HELP! Goals/Interventions- Diabetic foot ulcer/CHF

[almostfearless]

I'm a second semester (out of 5) ADN student-- And tomorrow is one of the last two clinical days I have left for this semester. Today was preclinical.

I'm a bit nervous because I failed one of the two previous paperwork days because of the goals sheet. My professor is wanting good, cut-the-crap kind of goals.

I'm having trouble coming up with any.

She has beginning COPD, beginning congestive heart failure, hypertension, a diabetic ulcer on half of her great toe that's looking better than I'd expected.

I have this one:

Goal: Prevent infection of Great Toe ulcer.

Interventions:

Keep clean

Keep Covered

(I Can't come up with a third one!!)

And I need a second goal, complete with three more interventions.

I'm thinking:

Goal: Maintain blood pressure at or below 145/85

Interventions:

Medicate per MAR

?

?

Some of the confusion is coming from the fact that our professor gave us an additional lecture last week that if we write out a goal, our interventions should be only things that DIRECTLY and MEASURABLY effect the outcome-- Like if the problem is edema, you can't say daily weights, because while that is a good thing to do, it does not achieve your goal of reducing edema. Which is understandable. But it leaves me completely blank.

AAAH!

[almostfearless]

Also, she is severely anemic.

How about this:

Goal: Patient will have no falls related to syncope/Nutritional status

Interventions:

1) Sit patient up slowly to prevent syncope

2) Check blood pressure before standing

3) Keep bed rails up x2

[Rednights]

Well for the edema, if you go from +4 to +2, that's an obviously a measurable outcome. Also lung sounds if the crackles start to subside ... I'm going to assume it's present with CHF and edema already seen o_O. You can do patient edcuation on restricting salts, DASH diet for the hypertension, or simple exercise, though I imagine the COPD/CHF will make that slightly unrealistic and elderly patients are hard of accepting such "simple" advice to begin with. So for that fatigue have provide adequate rest periods during procedures or what not. Ah, some form of Diuretic I would imagine is already ordered for. Inspecting feet daily too. Well that's what I can come up with on top of my head.

Edit:

Anemic

Lab values (Hemotracit, Hemoglobin, Platelets, all that good stuff)

Maintain adequate O2 sat levels > 9X or whatever

Diet --> Folic Acid + b12 ... or some Iron prepration of some sort --> Check labs again ....