcer. 1
Step 1 GOALS 1. Tell what signs/symptoms require emergency attention; tell what signs/symptoms to report to your doctor right away. Disease Today, you are able to do the following Medication 2. Name or describe the medications you take; tell when you should take them. Safety 3. Tell whom to call for help and the reasons why. 4. Tell what things you do to keep safe at home. 5. If you use equipment or aids such as a cane or walker, show how to safely use the equipment. Psycho/Social 6. Describe why you need healthcare services and what your goals are. Community 7. Describe the types of services you are going to receive and for about how long. 8. Tell of agreement with the plan of care. 2
CALL 911 FOR Chest pain (angina) Difficulty breathing Call Your Doctor or Nurse if you ODOR Have new symptoms or old symptoms that are worse See more swelling in your legs Feel weak Are not able to eat or drink Are not able to do your planned activity Are not able to do your wound care REDNESS Smell a bad odor from the wound See redness or dark areas around the wound Feel pain, warmth or swelling around the wound Have chills or fever over 100 degrees F for more than 24 hours Ways to Keep Safe Remove Throw rugs Extension cords Small objects from floor Use Handrails Lights for stairs Night lights Check Water temperature in bath or shower If Bed Bound Keep side rails up Have call system in place, like a bell Have bed height in lowest position Always lock bed wheels Wear Flat shoes that are not too worn Robes or pants that are not too long Get up slowly from laying down or sitting to avoid dizziness or falls. Your Healthcare Goals 3
Step 2 GOALS Disease 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Describe why you are on the following medication, how it works and what side effects it may have. Medication Activity 4. Describe how you manage your daily activities like personal care needs and shopping. 5. Describe activities that can help with blood flow in your legs. 6. Tell whom to call for help and the reasons why. Safety 7. Tell of plans to learn dressing change and wound care procedure. (See Wound Care Dressing and Wound Care, pages 30 and 31.) Tests & Treatments 8. Name the people you can count on for help and support. Psycho/Social 9. Describe any reasons why you might have a hard time meeting the goals of your plan of care. 4 Community
What Causes Leg Ulcers? Leg ulcers or wounds are usually caused by blood flow problems. If you have diabetes, you may be more likely to develop leg ulcers. Most leg ulcers are chronic. Chronic means the wound is present for a long time and is hard to heal. For causes of your type of leg wound see Arterial Ulcer, pages 20 and 21 Diabetic Neuropathy Ulcer, pages 22 and 23 Venous Ulcer, pages 24 and 25 Common Risk Factors for Leg Wounds Artery or vein disease Diabetes Smoking Injury to your leg or foot Keep Active, Stay Safe Keeping active is very important in the wound healing process for CAUTION! artery cholesterol build up most ulcers. This can improve blood flow to the wound. Be careful and avoid injury to your legs and feet during activity. While sitting or laying down, position your feet and legs so there is no pressure on the wound. See Exercise and Activity, page 26 and Protect Wound, Promote Healing, page 27. Always check with your doctor before starting any exercise program. Your Activity Goals Caring for Your Leg Wound Your doctor has ordered wound care that may include Cleaning the wound Removing dead tissue and drainage Dressing the wound Your healthcare provider will show you how to take care of your wound and change the dressing. See Wound Care Dressing and Wound Care, pages 30 and 31. 5
Step 3 GOALS Disease 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. (See Wound Care/Symptom/Activity Log, page 32.) 4. Tell 3 signs/symptoms of infection; describe how to prevent a wound infection. Medication 5. Show that you are taking your medication correctly. 6. Describe why you are on the following medication, how it works and what side effects it may have. 7. Tell that your symptoms are under control. (See log, page 32.) Nutrition 8. Describe why food and fluids are important to healing your wound. (See Nutrition, Food Tips, page 28.) 9. Show that you can protect your wound while sitting or laying; show that you can transfer and walk safely to prevent injury. Activity Tests & Treatments 10. Show the correct way to do the wound care treatment and dressing change, with help if needed. Tell possible problems that may occur with your wound treatment. Tell when to stop treatment and call your healthcare provider. 6 Community 11. Name community resources and tell how you can contact them for long term help if needed.
Promote Healing Healing a leg wound depends on Providing care for your wound Good nutrition Controlling other conditions like diabetes Preventing an infection in your wound Your Fluid Needs Your Diet Good Nutrition Your body needs good nutrition to help your wound heal. Calories, protein and other nutrients are needed for healthy skin. Try to eat 4 to 6 small meals a day from all food groups. See Nutrition, Food Tips, page 28. If you are not able eat enough good foods or you start to lose weight, call your healthcare provider. Keep Track of Symptoms Infection If your wound gets infected it takes longer to heal. The infection can spread to the rest of your body. Call your healthcare provider for any of these symptoms. Symptoms of Wound Infection Yellow or green drainage in the wound Bad odor from the wound Redness or dark area around the wound Swelling or warmth around the wound Pain around the wound Symptoms of Infection in Your Body Fever over 100 degrees F for more than 24 hours Chills Weakness If you are on medication for an infection, keep track to see if your symptoms are getting better. Prevent a Wound Infection by Following the wound care as taught by your healthcare provider Keeping wound dressing supplies in a clean area Keeping skin clean and dry 7
Step 4 Disease GOALS 1. Today, your symptoms and test results are within goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. 4. Tell 3 things to do for skin care to prevent leg wounds. Medication 5. Show that you are taking your medication correctly. 6. Describe why you are on the following medication, how it works and what side effects it may have. 7. Show that your wound has signs of healing; you do not have any new leg wounds; and if you have pain or other symptoms, they are under control. (See log, page 32.) Nutrition 8. Name 3 foods high in protein and 3 foods high in Vitamin C. (See Nutrition, Food Tips page 28.) Safety 9. Tell 3 things you are doing to prevent yourself from spreading germs to others or from getting sick from other people or things. 10. Describe how to make your house safe to prevent injuries or falls. 8 Tests & Treatments Psycho/Social 11. Show the correct way to do the wound care treatment and dressing change. 12. Your caregiver describes how they are coping with your condition and can name the people they can count on for support.
Keep Track of Symptoms Edema Edema is the swelling you may get in your legs. It is usually caused by poor circulation. For tips on how to reduce the edema common to your type of ulcer see Arterial Ulcer, pages 20 and 21 Venous Ulcer, pages 24 and 25 Skin Care and Preventing Wounds Check your feet and legs every day for red or dark areas or sores. Use a mirror to help. Use warm (not hot) water for baths and showers. Use a mild soap. Use creams or oils to prevent dry skin. Avoid walking barefoot. Avoid bumping your feet and legs. Cut your toenails straight across. If you can not care for your nails, get nail care done by a healthcare professional. Avoid hot water bottles, heating pads, and electric blankets. CAUTION! Eating Easy, Eating Right Protein, calories and Vitamin C can help the wound heal. See Nutrition, Food Tips, page 28. High Protein Meat Yogurt Eggs Milk and cheese High Vitamin C Citrus Fruit Dark green vegetables Tomatoes Potatoes Staying Healthy Wash your hands often. Put soiled dressings in a plastic bag before throwing in the garbage. Keep your dressing supplies clean. Use clean gloves for each dressing change as taught by your healthcare provider. Caregiver Coping As a caregiver, you need to take time for yourself and stay healthy too. Try to Meet with friends. Maintain as normal a schedule as possible. Have someone to talk with. 9
Step 5 Disease GOALS 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Tell what signs and symptoms require emergency attention; tell what signs/symptoms to report to your doctor right away. 4. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. Medication 5. Show that you are taking your medication correctly. 6. Describe why you are on the following medication, how it works and what side effects it may have. 7. Show that your wound has signs of healing; you do not have any new leg wounds; and if you have pain or other symptoms, they are under control. (See log, page 32.) Nutrition 8. Name some types and amounts of foods you should eat and those you should avoid on your diet. (See Nutrition, Food Tips, page 28.) Activity Safety 9. Tell 3 things that may happen to your wound and other conditions if you do not do your planned physical activities (See Exercise and Activity, page 26.) 10. If you use equipment or aids such as a cane or walker, show how to safely use the equipment. 11. Show that you have made your house safe to prevent injuries or falls. Tests & Treatments 12. Show the correct way to do the wound care and dressing change. Psycho/Social 13. Describe what you do to cope with your condition. 10 Community 14. Tell of agreement with plans for you to manage your condition.
Keep Your Symptoms Under Control Pain Some leg wounds can be very painful. For pain relief measures for your kind of wound see Arterial Ulcer, page 21 Venous Ulcer, page 24 Your doctor may have ordered medication for pain. You may need to take the medication 30 to 40 minutes before doing your wound care. Keep track if the medication helps relieve the pain. If not, call your healthcare provider. Stay Active, Help Heal Your Wound Exercise your arms and legs. This keeps them from getting weak and stiff. Exercise can also increase blood flow through the body and to your wound. The type and amount of activity that is right for you will depend on your type of leg wound and on your ability to move without help. Your nurse or therapist will help you with the exercises that are right for you. Range of Motion There are exercises you can do or your caregiver can do for you. These are called Range of Motion (ROM) exercises. See Exercise and Activity, page 26. Sitting or laying in bed all day without moving can make your wound worse. For other problems that can happen, see Exercise and Activity, page 26. Did You Know Some over-the-counter and prescription medications can affect wound healing or make your condition worse. Never take any medications or supplements without first checking with your doctor or pharmacist. Tips for Coping Talk about what worries you. Write down what worries you. Do things that make you happy. Learn to relax. Spend time with family, friends or pets. 11
Step 6 GOALS Disease 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. 4. Describe how nutrition, activity, skin care and wound care can help heal your wound. Medication 5. Show that you are taking your medications correctly. 6. Describe why you are on the following medication, how it works and what side effects it may have. 7. Show that your wound shows signs of healing; you do not have any new leg wounds; and if you have pain or other symptoms, they are under control. (See log, page 32.) Nutrition 8. Show that you are eating and drinking the right types and amounts of food and fluids (See Diet Log, page 29.) Safety 9. Tell 3 things you are doing every day to prevent yourself from spreading germs to others or from getting sick from other people or things. Tests & Treatments 10. Show that you have been following correct wound care and dressing change measures. Psycho/Social 11. Describe your concerns about how your condition has affected your lifestyle. 12
Control Your Symptoms High Blood Pressure (BP) If you have high BP, keep it under control to help heal your wound. High BP can damage your blood vessels and reduce the blood flow to your wound. Normal BP is less than 120/80. People with high BP usually have a different goal. Your BP goal is. If you take your BP at home, call your healthcare provider if it is higher than your goal. Try to Take your prescribed medication. Lose weight if you are overweight. Take your blood pressure, or have it checked every. Eat foods that are low in salt. Foods Low in Salt Fresh chicken, fish, beef Fresh or frozen fruits and vegetables Low salt cheese Foods High in Salt Canned foods or frozen meals Fast food and deli meats Chips, crackers Keep Up with Your Wound Care If you are having a problem with your wound dressing or doing your wound care, call your healthcare provider right away. If you have a venous ulcer and are using a compression bandage, see page 25 for signs of problems. Eat the Right Things Boost Your Energy and Protein Levels If your appetite is not very good, try different ways to add calories, protein and Vitamin C to your diet. This will give you more energy and help your wound heal. If you do not feel like eating, try a nourishing drink instead. Make this high energy milk shake. Blend Scoop of ice cream Milk and fruit or yogurt 2 to 3 teaspoons of a high energy powder like an instant breakfast product Feeling Blue, Talk About It It is normal to feel anxious or depressed with your condition. Try not to let things bottle up inside. It helps to talk about your worries and fears. Try to stay as active as possible. Not doing your exercises and moving around can make you feel depressed. Try to Do your personal care like brushing your teeth, washing your face and combing your hair every day. Keep up with activities you can do that you enjoy. 13
Step 7 GOALS Disease 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. 4. Describe why you need to take your medications correctly, follow your diet and fluid plan, keep up with your activity and do your wound care. Describe what might happen if you do not. Medication 5. Show that you are taking your medication correctly 6. Describe why you are on the following medication, how it works and what side effects it may have. 7. Show that your wound has signs of healing; you do not have any new leg wounds; and if you have pain or other symptoms, they are under control. (See log, page 32.) Safety 8. If you use equipment or aids such as a cane or walker, show how to safely use the equipment. Psycho/Social 9. Tell the activities you are doing that you enjoy. 10. Describe how you are coping with the changes in your lifestyle. 11. Tell of agreement with plans for you to manage your condition. Community 14
Stay Healthy and Prevent Problems Know and avoid things that may cause problems and delay wound healing. Avoid Sitting or standing in one place for long periods of time. Crossing your legs. Scratching the skin around your leg wound. Wearing tight clothing, socks, slippers or shoes. Sitting in a chair so that the edge of the seat presses against the back of your leg. Promote Health and Healing Try to Wear support stockings if your doctor prescribed them. Walk or exercise according to your treatment plan. Keep your stress under control. Keep other conditions like diabetes or high blood pressure under control. Healthy and Healing Wound Symptoms of healing include Smaller size Less drainage in the wound Light red or pink wound tissue that looks lumpy and shiny SMALLER, HEALING WOUND Leg Wound That Gets Worse Leg wounds can get worse. Symptoms can range from a change in the color of the skin to severe, deep wounds down to the muscle or bone. Symptoms of a wound that is not healing include Skin around the wound changes color - In light-skinned people, a change in skin color to a dark purple or red. - In dark-skinned people, the skin becomes darker than normal. Wound is larger More drainage coming from wound Symptoms of a wound infection (See Symptoms of a Wound Infection, page 7.) It is important to do the things that help your wound heal. If you do not, you may get a more serious problem like An infection in the bone Gangrene and the need for removal of part of your foot or leg (amputation) Tell your healthcare provider if the wound is larger, deeper, has more drainage or has an odor. 15 LARGER, DRAINING WOUND
Step 8 GOALS Disease Medication 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following 3. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. 4. Show that you are taking your medication correctly 5. Describe why you are on the following medication, how it works and what side effects it may have. 6. Show that your wound shows signs of healing; you do not have any new leg wounds; and if you have pain or other symptoms, they are under control. (See log, page 32.) Nutrition 7. Tell how you are adding enough calories, protein and vitamins to your diet. Activity 8. Describe why it is important to do your planned activities every day; show that you are able to increase your activity as planned. (See log, page 32.) Tests & Treatments 9. Show that you have been following the correct wound care and dressing change measures. 10. Show what you do to cope with your condition and care needs. Psycho/Social 16 Community 11. Describe the importance of seeing your doctor and other healthcare providers regularly. 12. Tell of agreement with plans for you to manage your conditon.
Risk Factors You Can Change You can help heal your wound and prevent other chronic wounds if you Control Your Blood Pressure CAUTION! artery cholesterol build up High blood pressure puts a lot of pressure on the walls of your arteries. This can damage the vessels and affect the blood flow in your legs and feet. Lose Weight if You Are Overweight Extra weight makes your heart pump harder. This can lead to high blood pressure. Extra weight can also restrict blood flow when sitting. Quit Smoking Nicotine in cigarettes damages the walls of your blood vessels. Damaged blood vessels are more likely to form clots or to break down. Nicotine also makes the vessels smaller making it harder for blood to flow. Lower Cholesterol and Lipid (Fat) Levels High cholesterol and lipid levels can cause plaque to build up in your arteries. Your arteries become narrowed and blood flow is slowed or blocked. You can lower your cholesterol by losing weight; being active; limiting red meat, eggs, shell fish and whole milk; and taking medication if it is prescribed for you. Exercise If you do not exercise, this can lead to obesity and high blood pressure. It can also reduce your blood flow in your legs and feet. Follow your activity plan. Prevent Injury If you do not have a lot of feeling in your legs or feet, you have to be careful around very hot or very cold temperatures. Be sure to wear shoes all the time to protect your feet. Stay Motivated Keep up with your wound care and prevention plans. Stay as active as possible. Let your healthcare provider know if you are feeling sad or losing your motivation. If you are stressed, learn how to relax Listen to music. Watch a movie. Read a book. Spend time with family, friends, pets. 17
Step 9 GOALS 1. Today, your symptoms and test results are within your goal range set by you and your healthcare provider. 2. Since the last visit or phone call with your healthcare provider, you had no unplanned trips to the doctor, hospital or emergency room. Today, you are able to do the following Disease 3. Show that your wound does not have signs/symptoms of an infection or that it is not getting bigger. 4. Show how you keep track of your condition including watching for signs/symptoms of new wounds or infection and checking your blood pressure or other symptoms. (See log, page 32.) Medication 5. Show that you are taking your medication correctly. 6. Show that your wound has signs of healing; you do not have any new leg wounds; and if you have pain or other symptoms, they are under control. (See log, page 32.) Nutrition 7. Show that you are eating and drinking the right types and amounts of foods and fluids. (See log, page 29.) Safety 8. Show how you are keeping yourself safe at home without injury or falls. 9. Describe how you plan to get your medication, equipment, and supplies. Tests & Treatments Psycho/Social 10. Your caregiver describes how they are coping with your condition and can name people they can count on for support. 11. Tell the activities you are doing that you enjoy. 18 Community 12. Describe how you will keep your visits to your doctor and other healthcare providers. Describe how you will get your tests and shots including a yearly flu and pneumonia shot if you need one. 13. Tell of agreement with plans for you to manage your condition.
Avoid Getting the Flu Get a flu shot every year. Ask your doctor if you need a pneumonia shot. Even if you have already had one, it may be time for you to get another. Avoid crowds and people who are ill during flu season. Staying Healthy Staying healthy is very important in preventing or healing wounds. Conditions that may put you at a greater risk for getting wounds or for having problems with healing them include Arterial disease Anemia Diabetes Heart disease High blood pressure Arthritis Obesity Follow Your Medication, Diet and Activity Plan and Check your blood sugar if you are diabetic Check your blood pressure if you have high blood pressure Stop smoking Avoid any activities that may injure the skin What if the Wound is Not Healing? If wounds are not showing signs of healing after using a treatment for more than 2 weeks or, your healthcare provider may need to change the treatment plan. It is very important to look at the wound every time the dressing is changed. Do this right after cleaning it. Tell your healthcare provider if the wound is larger, deeper, or has more drainage, odor or pain. Self Care Check List Supplies: Where to order? Who to pick up? Equipment: Where to order? Who to pick up? Lab Tests: When? Where? What? Medications: Where to refill? Who to pick up? Next Healthcare Provider Contact: When? Where? 19
Arterial Leg Ulcer 20 Arterial Leg Ulcer Causes Arteries are blood vessels that bring blood with oxygen and nutrients to the body s tissues. Damage to arteries can decrease or block the flow of blood, oxygen and nutrients to the skin. This damage is called arteriosclerosis. There are many things that may cause arteriosclerosis. These are called risk factors. Some risk factors are Diabetes Stress Smoking Obesity High cholesterol Family history High blood pressure Advanced age artery cholesterol build up Symptoms of Decreased Blood Flow to the Legs The skin usually looks pale (white), blue or lighter in color when the legs are raised. The skin looks red or darker when sitting or standing. Pain in legs and feet with exercise, when at rest or when laying down Edema after sitting or standing for long periods of time Shiny, thin skin Skin feels cool Not much hair on the legs Toenails are often thick and yellow Pulse in ankles and feet is weak or absent Tips For Healing Your Wound Exercise. Walking or other exercises help force your blood vessels to form new vessels and improve the blood flow (circulation) in your legs. It is possible to exercise while sitting down. Move your feet around in circles and then move them up and down. Take rest breaks and do not over do it. Too much exercise can cause pain. Follow your exercise plan. Drink 6 to 8 glasses of fluid each day. Wear comfortable, not tight clothing. Wear shoes that fit well. Do not cross your legs. Avoid cold temperatures. Do not smoke. Avoid caffeine.
Control Symptoms Pain If you feel pain in your legs or feet, there are things you can do to help lessen the pain. Pain while laying in bed: Sit on the edge of the bed with your feet dangling or on the floor. Gravity will cause blood to flow into your legs. Pain with activity: You may have pain that feels like a cramp in your legs when you walk. This is because your leg muscles are not getting enough blood. This pain should go away if you stand still for a few minutes. Pain with wound care: Take your pain medication 30 to 40 minutes before you do your wound care. Edema Check for swelling (edema) in your legs. If you have swelling in your legs Avoid sitting or standing in one place for long periods of time. Elevate your legs. Caution: Do not elevate your legs above the level of your heart if you have an arterial ulcer. Take your diuretics (water pills) if they are prescribed for you. Arterial Leg Ulcer Prevent Leg Wounds Make sure your shoes fit right - Not too tight - No sharp edges inside Keep feet warm and dry Avoid injuries to feet and legs Check feet and legs daily for signs of sores Cut toenails straight across. If you can not care for your nails, get nail care done by a healthcare professional. 21
Diabetic Leg Ulcer Diabetic Neuropathy Leg Ulcer Causes Conditions like diabetes or spinal cord injuries can affect the nerve endings in the legs and feet. As a result, there is a loss of feeling in the legs and feet to touch, pain or temperature. This loss of feeling is called peripheral neuropathy. If you get an injury on your leg or foot, you may not feel it. If you do not take care of a sore or injury right away, it can get worse and turn into an ulcer. Conditions like diabetes also can cause less blood flow in the legs and feet. Decreased blood flow makes it harder for the wound to heal. Healing Wound Promote Blood Flow (Circulation) Exercise. Walking or other exercises help force your blood vessels to form new vessels and improve the blood flow in your legs. It is possible to exercise while sitting down. Move your feet around in circles then up and down. Take rest breaks. Do not over do it. Follow your exercise plan. Drink 6 to 8 glasses of fluid each day. Wear comfortable, not tight clothing. Wear shoes that fit well. Do not cross your legs. Avoid cold temperatures. Do not smoke. Avoid caffeine. CAUTION! Control Symptoms Diabetes Keeping your blood sugar under control will help with wound healing. Normal fasting blood sugars are between 90 and 130. Call your doctor if your blood sugars are outside the range set for you,. Keep track of symptoms of high and low blood sugar. Hyperglycemia High Blood Sugar greater than 200 mg 22 Causes Symptoms include Too much food Frequent urination Not enough diabetes medication Dry skin Illness Hunger Extreme thirst Stress Nausea Blurred vision
Control Symptoms Diabetes Hypoglycemia Low Blood Sugar less than 70 mg Causes Symptoms include Too little food Shaking Dizziness Too much exercise Sweating Hunger Too much diabetes medication Weakness Anxious Headache Blurred vision Prevent Leg Wounds Prevent wounds by avoiding injury and taking good care of your feet. CAUTION! Avoid Injury Wear shoes or slippers all the time. Avoid walking with bare feet. Make sure your shoes fit right - not too tight - no sharp edges inside. Wear socks or stockings (without seams) with shoes. Avoid hot water bottles, heating pads and electric blankets. Do not soak feet in hot water. Test water with your elbow before taking a bath or shower. In winter, take extra care of your feet by wearing extra thick or wool socks and boots. Apply a thin coat of cream or oil on your feet after bathing. Do not use between toes. Foot Care Check your feet at least once a day for blisters, cuts, scratches. See your doctor for care of corns, calluses or athlete s foot. Do not try to treat them yourself. See a foot doctor once a year. Cut toenails straight across. If you can not care for your nails, get nail care done by a healthcare professional. Change socks or stockings every day to prevent an infection. Diabetic Leg Ulcer 23
Venous Leg Ulcer 24 Venous Leg Ulcer Veins are blood vessels that bring blood back to your heart. If the veins or the valves in the veins are damaged, they may not work right. This is called chronic venous insufficiency. When this happens blood and fluid pool and cause veins and the tissue around them to swell (edema). This makes it harder for a wound to heal. Control Symptoms Controlling symptoms is very important in preventing and healing wounds. If you have a lot of swelling in your legs, your skin can weep or drain fluids (weepy skin). Follow your wound care plan and your plan to reduce the swelling or edema. Pain and Swelling (Edema) If you have pain in the area of your wound or more swelling in your legs, call your healthcare provider. To help control the pain and swelling, try to Elevate legs above the level of the heart for at least 30 to 60 minutes, 3 to 4 times every day or. Caution: If you also have arterial disease you should not elevate your legs above the level of your heart. Take your diuretic (water pill) if it is prescribed for you. Follow your activity plan. Prevent Venous Leg Wounds Control Risk Factors Control blood pressure or other conditions like congestive heart failure. Lose weight if you are overweight. Do not smoke. Do not cross your legs. Do not stand for long periods of time. Wear support stockings if they are prescribed for you. Apply a thin coat of cream or oil on your feet after a shower or bath. Do not use between toes. Avoid Injury Avoid hot water bottles, heating pads and electric blankets. Keep your halls and pathways clear of clutter. CAUTION! Promote Blood Flow (Circulation) An important part of healing venous ulcers is improving blood return to the heart and decreasing the swelling in your legs. Exercise and compression therapy promote circulation.
Exercise Walking or other exercises help blood and fluids flow back to the heart and reduce edema. Exercise also helps prevent blood clots. Follow your exercise plan. Compression Therapy Your doctor may order compression therapy. Compression therapy is the use of tight fitting stockings or bandages on the lower legs. This can help blood and fluids flow back to the heart and reduce edema. Caution: If you also have arterial disease, you should not use compression therapy. There are a few types of compression therapy. Your wound plan includes Unna boot: Treated gauze that hardens into a stiff cast or boot. Your healthcare provider will usually apply the unna boot. Compression stockings: Tight stockings 1. Put stocking on first thing in the morning when swelling is less. 2. Insert your hand into the stocking until the heel area is reached. 3. Pinch the heel area of the stocking between your forefinger and thumb and turn stocking inside out until heel pocket is seen. 4. Position stocking over foot, making sure heel pocket is over the heel. 5. Pull rest of stocking over the foot and up the leg to just below the knee. Compression bandages: 2 layers to 4 layers of compression bandages 1. Special padding is put on first, starting at the toes and ending below the knees. 2. Bandages should always be rolled before putting on. 3. Put on bandage so that the roll is facing you and you are rolling away from your fingers. 4. Bandage begins to be wrapped starting at the toes and ending below the knee. 5. Do not leave gaps, you do not want skin showing. 6. Bandage is changed every week or. 7. Other instructions:. Make Sure the Bandage is Not Too Tight These symptoms mean that the arteries are being squeezed too tight to let blood flow. Watch for these symptoms Skin is cool or cold to touch Skin is pale, blue, white (mottled) or lighter in color May feel severe pain Remove the compression bandage and call your healthcare provider right away. Venous Leg Ulcer 25
Exercise and Activity Staying active and taking walks help improve circulation in your legs. You can exercise while sitting or while in bed. Move your feet around in circles then up and down. 26Exercise and Activity Range of Motion (ROM) Exercise Range of motion is the amount of movement you have in each joint. The purpose of range of motion exercises is to reduce stiffness and help keep joints moveable. ROM exercises include Bending Stretching, straightening Moving arms and legs away from the body Moving arms and legs toward the body Moving arms and legs in circles ROM Exercises Active ROM exercise means you are able to do the exercises on your own. Passive ROM exercise means another person moves you. Exercise Tips Do ROM exercises at least once a day or. Try to do ROM exercises at the same time each day. ROM exercise schedule:. Check with your doctor before starting any exercise program. Stay Active, Get Stronger Small amounts of activity every day are important to help you feel better and get stronger. Even if you need help, try to do activities like brushing your teeth, combing your hair, dressing yourself and doing your Range of Motion exercises. Stay Active, Avoid Problems Sitting or laying in bed all day without moving can cause Your wound to get worse Blood clots in your legs Bed sores (pressure wounds) Muscles and joints to get stiff Shortness of breath Weakness and fatigue Depression or sadness
Protect Your Leg Ulcers and Avoid Injury It is important to protect your leg ulcer and avoid injury so that your ulcer can heal properly. Be careful not to bang your leg against hard objects. Avoid hot water bottles, heating pads and electric blankets. Keep your hallways and pathways clear of clutter. Never go barefoot. If You Are Chair or Bedridden Avoid lying on your ulcer. Keep your sheets loose so your feet can move around easily. Pad bony areas like your heels and ankles. Promote Healing Stop smoking, if you smoke. Avoid caffeine. Eat a healthy diet, low in fat and high in Vitamin C and protein. Drink plenty of liquids, if allowed. Exercise, as instructed by your physician. Keep your wound clean and change your dressing as instructed. Wear well-fitting shoes; avoid crossing your legs. Avoid sitting or standing for long periods. Inspect your ulcer every day and report signs of infection. If You Have a Venous Ulcer Elevate your leg while sleeping. Elevate your leg while standing. Wear your compresssion stockings. Keep Your Other Medical Conditions Under Control Maintain your proper body weight. Control your blood sugar. Keep your blood pressure under control. Common Leg Ulcer Locations Insides of legs between the knees and the ankles Around the ankle Between the toes or bottom of foot On the bony area of leg below the knee If You Have an Arterial Ulcer Exercise to get more oxygen to your ulcer. Do not wear tight stockings. Avoid cold weather. Protect Wound, Promote Healing 27
28Nutrition, Food Tips High Protein Meat Fish Poultry Milk and cheese Yogurt Eggs Peas Lentils Kidney Beans Navy Beans Lentils Nutrition, Food Tips Good nutrition is important because it helps your body heal the wound. If you do not get the calories, protein and other nutrients, your wound will not heal. To help in the healing of your wound, a diet with protein, Vitamin C and other nutrients is needed. Include 6 to 8 glasses of fluid each day. Limit caffeine intake. Caffeine can make your blood vessels smaller so less blood flows to the wound. Your doctor may prescribe the number of calories you will need, as well as any special dietary needs, like a diabetic diet, low salt diet or supplements. Try to eat foods higher in protein and Vitamin C like Eating Easy, Eating Right Sample menu Breakfast 1 cup of decaffeinated coffee or tea 2 eggs 1 slice of whole wheat toast 1 medium orange Mid Morning Snack 6 to 8 oz fruit drink 1/2 cup peaches 1/2 cup cottage cheese Garbanzo beans Lima Beans Soybeans Peanuts Lunch 8 oz decaffeinated drink Turkey sandwich with mayonnaise Tossed salad with low fat dressing Cantaloupe slice Afternoon Snack 6 to 8 oz decaffeinated drink 2 tbs peanut butter 3 to 4 graham crackers High Vitamin C Citrus fruits Cabbage-type vegetables Dark green vegetables Cantaloupe Strawberries Peppers Lettuce Tomatoes Potatoes Papayas Mangos Dinner 8 oz nonfat milk Chicken Medium baked potato Green beans 1 whole wheat dinner roll 1/2 cup pudding Bedtime Snack 6 to 8 oz nonfat milk 1 cup yogurt 2 slices soft cheese
Diet Log Every day write down what you eat and drink. Show this log when you visit with your healthcare provider. Day Breakfast Lunch Dinner Snacks Diet Log 29
30Wound Care Dressing Different Wound Care Products Your healthcare provider will order the type of product that is best for your wound. The type of products depend on the Size of wound Amount and kind of drainage Presence of an infection Purpose of Your Wound Dressing or Treatment is to Keep the wound moist and the surrounding skin dry Promote healing Control leakage from the wound Control odor Protect wound from further damage Wound Products or Treatments You Use Gauze Film (see-through) Foam Gel Wafer Powders Pads Other Care of Dressing Supplies In your home, clean dressings (not sterile) are usually used. You should keep the supplies from getting dirty. Try to Store dressings in their original packages in a clean, dry place. Wash hands with soap and water before and after each dressing change. Remove dressings from their packages only when ready to use. Throw out the entire package if the dressing becomes wet or dirty. Wear gloves as taught by your healthcare provider. Put soiled dressing and gloves in a small plastic bag before placing in garbage.
Wound Care and Dressing Change Do your wound care as ordered by your healthcare provider. Prepare Wash your hands with soap and water. Gather all supplies and keep nearby during wound care. Circle items you need (dressings, tape, gloves, small basin or paper towels, small plastic bag, large plastic bag, towel or gauze, syringe, cleaning solution for the wound, other ). Place large plastic bag under wound to protect bed furniture. Get into a comfortable position. Remove old dressing Put on clean gloves. Carefully remove old dressing and place in small plastic bag. Remove gloves and wash hands. Clean wound to remove dead tissue and drainage Put on clean gloves. Fill syringe or with wound cleaning solution:. Place paper towels under wound to catch drainage. Hold syringe or other device 1 to 6 inches from the wound and spray with the wound cleaning solution. Use enough force to remove the dead tissue and drainage but not enough to damage new tissue. Note the color and odor of any drainage. Carefully remove wet paper towels. Dry skin around the wound with the towel or gauze. Remove gloves and wash hands. Look at the wound Look to see if there are any changes in the wound and if there is new tissue. If you need to touch the wound, put on clean gloves. Look at how wide and deep the wound is. New healthy tissue looks light red or pink and lumpy and shiny. Dressing the wound Wash your hands before touching clean dressings. Put on clean gloves. Open dressing package and place new dressing over wound as taught by your healthcare provider. Remember to Keep track of your wound on the Wound Care, Symptom, Activity Log. Wound Care 31
32Wound Care, Symptom, Activity Log Wound Care, Activity, Symptom Log Do wound care and dressing change every. Place a in the wound care column each time wound care was done during that day. Write down how the wound looks in the Symptom columns using the words provided. Include signs of healing or signs that the wound is getting worse. Take your blood pressure time(s) a day at the same time(s). If you have edema in your legs or feet, keep track if it gets better or worse. If you have wound pain, rate the pain on a scale of 0 to 10. In the Activity column, write down the level of activity or how many minutes of exercise you did that day. Write down any other comments. Wound Symptoms Date Wound Care Done Size Same Bigger Smaller Drainage Yes/Color or No Other Symptoms/ Odor/ Depth Blood Pressure Edema No/Yes Better or Worse Pain Rate pain 0=none 1=mild 10 =worst Activity Level and Comments
Medication/Vitamin/Supplement Schedule Medication/Vitamin/Supplement Time Dose Medication Schedule 33
Step by Step Guide to better health Your quality of life is important. Sometimes understanding and managing your disease can be difficult. This booklet was created for you and anyone helping you. The goals and educational content should assist you in managing your health and living better. This publication is intended for informational purposes only and cannot serve as a substitute for the care provided by a licensed physician or healthcare provider. Readers are advised to seek medical guidance before making any changes in self-care practices or medical therapies. Stock No. WB1-101 Developed by: Innovative Healthcare Solutions www.innovativehcs.com Published and Distributed by: Briggs Corporation www.briggscorp.com