Teaching Plan Pvd

M E T H O D TEACHING PLAN Client’s Initials: A. A.

Student: _Cassie Williams___

Date: _March 28, 2009__

Diagnosis: __Peripheral Vascular Disease_______ Teaching Techniques: Give explanations, One-on-One discussions, Demonstrations, and information pamphlets. M (Medications): Lovenox (enoxaparin sodium). This medication is an anti-coagulant. It helps to prevent DVT’s, and pulmonary embolisms. DVT’s are blood clots in the peripheral veins (usually the legs) that can travel to your lungs and cause a pulmonary embolism. This drug is very important because with peripheral vascular disease your peripheral venous system is not getting efficient circulation, and Lovenox will help stop the clotting process. This drug is given as an injection usually around left and right abdomen walls where there is fatty tissue. Be sure and rotate your injection sites. You will be taking 40 mg SubQ once daily. You will need to avoid OTC drugs that contain aspirin or other salicylates. Also watch for signs of bleeding if noted notify you MD at once. Some other adverse reactions to look for are edema, peripheral edema, nausea and confusion. If you experience any of these reactions notify your MD. Aldactone (spironolactone). This medication is a potassium-sparing diuretic. It promotes water and sodium excretion and hinders potassium excretion, it also helps to lower your BP. This medicine will help control any edema in your lower extremities because your Lovenox can cause peripheral edema. This will also help to maintain a stable BP. You will be taking 50 mg P.O. daily. Take this drug with meals to enhance absorption, and stay away from foods that are high in potassium because this medication is a potassium sparing diuretic and you could be at risk for hyperkalemia. Also try and take this medicine early in the day to prevent loss of sleep due to nocturia. Diflucan (fluconazole). This medication is an anti-fungal. Since you have a wound on your foot it is going to hinder fungal growth. This medication will help with the healing process and help clean your blood of fungal growth. You will be taking 200 mg P.O. daily. Some adverse reactions

to watch out for are nausea, anaphylaxis, headache and abdominal pain. If any of these occur notify your MD. Also while taking this medication be sure and stay properly hydrated. Zosyn (piperacillin sodium and tazobactam sodium). This medication is an antibiotic. It kills susceptible bacteria from infections. You will be receiving 3.375 g Zosyn q6h as a 30 minute I.V. infusion. While taking this drug you will need to watch your salt intake because pipercillin contains 1.98 mEq of sodium per gram. Also watch out for adverse reactions such as headache, insomnia, constipation, diarrhea, and nausea. We will need to monitor you PT/INR also because taking this drug with anticoagulants tends to increase the risk of bleeding complications.

E (Environment): (I am going to assess the patient for social support to help her ambulate because she has a large wound on her left foot at the amputation site.) Since you are having difficulties getting around due to your infected foot keep in mind that when you get home you will need to make sure there is no debris on the floor to aid you in falling. If there are throw rugs make sure they are picked up so that your walker does not get tangled when ambulating. Also if there are any family pets make sure they are not circling around your feet or in the general area when you are ambulating. You want your major traffic areas to be clean and easy to get around in. If there are any coffee tables with sharp edges make sure and move them if possible so that you don’t have a chance of bumping your leg and breaking the skin. When you are at home sitting in a chair elevate your feet or the foot of the bed 6 to 8 inches. This will help arterial blood supply to the extremities. You have been ambulating without assistance just remember, when you go home to make sure you don’t overdo yourself. Try and utilize having your daughter there to help you. T (Treatments): While in the hospital you are having hyperbaric oxygen therapy (HBO). HBO is a treatment that uses pressurized oxygen to aid in healing wounds. While you are in therapy you will be placed in a chamber that circulates 100%

pressurized oxygen. (Patient received a copy of the info. pamphlet.) Your treatments will typically last 90 to 120 minutes. The chamber is clear so you can watch tv or take a nap it you like. There will be a nurse and doctor with you to monitor your status. There are limited side effects and they are listed in the information pamphlet I gave you. If you have any questions at all feel free to ask. While in the hospital you will be receiving wound care but when you go home you will need to be able to properly do this yourself if needed when the home health nurse is not there. ( I instructed the patient on how to use proper aseptic technique when performing wound care and she demonstrated that she was able to do it without any complications.) The home health nursing you will have coming to assist you can also show your daughter how to assist you or herself in proper wound care. Try and keep your feet well taken care of because you have PVD, and diabetes you sores with heal at a slower rate and you have poor circulation. Your tissues don’t get proper tissue perfusion so your wounds will take a lot longer to heal. So the best thing to do is to prevent any possible wounds and keep your feet clean and well taken care of. H (Health Knowledge of Disease): Since you have diabetes, hypertension, and septicemia, it is very important that you understand what peripheral vascular disease is and how it affects you. Peripheral vascular disease is an abnormal condition that affects the blood vessels in the legs and arms. As you already have stated you know that having diabetes slows down the healing process and lowers your immunity. Well having PVD along with diabetes really puts you at risk for wounds because you aren’t getting sufficient blood perfusion to your legs and feet. As a diabetic foot care is extremely important and has to constantly be kept up with to prevent breakdown. If you aren’t getting sufficient blood to your peripheral extremities then keeping up with your foot care is going to be a struggle as you can see with your wound and amputation. Also having PVD puts you at risk for DVT’s and pulmonary embolisms. So it’s very important that you keep on your medication regimen and eat a balanced diet and exercise. Upon discharge if you see that your condition is worsening contact your MD asap to schedule an appointment. O (Out/In patient Referrals):

There is a consult for the dietitian to assist with the explanation of your diet and to help include daughter in meal planning at home. You have a consult for a home health nurse so she will be following up with you. Make sure that you quickly address any appointments you need to make after discharge. And finally, follow up with your primary care physician. D (Diet): You are on a 1800 calorie ADA diet, no added sugar, no concentrated sugar. Also you need to be aware of foods that are high in sodium, and potassium so there are no adverse reactions with your medications. (I gave a sample menu to the patient.)