Ask the care expert ... about often missed areas

Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

Q: When looking at the care of the older adult, what is one area you think we most often miss?

Foot care, because the lack of it may contribute to increasing falls.

I am not talking about cutting of the toenails. I am talking just simply looking at the feet to see if there is dry skin, open areas or blisters. We should teach staff to check the nails to see if any are thickened, broken with sharp edges or have red areas around them (perhaps becoming ingrown). 

We should go over selecting footwear, socks or whatever the resident prefers to wear — and to be sure that the socks or stockings are cleaned daily. 

The nurse aide providing consistent care for the residents knows them best. They know if the resident's legs swell in the afternoon, if the resident does lots of walking or depends on a wheelchair for mobility, or perhaps walks before lunch and uses a wheelchair after lunch.

Not only do residents' socks or stockings need a daily assessment, but so do their shoes, sneakers, running shoes or slippers. The footwear needs to be looked examined to assess if the insides are worn or have rough areas that could irritate on the foot. 

Moisturizing lotion also can assist with keeping the skin intact as dry rough skin tends to break open much easier than soft, pliable skin that has the proper amount of natural or added moisture. 

Some residents may need to have their shoes changed in the afternoon, as their feet tend to swell — especially if they walk, let their feet dangle, or stand for long periods of time. Also, if the feet sweat, changing to a dry pair of footwear after lunch will help. 

Teaching staff to check residents' feet and apply lotion if needed can make a huge difference.

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