Diabetic neuropathy, a significant complication of diabetes mellitus (DM), manifests as nerve damage resulting from prolonged exposure to elevated blood glucose levels. The progression and severity of this condition are closely linked to the duration of diabetes and how effectively a patient manages their blood sugar through lifestyle adjustments and medical treatments. For nurses, understanding and addressing diabetic neuropathy is crucial in patient care, and accurate nursing diagnoses form the cornerstone of effective intervention strategies.
Chronically elevated blood glucose in diabetes initiates a cascade of cellular damage and inflammation. This hyperglycemic environment attracts immune cells like macrophages, exacerbating inflammation and leading to nerve fiber degeneration. Initially, the distal sensory and autonomic nerve fibers are affected, gradually diminishing sensation in the skin and underlying tissues, particularly in the extremities. This insidious onset often means patients are unaware of developing issues until symptoms become pronounced.
There are several types of diabetic neuropathy, each with distinct characteristics and implications for nursing care:
Peripheral neuropathy is the most prevalent form among diabetic individuals. It affects the peripheral nerves, typically resulting in sensations of burning, tingling, and numbness, predominantly in the lower legs and feet. This sensory impairment significantly increases the risk of foot injuries and complications.
Autonomic neuropathy involves damage to the nerves controlling internal organs. This can disrupt the function of the heart, digestive system, sexual organs, and sweat glands, leading to a range of symptoms including altered bowel habits, sexual dysfunction, nausea, vomiting, and orthostatic hypotension.
Focal neuropathy involves damage to a single nerve, most commonly in the hand, chest, or leg. Carpal tunnel syndrome, a nerve entrapment condition, is a frequent example of focal neuropathy.
Understanding these types of neuropathy is essential for nurses to formulate precise nursing diagnoses and tailor care plans accordingly. This article will delve into the nursing process for diabetic neuropathy, focusing on assessment, interventions, and care plans, with a strong emphasis on nursing diagnoses to guide effective patient management.
The Nursing Process for Diabetic Neuropathy
Nursing care for patients with diabetic neuropathy centers around mitigating risks and managing symptoms. Key nursing considerations include addressing risk for injury, risk for infection, and managing pain. Routine assessments of the extremities are paramount to detect early signs of infection, injury, or ulceration. Patients with diabetic neuropathy are inherently more vulnerable due to diminished protective sensation and impaired wound healing capabilities. A proactive nursing approach, emphasizing patient education on meticulous foot care, medication adherence, diet, and lifestyle modifications, is vital in preventing severe complications.
Nursing Assessment: Gathering Subjective and Objective Data
The initial phase of the nursing process is comprehensive assessment. This involves gathering subjective data through health history review and patient interviews, and objective data through physical examinations and diagnostic procedures.
Review of Health History: Uncovering Subjective Symptoms and Risk Factors
1. Assessing General Neuropathy Symptoms: Diabetic neuropathy symptoms are diverse, encompassing sensory, motor, and autonomic manifestations.
Sensory symptoms often develop gradually and can be widespread or localized. Key manifestations include:
- Numbness: A diminished sense of touch.
- Loss of balance: Difficulty maintaining equilibrium, especially when walking.
- Loss of sensation: Reduced ability to feel pressure, pain, or temperature changes.
- Burning pain: A persistent, often intense burning sensation, particularly in the feet and legs.
- Tingling (paresthesia): “Pins and needles” sensation.
- Hypersensitivity (allodynia): Pain from stimuli that are not normally painful, such as light touch.
Motor symptoms manifest as weakness, typically in the upper or lower extremities. Patients may report:
- Impaired coordination: Difficulty with fine motor skills and complex movements.
- Difficulty climbing stairs: Leg weakness affecting mobility.
- Difficulty rising from a seated position: Muscle weakness in the legs and hips.
- Falls: Increased risk due to balance issues and muscle weakness.
Autonomic symptoms affect various bodily functions and may include:
- Dysphagia: Difficulty swallowing.
- Abdominal pain: Discomfort or pain in the abdomen, potentially related to gastroparesis.
- Nausea/vomiting: Symptoms of gastroparesis, delayed stomach emptying.
- Orthostatic hypotension: Dizziness or lightheadedness upon standing due to blood pressure drop.
- Arrhythmias: Irregular heartbeats due to cardiac autonomic neuropathy.
- Near syncope: Episodes of lightheadedness or dizziness that almost lead to fainting.
- Difficulty urinating: Urinary retention or incontinence due to bladder dysfunction.
- Excessive sweating (hyperhidrosis) or decreased sweating (anhidrosis): Thermoregulation issues.
2. Identifying Risk Factors: Several factors elevate the risk of developing diabetic neuropathy:
- Advanced age: Risk increases with age.
- Obesity: Associated with insulin resistance and increased risk of diabetes complications.
- Poor glucose control: Prolonged hyperglycemia is the primary cause of diabetic neuropathy.
- Smoking: Impairs circulation and exacerbates nerve damage.
- Excessive alcohol consumption: Can worsen neuropathy.
- Hypertension: Contributes to microvascular damage.
- Dyslipidemia: Abnormal lipid levels can worsen cardiovascular and nerve health.
3. Reviewing Medical History: A comprehensive medical history should detail the patient’s diabetes history, including type, duration, and management, as well as the presence of other chronic conditions like hypertension and dyslipidemia. It’s important to note that patients with type 1 DM might not experience neuropathy symptoms for many years after the onset of hyperglycemia, while those with type 2 DM may develop symptoms sooner, even around the time of diagnosis.
4. Interviewing about Diabetes Management: Assess the patient’s daily diabetes management practices. Pertinent questions include:
- Frequency of blood glucose monitoring.
- Last A1c test and result (reflecting long-term glucose control).
- Adherence to antidiabetic medications (missed doses).
- Dietary habits (assessing for diabetic-friendly diet).
- Physical activity levels (regular exercise is crucial for glucose control).
5. Assessing Foot Care Practices: Inquire about the patient’s foot hygiene and care routines. Patients with diabetes should undergo a comprehensive foot exam annually by a physician or podiatrist and a visual foot inspection at every healthcare visit (every 3-4 months). Daily self-examination of the feet for cuts, wounds, skin breaks, or ulcerations is also crucial.
Physical Assessment: Objective Signs of Neuropathy
1. Performing Peripheral Neuropathy Testing: Physical examination should include tests for sensory and motor function in the extremities. Patients with neuropathy may exhibit diminished or absent sensations. Testing should encompass:
- Muscle strength: Assessing for weakness in major muscle groups of the arms and legs.
- Reflexes: Testing deep tendon reflexes (e.g., ankle, knee) for diminished or absent responses.
- Sensation:
- Light touch: Using a cotton wisp to assess tactile sensation.
- Vibration: Using a tuning fork to assess vibration perception, often reduced in neuropathy.
- Proprioception: Testing the patient’s awareness of their body position in space, often assessed by asking them to identify the direction of movement of their big toe while their eyes are closed.
2. Assessing Skin Condition: Regularly inspect the skin of the lower extremities and feet for signs of cracking, dryness, or open lesions. These findings are crucial indicators of potential tissue integrity issues related to neuropathy.
Alt text: A nurse carefully examines a patient’s foot for signs of diabetic neuropathy, checking for skin integrity and sensation.
Diagnostic Procedures: Confirming Diagnosis and Assessing Severity
1. Reviewing Lab Results: Hemoglobin A1c (HbA1c) and fasting plasma glucose are essential lab tests for assessing long-term and current glycemic control, respectively. Out-of-range results strongly correlate with the presence and severity of diabetic neuropathy.
2. Cardiovascular System Assessment: Given that autonomic neuropathy can affect the cardiovascular system, assess for orthostatic hypotension by measuring blood pressure in both supine and standing positions. Obtain an ECG to detect potential arrhythmias indicative of cardiac autonomic neuropathy.
3. Nerve Conduction Studies: Nerve conduction studies (NCS) and electromyography (EMG) are valuable in characterizing neuropathy. These tests assess the speed and strength of electrical signals traveling through nerves and can reveal the severity and prognosis of the condition.
4. Imaging Scans (Rule out other conditions): While not directly diagnostic for neuropathy, imaging scans like plexus MRI, CT myelography, nuclear imaging, or Doppler imaging can be used to exclude other conditions that may mimic or contribute to nerve symptoms, such as nerve compression or vascular issues.
Nursing Interventions: Strategies for Management and Symptom Relief
Effective nursing interventions are crucial for managing diabetic neuropathy, alleviating symptoms, and preventing complications.
1. Early Diagnosis is Key: Neuropathy being the most common diabetes complication underscores the importance of early detection and management, ideally starting at diabetes diagnosis. Misdiagnosis or inadequate treatment can lead to severe consequences like amputation and paralysis.
2. Emphasize Foot Care Education and Implementation: Provide comprehensive foot care education, focusing on preventive measures against foot ulcers. Key interventions include:
- Advise patients to always wear socks and appropriate footwear, even indoors, to protect feet from injury.
- Instruct on daily self-inspection of feet, using a mirror for hard-to-see areas.
- Refer patients to a podiatrist for annual comprehensive foot exams and routine foot care.
3. Strict Glucose Level Management: Maintaining tight glycemic control is paramount in preventing and managing diabetic neuropathy. Fluctuations in blood glucose, both hypoglycemia and hyperglycemia, can trigger or worsen neuropathic pain. Improved glucose control can slow neuropathy progression.
4. Promote Pain Relief Strategies: Managing neuropathic pain requires a multimodal approach. Treatment options are categorized into conservative, pharmacological, and interventional therapies.
Conservative Therapy:
- First-line: Physical therapy:
- Weight-bearing exercises to improve circulation and function.
- Tai chi for balance and coordination.
- Massage therapy to improve circulation and reduce muscle tension.
- Second-line: Health management:
- Glucose control optimization.
- Management of comorbid conditions (hypertension, dyslipidemia).
- Healthy diet emphasizing balanced nutrition.
- Weight loss if overweight or obese.
- Third-line: Minimally invasive treatments:
- Acupuncture: May provide pain relief for some patients.
- Transcutaneous electrical nerve stimulation (TENS): Uses mild electrical currents to stimulate nerves and reduce pain.
Pharmacological Therapy:
- First-line agents:
- Gabapentinoids (pregabalin and gabapentin): Anticonvulsants that modulate nerve pain.
- Duloxetine: SNRI antidepressant effective for neuropathic pain.
- Second-line agents:
- SSRIs and SNRIs (sertraline, venlafaxine): Antidepressants that can help with pain management.
- Tricyclic antidepressants (amitriptyline): Older antidepressants also effective for neuropathic pain, but with potential side effects.
- Topical capsaicin: Cream made from chili peppers that can reduce pain over time.
- Transdermal lidocaine: Patch that provides local pain relief.
- Third and Fourth-line agents (for severe pain):
- Tramadol: Opioid-like analgesic.
- Dextromethorphan: Cough suppressant that can have pain-relieving effects at higher doses.
- Morphine and Oxycodone: Strong opioid analgesics, used cautiously due to addiction potential.
Interventional Therapy (for refractory pain):
- First-line: Dorsal column spinal cord stimulation:
- Commonly using 10 kHz frequency.
- Tonic waveforms to interrupt pain signals.
- Second-line: Additional neuromodulation options:
- Burst spinal cord stimulation: Delivers pain relief in bursts.
- Dorsal root ganglion spinal cord stimulation: Targets specific nerve roots.
- Peripheral nerve stimulation: Stimulates specific peripheral nerves.
- Third-line: Intrathecal drug delivery system:
- Intrathecal opioids (morphine, fentanyl, hydromorphone): Direct delivery of opioids to the spinal fluid for potent pain relief.
- Intrathecal ziconotide: Non-opioid pain medication delivered intrathecally.
5. Treat Autonomic Dysfunction: Address specific symptoms of autonomic neuropathy:
- Erectile dysfunction: May be treated with sildenafil and phosphodiesterase type 5 (PDE5) inhibitors.
- Orthostatic hypotension: Management includes increased fluid and salt intake, compression stockings, or medications if needed.
- Gustatory sweating (sweating while eating): Treated with glycopyrrolate to reduce excessive sweating.
6. Restore Function through Rehabilitation: Refer patients for rehabilitation services.
- Physical therapy and exercise: Help manage the disease, improve mobility, and reduce pain.
- Occupational therapy: Focuses on home modifications and adaptive equipment to enhance daily living with neuropathy.
7. Monitor for Complications: Peripheral neuropathy can lead to serious complications.
- Ulcerations and infection: Educate patients to monitor for signs of infection in the feet and legs, such as draining wounds, erythema, or fever, which require immediate medical attention.
- Amputation: Preventive foot care and early intervention are crucial to minimize amputation risk.
8. Emphasize Long-Term Follow-Up: Stress the importance of ongoing monitoring and adherence to the treatment plan to prevent neuropathy progression and complications. Remind patients of scheduled follow-up consultations with specialists, including:
- Endocrinologists for diabetes management.
- Neurologists for nerve-related issues.
- Vascular surgeons for circulatory problems.
- Cardiologists for heart-related autonomic neuropathy.
- Podiatrists for foot care.
- Gastroenterologists for digestive autonomic neuropathy.
Nursing Care Plans and Nursing Diagnoses for Diabetic Neuropathy
Once a thorough assessment is completed, nurses formulate nursing diagnoses to guide care planning. Nursing care plans prioritize assessments and interventions to achieve both short-term and long-term patient care goals. Common nursing diagnoses related to diabetic neuropathy include:
Impaired Tissue Integrity
Nerve damage from chronic hyperglycemia can lead to numbness and loss of sensation, increasing the risk of injury and impaired tissue integrity, particularly in the feet.
Nursing Diagnosis: Impaired Tissue Integrity
Related to:
- Disease process (diabetic neuropathy)
- Obesity (contributing to poor circulation and wound healing)
- Malnutrition (impairing tissue repair)
- Insufficient knowledge about foot care and tissue integrity maintenance
As evidenced by:
- Pain (at the site of tissue impairment)
- Delayed wound healing
- Tissue damage (ulcers, lesions)
- Numbness (loss of protective sensation)
- Swelling (inflammation)
- Erythema (redness, indicating inflammation or infection)
Expected outcomes:
- Patient will report any altered sensation or increased pain in areas of tissue impairment, demonstrating awareness of potential problems.
- Patient will verbalize understanding of the treatment plan aimed at healing tissue injury and preventing infection, indicating engagement in their care.
- Patient will demonstrate progressive wound healing, evidenced by a decrease in wound size and the development of granulation tissue.
Assessment:
1. Assess the site of impaired tissue integrity. Characteristics like redness, pain, burning, swelling, and itching indicate inflammation, a typical response to compromised tissue integrity.
2. Determine wound size, depth, and characteristics. Routine, meticulous wound assessment, including length, width, and depth, is essential to track changes over time and evaluate treatment effectiveness.
3. Monitor for alterations in sensation. Patients with diabetic neuropathy often have reduced sensation in extremities, predisposing them to tissue damage. Assess sensation by testing the patient’s ability to differentiate between soft, sharp, or cold sensations.
Interventions:
1. Inspect and monitor the impaired tissue integrity site. Instruct the patient to daily inspect their feet and lower legs. They may use a mirror for hard-to-see areas or request assistance from a family member. Color changes, swelling, redness, warmth, and other infection signs must be promptly reported.
2. Clean, dry, and moisturize the skin. Maintaining clean, dry, and moisturized skin enhances the skin barrier, aids tissue repair, and preserves skin integrity.
3. Provide wound care as indicated. Proper wound care promotes tissue integrity and healing. Diabetic wound healing can be complex and may necessitate outpatient wound care or advanced treatments like hyperbaric oxygen therapy.
4. Encourage physical therapy and exercise. Physical therapists can recommend appropriate exercises to maintain mobility and strength. Even low-intensity aerobic exercise has been shown to improve foot sensation and reduce pain.
5. Involve case management and home care. Wound healing can be prolonged. Educate the patient and family on wound care, dressing changes, follow-up appointments, and coordinate with case management and home health services as needed.
Alt text: A close-up view of a nurse providing meticulous wound care to a diabetic foot ulcer, demonstrating the importance of infection prevention and healing promotion.
Ineffective Peripheral Tissue Perfusion
Diabetic neuropathy, as a microvascular complication, impairs tissue perfusion, potentially leading to necrosis and amputation if unmanaged.
Nursing Diagnosis: Ineffective Peripheral Tissue Perfusion
Related to:
- Disease process (diabetic neuropathy)
- Sedentary lifestyle (reducing blood flow)
- Impaired circulation (due to diabetes-related vascular damage)
- Smoking (vasoconstriction and reduced oxygen delivery)
As evidenced by:
- Absent or decreased peripheral pulses (indicating reduced blood flow)
- Numbness (due to nerve ischemia)
- Altered motor function (muscle weakness or paralysis due to ischemia)
- Delayed peripheral wound healing (inadequate blood supply for tissue repair)
- Paresthesia (nerve irritation from poor perfusion)
- Extremity pain (ischemic pain)
Expected outcomes:
- Patient will exhibit adequate peripheral tissue perfusion, as evidenced by palpable peripheral pulses and warm, dry skin.
- Patient will demonstrate understanding of interventions to improve tissue perfusion and prevent further complications of diabetic neuropathy, indicating proactive self-management.
Assessment:
1. Assess for signs of decreased tissue perfusion. Diabetic neuropathy primarily affects extremities. Signs and symptoms of reduced peripheral tissue perfusion include skin color changes (pallor, cyanosis), pain, absent or diminished pulses, numbness, and sensory/motor function loss.
2. Assess and monitor blood glucose levels. Prolonged hyperglycemia damages nerves and blood vessels, significantly reducing blood flow and impairing tissue perfusion.
3. Assess capillary refill time. Diabetic neuropathy-related nerve and blood vessel damage from hyperglycemia leads to microvascular insufficiencies. Capillary refill time assesses tissue perfusion and microcirculatory status.
4. Assess for comorbidities. Peripheral vascular disease, arterial insufficiency, hypertension, and dyslipidemia exacerbate impaired tissue perfusion.
Interventions:
1. Educate on proper blood glucose management. Explain the critical role of tight glycemic control in preventing blood vessel damage and poor tissue oxygenation. Ensure patient understanding of glucose monitoring and adherence to antidiabetic medication regimens.
2. Encourage ambulation as tolerated. Ambulation promotes blood flow and tissue perfusion. If mobility is limited, recommend seated exercises to improve circulation.
3. Educate and assist with foot and leg care. Instruct on daily foot inspection and podiatry consultation for any concerns. Discuss the need for specially fitted footwear or inserts to improve circulation and protect feet.
4. Instruct to avoid heat application to poorly perfused tissues. Heat application to extremities with diabetic neuropathy can easily damage ischemic tissues due to reduced sensation and circulation.
Unstable Blood Glucose
Uncontrolled glucose levels significantly increase the risk of diabetic neuropathy and its complications.
Nursing Diagnosis: Unstable Blood Glucose
Related to:
- Insufficient adherence to diabetes management plan
- Inadequate blood glucose monitoring
- Deficient knowledge of diabetes disease process and management
- Changes in weight (affecting insulin sensitivity and requirements)
- Change in activity level (altering glucose utilization)
- Stress (hormonal effects on glucose levels)
As evidenced by:
- Frequent urination (polyuria, symptom of hyperglycemia)
- Increased thirst (polydipsia, symptom of hyperglycemia)
- Tingling sensation/numbness in feet (neuropathy symptoms worsened by glucose fluctuations)
- Headache (can be associated with both hypo- and hyperglycemia)
- Dizziness (can be associated with both hypo- and hyperglycemia)
Expected outcomes:
- Patient will maintain glucose levels within the target range (e.g., at or below 125 mg/dL fasting, as individualized).
- Patient will verbalize a plan for lifestyle modifications to prevent glucose level variations, demonstrating self-management skills.
- Patient will accurately describe their medication regimen for diabetes management, indicating understanding and commitment to therapy.
Assessment:
1. Assess patient knowledge of their disease process. Evaluating understanding of diabetes and its treatment helps identify knowledge gaps that contribute to unstable glucose levels.
2. Monitor for signs and symptoms of hypo/hyperglycemia. Signs of hypoglycemia include altered level of consciousness, cool and clammy skin, tachycardia, headache, lightheadedness, anxiety, and hunger. Symptoms of hyperglycemia include increased thirst, polyuria, blurred vision, and recurrent infections. Uncontrolled glucose directly increases neuropathy risk.
Interventions:
1. Perform blood glucose testing. Patients with diabetes have individualized glucose control goals, but generally, levels should be within the target range recommended by their healthcare provider.
2. Conduct meal planning with patient and family. Diet is central to diabetes management. Recommend complex carbohydrates for stable glucose levels, lower cholesterol, and satiety. Carbohydrate intake must be balanced and tailored to individual needs. Family involvement enhances support, especially if they prepare meals.
3. Administer hypoglycemic medications as prescribed. Pharmacological therapy is core to diabetes management. Common antidiabetic medications include:
- Sulfonylureas (glipizide, gliclazide, glimepiride): Stimulate insulin release from the pancreas.
- Meglitinides (repaglinide and nateglinide): Similar to sulfonylureas, promoting insulin secretion.
- Biguanides (metformin): First-line for type 2 DM, reduces liver glucose production and improves insulin sensitivity.
- Thiazolidinediones (rosiglitazone, pioglitazone): Increase insulin sensitivity in peripheral tissues.
- α-Glucosidase inhibitors (acarbose, miglitol, voglibose): Slow carbohydrate absorption in the gut.
- DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin): Enhance insulin release and reduce glucagon secretion.
- SGLT2 inhibitors (dapagliflozin and canagliflozin): Increase glucose excretion in urine.
- Insulin: Injectable insulin to supplement or replace endogenous insulin.
4. Educate about home diabetes management. Address reasons for unstable glucose, such as poor adherence and inadequate monitoring. Emphasize the importance of adherence and provide comprehensive education on disease management to improve patient compliance.
Risk for Impaired Skin Integrity
Loss of protective sensation and impaired tissue perfusion due to hyperglycemia increase vulnerability to skin damage.
Nursing Diagnosis: Risk for Impaired Skin Integrity
Related to:
- Decreased blood and nutrient supply to tissues secondary to DM (impaired healing)
- Imbalanced nutrition (affecting skin health and repair)
- Obesity or emaciation (both can compromise skin integrity)
- Mechanical trauma secondary to alterations in protective sensation (increased risk of unnoticed injuries)
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred; interventions are preventive.
Expected outcomes:
- Patient will maintain intact skin integrity, free from new lesions or breakdown.
- Patient will verbalize understanding of diabetic neuropathy, its risk factors for skin breakdown, and potential complications.
- Patient will demonstrate lifestyle changes to prevent impaired skin integrity, such as daily foot inspections and proper footwear.
Assessment:
1. Assess blood supply and sensation, especially in the feet. Feet are most vulnerable to poor wound healing due to impaired perfusion and neuropathy-related loss of sensation.
2. Identify risk factors for impaired skin integrity. Besides DM, consider poor physical conditioning, mobility limitations, age, self-care deficits, and other chronic conditions that increase skin integrity risk.
Interventions:
1. Provide or encourage optimal nutrition. Adequate nutrition supports tissue health and repair. Proper hydration maintains cell fluid balance and improves circulation.
2. Recommend routine podiatry visits. Patients with diabetic neuropathy benefit from regular podiatry care for foot inspections and safe toenail trimming.
3. Instruct on proper extremity care. Feet are highly susceptible to skin integrity issues due to distal location and impaired perfusion. Advise against harmful practices like pedicures, barefoot walking, and tight shoes.
4. Protect from environmental hazards. Decreased sensation in neuropathy reduces awareness of hazardous objects or temperatures. Educate on avoiding extreme temperatures and sharp objects to prevent injury.
Risk for Infection
Patients with DM and neuropathy are at increased risk of infection due to compromised immunity and skin integrity.
Nursing Diagnosis: Risk for Infection
Related to:
- Alteration in skin integrity (potential entry point for pathogens)
- Compromised physical health secondary to DM (impaired immune response)
- Immunosuppression (diabetes can affect immune function)
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred; interventions are preventive.
Expected outcomes:
- Patient will remain free from infection throughout care.
- Patient will demonstrate infection prevention techniques and lifestyle changes, such as proper handwashing and wound care.
Assessment:
1. Monitor for signs of infection or inflammation. Early detection of local infection signs (erythema, swelling, pain, loss of function, warmth) prevents systemic spread.
2. Monitor vital signs. Vital signs provide quick indicators of physical health. Hyperthermia, tachycardia, and tachypnea may signal infection or inflammation.
3. Assess lab values. Monitor WBC count, wound cultures, and CRP levels for signs of infection and inflammation.
Interventions:
1. Maintain aseptic technique for all procedures. Aseptic techniques, especially during wound care, minimize cross-contamination and pathogen introduction.
2. Obtain specimens for culture and sensitivities, as indicated. Identifying the causative pathogen guides appropriate antibiotic therapy.
3. Administer antibiotics as prescribed. Antibiotics treat infection and prevent resistance development.
4. Instruct patient and family on proper handwashing. Handwashing is the most effective and simple way to prevent infection transmission.
5. Educate on wound healing and infection prevention. Diabetes impairs wound healing. Emphasize precautions to prevent infection, especially post-surgery or during wound care.
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