What are the wound care orders for a patient with a diabetic ulcer on the bottom of the left foot and a venous ulcer on the right leg, currently dressed with hydrocolloid and foam dressing, respectively?

Wound Care Orders for Diabetic and Venous Ulcers

For optimal wound healing and prevention of complications, the diabetic foot ulcer should be treated with sharp debridement and a basic wound dressing that maintains a moist environment, while the venous ulcer should be managed with a foam dressing that absorbs exudate effectively. 1, 2, 3

Diabetic Foot Ulcer Management (Left Foot)

Offloading

• Provide a non-removable knee-high offloading device as first-line treatment for the plantar diabetic foot ulcer to promote healing and reduce pressure 2
• If a non-removable device is unavailable, consider felted foam in combination with appropriate footwear 2
• For patients with bony deformities, prescribe extra wide or deep shoes; for severe deformities including Charcot foot, order custom-molded shoes 2

Wound Care

• Perform sharp debridement to remove slough, necrotic tissue, and surrounding callus during each visit 1, 2
• Discontinue current hydrocolloid dressing as these are not recommended for diabetic foot ulcers 1
• Apply a basic wound dressing that absorbs exudate and maintains a moist wound healing environment 1, 2
• Clean the wound with normal saline before each dressing change 2
• Change dressing every 1-3 days depending on exudate level 2
• Do not use topical antiseptic or antimicrobial dressings as they do not promote wound healing 1, 2

Venous Ulcer Management (Right Leg)

Compression Therapy

• Apply appropriate compression therapy (30-40 mmHg) to manage edema and improve venous return 3
• Use multi-layer compression bandaging or compression stockings based on patient mobility and compliance 3

Wound Care

• Continue with foam dressing as it effectively manages exudate in venous ulcers 3
• Clean the wound with normal saline before each dressing change 3
• Change dressing every 2-3 days or when strike-through occurs 3
• Assess and protect peri-wound skin with barrier cream to prevent maceration 3

Monitoring and Follow-up for Both Wounds

• Measure and document wound size weekly using planimetry or ruler measurement (length × width × depth) 2, 4
• Assess for signs of infection at each visit (increased pain, erythema, warmth, purulent drainage, odor) 2
• Monitor for a minimum 20-30% reduction in wound size within 2-4 weeks as an indicator of healing progression 5
• Adjust treatment if insufficient improvement is observed after 2 weeks 2
• Educate patient on daily foot inspection, especially important due to sensory deficits 2
• Consider home temperature monitoring with instructions to reduce activity and seek care if temperature differences exceed 2.2°C between feet on consecutive days 2

Additional Considerations

• Ensure adequate blood glucose control to promote wound healing 6
• Assess nutritional status and provide supplementation if needed 1
• Evaluate for signs of osteomyelitis if wound healing is delayed 4
• For non-healing diabetic foot ulcers after 2 weeks of standard care, consider sucrose-octasulfate impregnated dressing as an adjunctive treatment 1, 2
• For wounds that do not respond to initial treatment, consider hyperbaric oxygen therapy as an adjunct therapy where resources exist 1, 2

Common Pitfalls to Avoid

• Failing to provide adequate offloading is a major barrier to healing diabetic foot ulcers 2
• Overreliance on advanced therapies before optimizing standard care delays healing 2
• Neglecting the recurrence risk after healing leads to new ulcers; therapeutic footwear should be prescribed for healed plantar ulcers 2
• Using collagen or alginate dressings for diabetic foot ulcers is not recommended 1
• Ignoring pain in diabetic foot ulcers, which may indicate deep infection, Charcot change, or critical ischemia 7