Nursing Interventions
PROMOTING TISSUE PERFUSION
Neurovascular assessment of the exposed toes every 1 to 2 hours for the first 24 hours is essential to monitor the function of the nerves and the perfusion of the tissues. If the patient is discharged within several hours after the surgery, the nurse teaches the patient and family how to assess for swelling and neurovascular status (circulation, motion, sensation). Compromised neurovascular function can increase the patient’s pain.
RELIEVING PAIN
Pain experienced by patients who undergo foot surgery is related to inflammation and edema. Formation of a hematoma may contribute to the discomfort. To control the swelling, the foot should be elevated on several pillows when the patient is sitting or lying. Intermittent ice packs applied to the surgical area during the first 24 to 48 hours may be prescribed to control swelling and provide some pain relief. As activity increases, the patient may find that dependent positioning of the foot is uncomfortable. Simply elevating the foot often relieves the discomfort. Oral analgesics may be used to control the pain. The nurse instructs the patient and family about appropriate use of these medications.
IMPROVING MOBILITY
After surgery, the patient will have a bulky dressing on the foot, protected by a light cast or a special protective boot. Limits for weight bearing on the foot will be prescribed by the surgeon. Some patients are allowed to walk on the heel and progress to weight-bearing as tolerated; other patients are restricted to non–weight-bearing activities. Assistive devices (eg, crutches, walker) may be needed. The choice of the devices depends on the patient’s general condition and balance and on the weight-bearing prescription. Safe use of the assistive devices must be ensured through adequate patient education and practice before discharge. Strategies to move around the house safely while using assistive devices are discussed with the patient. As healing progresses, the patient gradually resumes ambulation within prescribed limits. The nurse emphasizes adherence to the therapeutic regimen.
PREVENTING INFECTION
Any surgery carries a risk for infection. In addition, percutaneous pins may be used to hold bones in position, and these pins serve as potential sites for infection. Because the foot is on or near the floor, care must be taken to protect it from dirt and moisture. When bathing, the patient can secure a plastic bag over the dressing to prevent it from getting wet. Patient instruction concerning aseptic wound care and pin care may be necessary. The nurse teaches the patient to monitor for temperature and infection. Drainage on the dressing, foul odor, or increased pain and swelling could indicate infection. The nurse instructs the patient to promptly report any of these findings to the physician. If prophylactic antibiotics are prescribed, the nurse provides instruction about their correct use.
PROMOTING HOME AND COMMUNITY-BASED CARE
Teaching Patients Self-Care
The nurse plans patient teaching for home care, focusing on neurovascular status, pain management, mobility, and wound care.
Evaluation
EXPECTED PATIENT OUTCOMES
Expected patient outcomes may include:
1. Maintains peripheral tissue perfusion
a. Demonstrates normal skin temperature and capillary refill
b. Exhibits normal sensations
c. Exhibits acceptable motor function
2. Obtains pain relief
a. Elevates foot to control edema
b. Applies ice to foot as prescribed
c. Uses oral analgesics as needed and prescribed
d. Reports decreased pain and increased comfort
3. Demonstrates increased mobility
a. Uses assistive devices safely
b. Resumes weight-bearing gradually as prescribed
c. Exhibits diminished disability associated with preoperative condition
4. Develops no infection
a. Reports temperature and pulse within normal limits
b. Reports no purulent drainage or signs of wound inflammation
c. Maintains clean and dry dressing
d. Takes prophylactic antibiotics as prescribed