A client is diagnosed with a venous stasis ulcer on the foot. Which of the following will be included in this client's plan of care? (Select all that apply.)
1. Administer oral antibiotics if infection is present.
2. Keep the foot open to the air.
3. Cover the foot with a hydrocolloidal dressing.
4. Provide pain medication with debridement.
5. Restrict fluids.
6. Instruct the client to ambulate without shoes.
1, 3, 4
Nursing care of a client diagnosed with a venous stasis ulcer includes provide with oral antibiotics if infection is present, cover the wound with hydrocolloidal dressing if indicated to promote the formation of granulation tissue, provide pain medication with debridement. The wound should not be kept open to the air. The client does not need a fluid restriction. The client should be instructed to never ambulate without appropriate foot protection.
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