LadyBug52

I need some help with a dm heel ulcer... I'm a homecare nurse, and we use Convatec protocol for our wound care (unless we come up with something else on our own of course). This DM patient has a heel ulcer which is about 2cmx2cmx0.3 and a few weeks ago it was hyperkeratotic/callused/dry so I went by the protocol for dry dm ulcer and did Aquacel Ag with Duoderm Signal. The patient hated the Aquacel, said it burned. So, I switched to Duoderm Hydrogel with Duoderm Signal as wound was still dry and this is another option in our protocol. Well, the wound went from dry/callused/hyperkeratotic to wet, macerated and is now deeper in one week. I haven't dealt with these extremes before, and am not sure what to do next, I don't want to change to a dry dressing and have it just go back to being callused but I don't want it to be macerated either?! Any advice is appreciated!

Alright...I'm doing a care plan for a 78 yo pt. with lower GI bleed s/p transverse colectomy. Pt hemoccult+, HgB & Hct low. Patient states not in any pain, no discomfort, nausea, fatigue...No complaints at all. Pt. has type 2 diabetes and recent CVA. I need a primary and secondary nursing diagnosis and I'm unsure. None of the NANDA suggestions for GI bleed seem to fit as he's not in any discomfort. Any help is appreciated!