Nursing measures for diabetic wounds

Priority should be given to controlling blood sugar within the standard range, targeted treatment according to wound classification, prevention and control of infection in the whole process, and minimizing local secondary injury. These four points can be achieved, and more than 80% of superficial sugar foot ulcers and daily injuries can heal smoothly within 2-4 weeks.

Don't neglect blood sugar management just because the wound is a local problem. Aunt Zhang, a 62-year-old who I met in the community chronic disease station, is a typical example: after 12 years of sugar, she accidentally cut her toenail and sewed a hole the size of a small grain of rice. After sticking a band-aid for half a month, she was not well, and her fasting blood sugar was measured to be 11.7mmol/L when she came. We first contacted an endocrinologist to adjust the hypoglycemic plan for her, and when the fasting blood sugar stabilized at 7. To put it bluntly, a high-sugar environment is like wood soaked in honey, and healthy new tissues cannot grow at all. Sugar control is always the premise. It is suggested that glycosylated hemoglobin should be controlled below 7% during wound healing.

As for the treatment of the wound itself, not all lacerations are treated in the same way. At present, the Wagner grading corresponding treatment methods commonly used in clinic can refer to the following table. There is probably a concept that will not be treated blindly without rote memorization:

At present, there are different ways to deal with the two problems in the industry, and there is no absolute right or wrong. The best one is the opportunity for debridement. Most nursing schools for chronic diseases tend to be "conservative and autolysis". If the patient is old and has poor coagulation function, hydrogel and alginate dressing should be applied to carrion first, so that necrotic tissue can slowly dissolve and fall off, so as to avoid damaging healthy tissue by debridement and bleeding. The surgical school even suggests "debridement as soon as possible". If there is much carrion, smelly exudate, rapid wound progress and physical conditions permit, the risk of infection spread can be greatly reduced. The other is the use of iodophor. Many people think that it is right to disinfect with iodophor every day, but in fact, if the wound has grown pink fresh granulation, frequent use of iodophor will kill the new epithelial cells. It is enough to clean it with normal saline. However, if the wound is red and swollen and the exudate is turbid, it is still necessary to regularly disinfect with iodophor to prevent and control infection.

After so many years of handling cases, I found that many people stepped on the same pit when their wounds were heavy: before, there was a 70-year-old uncle Li who felt his feet were cold in winter, and he soaked his feet with hot water at 45℃ every day, scalding a 2cm blister without realizing it, and finally developed into a deep ulcer, which took more than 20,000 yuan to cure; There is also a sugar friend in his thirties. The ulcer on his instep has just healed. He walked around the street in hard-soled shoes all day, but it was worn out the next day, and he changed his medicine for half a month. In fact, it's all very small details: pour the small sand in your shoes before putting on your shoes, change loose cotton socks, don't sprinkle Yunnan Baiyao powder on the wound casually (it's easy to scab and accumulate pus), and find a professional to see a small break that hasn't healed for more than 3 days, which is more effective than any folk prescription.

In the final analysis, the nursing of diabetic wounds has never been copied from the formula. Everyone's blood sugar situation, wound position and physical foundation are different. If you are really unsure, don't waste your time thinking about it yourself. You can save a lot of trouble by looking for a doctor in endocrinology or wound department to evaluate it early.