CEBRN

Thank you for saying this I 100% agree with your whole quote. We need to protect our patients but more importantly ourselves!!!

Definitely there would be a benefit to the skin. This patient has a lot going on and unfortunately their poor health related to their diabetes has taken a toll on several areas of their body. My biggest advice to you as a student is to start training your brain to look at the whole picture. Its like a detective putting all the pieces together, figuring what caused this whole process for the patient- critical thinking. If you treat the main problem most of the secondary issues will usually improve. So if you treat their diabetes by aggressively controlling their sugars their overall health will begin to improve, the skin will heal better, they will have more energy and be more active, but the biggest thing is you will improve any further damage. Unfortunately, this can be complicated because most diabetics, who have major secondary issues to their diabetes are usually non compliant in their care. That is why teaching is so important with these patients. Some times compliance is not the issue, it is just a knowledge deficient. You are on the right track though, by controlling their sugars future skin issues will be less likely. That is why daily skin inspection is equally important. Like I said earlier about patients have neuropathy, they are still at risk for more wounds to develop like if they cant feel that their prosthetic is not fitting right, they might develop a sore. If they are controlling their sugars the sore will heal quicker than if they had poor sugar control.

I believe you are on track. Yes the damage is done to the foot, but more tissue damage can occur because of poor BS control. With any diabetic patient BS control is a major key factor to their health. There is a lot of dynamics to the BS control and ulcers, one thing to remember bacteria loves sugar and if patients sugar is sky high its a bacteria playground. Diabetic patients do not heal wounds easily, and a high sugar makes it worse for healing. Patient needs tight glycemic control, meaning sugars needs to be monitored closely and treated aggressively while the wound is trying to heal. I would add daily skin inspection of the ulcer and proper care of the wound. Patient probably has neuropathy from their diabetes and cant feel their extremities or the ulcer for that matter until it was too late. Dont forget patient education as an intervention. Hope this helps.

Were other avenues attempted to ease the patients pain, positioning, heat or ice? I guess my feeling are, if your hurting that bad are you physically able to leave AMA? I understand as nurses we always have to believe that the patient has the pain they say they have, but sounds like there are other dynamics involved. Does Oxy effect HR? I understand the patient might be more relaxed and pain free but I dont believe HR would be effected. Is this a normal dose for the patient if they have chronic pain. I guess I am more concerned about the HR and the block.

i was looking for some honest feedback on where is a good place to work in vegas. i will be moving this summer and wanted to research my options. i currently work at a level 2 trauma hospital. i come from a 16 bed icu that cares for all types of critical care patients. i would like to continue in this type of icu that sees all different specialties, but understand bigger hospitals have different critical care areas. looking for a place with great environment and support, close knit team, great benefits and educational opportunities. any information would be greatly appreciated!:)