MULTIDISCIPLINE CARE PLAN - MCP
LEG ULCERS - VENOUS, ARTERIAL, DIABETIC

DATE

PROBLEM OR NEED

MEMBERS GOAL

STAFF APPROACHES/IMPLEMENTATION

RESPONSIBLE
DISCIPLINE

  Leg/Feet ulcer
locations: _____________
____________________
To attain/maintain intact skin and remain free of
preventable complications by:
________________________________________
________________________________________
ASSESS:

 

 
    a.  Maximize blood flow 1.  Extremities for redness, calluses, corns and wounds.  
    b.  Prevent recurrent ulcer formation. 2.  Peripheral pulses, capillary refill and pain.  
    c.  Prevent trauma. 3.  Skin - hair, color, temp, sensation, wound depth and margins, exudate,
edema granulation, infection, necrosis, eschar, gangrene.
 
    d.  Reduce infection risk. 4.  Smoking history, caffeine intake, blood sugars.  
    e.  Provide skin care to legs and feet. 5.  Nutritional status.  
    f.  Promote optimal nutritional and fluid intake. 6.  Mobility, gait and activity.  
      7.  Need for consultants.  
      INTERVENTIONS  
      8.  Discourage caffeine, tobacco. (Vasoconstrictive agents)  
      9.  Avoid exposure to cold.  
      10. Avoid constrictve garments.  
      11. Maintain leg position appropriate to ulcer etiology.  
      12. Ambulate to tolerance.  
      13. Correct application of vascular support devices if ordered.  
      14. Monitor for circulatory impairment.  
      15. Encourage patient to control weight.  
      16. Avoid Thermal trauma:  
     

a.  Temperature extremes

 
     

b.  Heating pads

 
     

c.  Hot water bottles

 
     

d.  Heat lamps

 
     

e.  Hot/cold solutions and soaks

 
     

f.   Sunburn

 
     

g.  Frost bite

 
     

h.  Ice packs

 

ACWCP - 1998

MULTIDISCIPLINE - MCP LEG ULCERS CONTINUED:

DATE PROBLEM OR NEED MEMBERS GOAL STAFF APPROACHES/IMPLEMENTATION RESPONSIBLE
DISCIPLINE
      17.  Avoid mechanical trauma:  
     

a.  Constrictive shoes

 
     

b.  Walking barefoot or with open sandals.

 
     

c.  Cutting and trimming corns and calluses (may need to refer to Podiatrist)

 
     

d.  Adhesive tapes

 
     

e.  Improper shaving

 
     

f.  Vigorous massage

 
      18.  Avoid chemical trauma:  
     

a.  Over the counter preparations for corn and calluses removal.

 
     

b.  Drying and irritating agents.

 
      19.  Do not soak feet.  
      20.  Carefully dry between toes but do not apply lubricant between toes.  
      21.  Report any cuts, burns, or breaks in skin.  
      22.  Do not use harsh disinfectants (eg Betadine, lodine, H202)  
      23.  Keep feet and legs clean and well lubricated.  
      24.  Daily feet inspection.  
      25.  Non-contricting white cotton socks recommended to absorb moisture.  
      26.  Avoid irritating dyes.  
      27.  Report symptoms of change in color, temp, sensation, pain, or presence of drainage and odor.  
      28.  Follow physicians orders for topical treatment and dressings.  
      29.  Monitor blood sugars if diabetic as ordered.  
      30.  Patient teaching as indicated.  
      31.  Evaluate progress in wound healing on an ongoing basis.
Notify physician as indicated.
 

 

1.  Nursing
Signatures:   
2.  Physical Therapy   3.  Dietary          4.  Activities      5.  Social Services    6.  Spiritual       7.  Member         
1.  ______________  2. _______________   3. ___________  4.  _____________  5. ______________  6. ____________  7. _______________
1. ______________ 2. _______________ 3. ___________ 4. _____________ 5. ______________ 6. ____________ 7. _______________
MEMBERS NAME: _______________________________ DATE: _________ REVIEW DATE: ________________ R# ______________

ACWCP - 1998