For your patient with diabetic retinopathy, a physician may prescribe eyedrops to lubricate the eyes, control postoperative pain, or fight infection. To make sure the patient administers the drops correctly, give her these instructions:
Wash your hands. Then check the drops for discoloration or sediment. If you see either, return the eyedrops to the pharmacy for a replacement.
Warm the eyedrops container by rolling it between your hands for several minutes.
Wipe any drainage from your eye with a clean cotton ball or a tissue moistened with water. Always wipe away from your eye, not toward it.
Tilt your head back slightly, look up at the ceiling, and pull down your lower eyelid.
Hold the container over the exposed lower part of your eye and place the prescribed number of drops onto the eye. Don't touch the sterile part of the container.
Release the lower lid and gently close your eye.
Then wipe away excess drops with a clean cotton ball or tissue.
Open your eye and keep it open for about 30 seconds. To prevent the eyedrops from being absorbed into your tear duct, gently press on the area where your eyelids join your nose.
Peripheral Vascular Disease: Selecting The Right Shoes
Advise your patient to purchase shoes that are made of natural material, such as leather. Explain that synthetics don't allow enough air circulation. If she has decreased sensation in her feet, suggest that she take a family member along when she buys new shoes. She can ask the family member to feel her foot through the shoe to make sure it isn't too tight. If necessary, tell her how to order adaptive footwear, such as extradepth or specially constructed shoes.
If your patient has an orthotic insert and she's buying regular shoes, tell her to make sure she has enough room between the sole and upper part of the shoe for the insert. Explain that orthotics help avoid pressure sores by dispersing pressure evenly across her foot. If she has foot deformities, such as claw toes, tell her to make sure that her toes don't rub against her shoe.
Tell your patient that good running shoes made of soft fabric may be an acceptable alternative to custommade shoes. Advise her to select running shoes that have a wide toe area and a thick sole and that lace up the front, not the side. Explain that by wearing comfortable running shoes, she'll have better balance and walk more comfortably.
Encourage her to avoid high heels because they increase pressure on the ball of the foot and may decrease sensation. Instead, she should buy low heels or flats.
Wearing New Shoes
Advise your patient to wear new shoes for about 2 hours and then examine her feet for pressure areasred spots that may turn into blisters. If she finds no pressure areas, she can continue to wear the shoes for a few more hours and then examine her feet again. If she still finds no pressure areas, she should increase the wearing time slowly over a few days. If she does notice pressure areas, she should avoid wearing the shoes because a foot ulcer may develop.
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