Validação de instrumento para investigação do conhecimento de enfermeiros sobre pé diabético / Validación del instrumento para la investigación del conocimiento de enfermeros sobre pie diabético / Validation of an instrument to investigate nurses' knowledge on diabetic foot

RESUMO Objetivo: construir e validar um instrumento para investigação do conhecimento de enfermeiros da Atenção Primária à Saúde sobre pé diabético. Método: estudo metodológico realizado de janeiro a junho de 2017, que seguiu o Modelo de Elaboração de Escalas Psicométricas de Pasquali, em três etapas: teórica, empírica e analítica. Para validação de conteúdo, adotou-sea técnica de Delphi em dois momentos, com a participação de 10 juízes. A validade de construto foi realizada por 73 enfermeiros que atuavam nos serviços de APS do município de Campina Grande-PB. Aos dados, aplicou-se o Índice de Validação de Conteúdo (IVC). Resultados: construiu-se o "Questionário de Investigação do Conhecimento do Enfermeiro sobre Pé Diabético (QICEPeD)" com 47 itens organizados em 12 domínios de conhecimentos sobre a temática. Após a segunda rodada de avaliação dos juízes, todos os itens atingiram escores máximos de concordância (IVC = 1,00). A análise da confiabilidade e da consistência interna total do instrumento foi considerada elevada (α=0,860). Conclusão: o instrumento QICEPeD foi considerado válido, quanto ao conteúdo e construto, podendo ser utilizado para avaliar o conhecimento de enfermeiros da Atenção Primária sobre pé diabético.

RESUMEN Objetivo: construir y validar un instrumento para la investigación del conocimiento de enfermeros de la Atención Primaria de la Salud (APS) sobre pie diabético. Método: estudio metodológico realizado de enero a junio de 2017, que siguió el Modelo de Elaboración de Propiedades Psicométricas de Pasquali, en tres etapas: teórica, empírica y analítica. Para la validación de contenido, se adoptó el método de Delphi en dos momentos, con la participación de 10 jueces. La validez del constructo fue realizada por 73 enfermeros que actuaban en los servicios de APS del municipio de Campina Grande-PB-Brasil. Para los datos, se aplicó el Índice de Validez de Contenido (IVC). Resultados: se construyó el "Cuestionario de Investigación del Conocimiento del Enfermero sobre Pie Diabético (CICEPeD)" con 47 ítems organizados en 12 dominios de conocimientos sobre la temática. Después de la segunda ronda de evaluación de los jueces, todos los elementos alcanzaron puntajes máximos de concordancia (IVC=1,00). El análisis de la confiabilidad y de la consistencia interna total del instrumento fue considerado alto (α=0,860). Conclusión: el instrumento CICEPeD fue considerado válido, en cuanto al contenido y constructo, pudiendo ser utilizado para evaluar el conocimiento de enfermeros de la Atención Primaria sobre pie diabético

ABSTRACT Objective: to construct and validate an instrument to investigate the knowledge of Primary Health Care nurseson diabetic foot. Method: methodological study carried out from January to June 2017, followed the Development Model for Psychometric Scales by Pasquali, in three stages: theoretical, empirical and analytical. In order to validate the content, the Delphi technique was adopted in two moments, with the participation of 10 judges. Construct validity was performed by 73 nurses who worked in PHC services in the municipality of Campina Grande-PB. The Content Validation Index (CVI) was applied to the data. Results: the "Questionnaire for Investigating Nurses' Knowledge on Diabetic Foot (QICEPeD, as per its Portuguese acronym)" was constructed with 47 elements organized into 12 domains of knowledge on the topic. After the second round of judges' assessment, all elements reached maximum agreement scores (CVI = 1.00). The analysis of the instrument's reliability and total internal consistency was considered high (α=0.860). Conclusion: the QICEPeD instrument was considered valid, in terms of content and construct, and can be used to assess the level of knowledge of Primary Care nurses on diabetic foot.

Assessment of chronic wounds in adults: an integrative review. / Valoración de las heridas crónicas en el adulto: una revisión integrativa.

OBJECTIVE: To identify the main aspects that should be assessed in adults with chronic wounds. METHOD: This was an integrative review of the scientific literature published between 2010 and early 2015 in the PubMed and Web of Science databases. RESULTS: Few studies exclusively address wound assessment. However, the review found many aspects to consider when assessing individuals with ulcers, grouped as follows: factors that significantly affect healing or the development of new wounds (age, nutritional status, functional capacity, or comorbidities), pyschosocial factors, and wound characteristics (location, size, depth, type of tissue, time of evolution). CONCLUSION: The literature search did not result in any one aspect that must be considered when assessing chronic wounds, but a complex interaction of factors that include both physiological and social and psychological elements. Professionals should be aware of this multifactorial approach to achieve early detection of the development and evolution of ulcers and to intervene accordingly.

Adecuación del método científico en cuidados intensivos: paciente con úlcera terminal de Kennedy / Adaptation of the scientific method in intensive care units: Patient with Kennedy terminal ulcera

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An improved flexible telemetry system to autonomously monitor sub-bandage pressure and wound moisture.

This paper presents the development of an improved mobile-based telemetric dual mode sensing system to monitor pressure and moisture levels in compression bandages and dressings used for chronic wound management. The system is fabricated on a 0.2 mm thick flexible printed circuit material, and is capable of sensing pressure and moisture at two locations simultaneously within a compression bandage and wound dressing. The sensors are calibrated to sense both parameters accurately, and the data are then transmitted wirelessly to a receiver connected to a mobile device. An error-correction algorithm is developed to compensate the degradation in measurement quality due to battery power drop over time. An Android application is also implemented to automatically receive, process, and display the sensed wound parameters. The performance of the sensing system is first validated on a mannequin limb using a compression bandage and wound dressings, and then tested on a healthy volunteer to acquire real-time performance parameters. The results obtained here suggest that this dual mode sensor can perform reliably when placed on a human limb.

Wound care costs in general practice - a cross-sectional study.

BACKGROUND: The management of wounds presents a significant burden to healthcare services, consuming a large amount of resources. This study aimed to determine the cost of wound care in general practice by conducting an audit of current wound management practices. METHODS: Eighteen general practices collected data on wound care episodes over a period of 14 days during December 2011. RESULTS: For most of the 332 wound care episodes, the total cost was greater than the total income, resulting in a net loss to the practice. General practitioner care was the greatest contributor to the total cost and the overwhelming majority of income was from Medicare Benefits Schedule billing items. DISCUSSION: In most cases, general practices are not recouping the costs of wound care. There is a need for policy makers and general practices to review wound care funding and practices to ensure equitable best practice care is being provided.

Úlcera provocada por picadura de araña. A propósito de un caso / Ulcer caused by bites of spider. Purpous of a case

Se presenta un caso de úlcera de larga evolución (más de un año), que pasa por diferentes fases y tratamientos, Su origen fue provocado por una picadura de araña(AU)

A case of ulcer of long evolution (more than one year), what happens is presented by different phases and treatment, its origin was caused by a spider bite (AU)

Lower extremity ulcer management: best practice algorithm.

AIMS AND OBJECTIVES: This literature review aims to define best nursing practice for lower limb ulcer care promoting stabilisation of this physiological consequence of diabetes mellitus and to help provide improved integration of health-within-illness for the patients. BACKGROUND: According to the Centers of Disease Control, the number of people with diabetes has risen from 20·8 million in 2005 to over 23·6 million in 2007. Research has identified best practice algorithms for care of the diabetic foot, yet none for the ulcerations on the limb from the knee to the ankle. DESIGN: The design of this literature review is to compile research from both nursing and medical communities to develop a best practice for the stabilisation of a lower limb ulcer. A literature search was conducted based on the theoretical framework of stabilisation of a chronic condition. METHODS: Twenty-nine articles were identified for use in the evaluation of best practice of lower limb ulcerations. Each article was synthesised using a protocol tool. RESULTS: Control of hyperglycaemia, infection control, ulcer debridement, use of dressings and compression therapy to relieve venous congestion were all identified as important factors in the treatment of lower limb ulcerations. CONCLUSIONS: This systematic literature review has resulted in a 'best nursing practice algorithm' for the stabilisation and care of lower limb ulcerations regardless of underlying cause. This care algorithm could be used in collaboration with other health care providers to promote stabilisation of lower limb ulcers and improve the overall quality of life of patient cohort. RELEVANCE TO CLINICAL PRACTICE: The results of this study yield a suggested 'best practice' algorithm for the stabilisation of a lower limb ulcer--treat and control hyperglycaemia; prevent and/or control infection of the ulcer; routine debridement of the ulcer; using the most appropriate type of dressings for each patient; and the application of compression therapy. This algorithm can also be used for to frame patient teaching regarding appropriate treatments and therapies to promote the patient's self-care and stabilisation of the ulcer.

Tratamiento de úlceras de diversa etiología Estudio prospectivo sobre Permafoam® / Care for ulcers having diverse etiology. Prospective study on PermaFoam®

El apósito a estudiar es una espuma de poliuretano con gradiente de poro, lo que permite: absorber rápidamente grandes cantidades de exudado, restos celulares y exudados viscosos gracias a la capa de poros de gran tamaño que se encuentra en contacto con la herida; distribuir y retener el exudado en la capa intermedia del apósito que presenta un diámetro de poro menor; y, a través de la última capa, que se caracteriza por un diámetro de poro más pequeño, conseguir una gran semipermeabilidad y adaptabilidad a las distintas localizaciones donde deba ser aplicado. Se llevó a cabo el presente trabajo para evaluar su utilidad en la cicatrización de heridas de diversa etiología. Como objetivos secundarios se tuvieron en cuenta: la reducción de superficie de la herida, el respeto de la piel perilesional, estimar su comodidad de manejo y aplicación, e identificar sus cualidades más destacables(AU)

PermaFoam®, the dressing under study, is characterized as a polyurethane foam having gradient pores which, besides all the aforementioned characteristics, makes it possible to: rapidly absorb large quantity of seepage or exudation, cell remains and viscous seepage thanks to a layer of large size pores that are in contact with the wound; distribute and retain seepage in an intermediate layer of this dressing which is composed of pores having a smaller diameter; and, through a final layer characterized by an even smaller pore which permits a high degree of semi-permeability and adaptability to the distinct locales where this dressing needs be applied.

[Neoplastic wounds. How nurses deal with them]. / Heridas neoplásicas. Abordaje desde enfermería.

The knowledge which nurses should have regarding the cicatrisation processes for neoplastic ulcers is important, as are the techniques and products designed for treatment of this type of lesions. On the other hand, we should be capable to provide positive reinforcement to increase the self-esteem of patients who undergo this type of wounds. This article was submitted at the VII National Symposium on Bed Sores and Chronic Wounds and at the First Latin American Congress on Ulcers and Wounds.

Terapia combinaa en úlcera vascular complicada. Primer premio Biatain 2008. Caso clínico úlcera vascular infectada / Combined Therapy for a Vascular Ulcer. 2008 BIATAIN First Prize. A Clinical Case of a patient with an infected vascular ulcer

La utilización de una terapia combinada (apósitos hidropoliméricos con plata iónica y apósitos liberadores de ibuprofeno), junto con una reevaluación constante, hace que se consiga cicatrizar una úlcera de 10 años de evolución. Para ello se partió de la evidencia de que, en el complicado proceso que constituye la cicatrización de las heridas tórpidas y de difícil curación, aparece una serie de factores involucrados en la regeneración tisular que son, a la vez, no esperados y desencadenantes del retraso y la ralentización de dicho proceso (colonización crítica e infección, el estado nutricional y metabólico, las infecciones de repetición, el estado vascular o las alteraciones hormonales). Trabajo ganador del Primer Premio Biatain 2008 en la categoría «Caso Clínico sobre úlcera vascular infectada(AU)

The use of a combined therapy which includes hydropolymeric dressings with ionic silver and dressings which release of ibuprofen together with a constant reevaluation made it possible to heal an ulcer which had afflicted a patient for 10 years. In order to succeed in doing so, medical professionals started off with the evidence that, in the complicated process which the cicatrization of long-lasting wounds difficult to cure constitutes, a series of factors involved in tissue regeneration appear which, at the same time, are not expected and which delay and slow down this process (critical colonization and infection, nutritional and metabolic state, repetitive infections, vascular state or hormonal alterations). This case story won the 2008 Biatain First Prize in the category «Clinical Case Study of a patient with an infected leg ulcer»(AU)

Heridas neoplásicas. Abordaje desde enfermería / Neoplastic Wounds, how nurses deal with them

Es importante el conocimiento que Enfermería debe tener sobre los procesos de cicatrización de las úlceras neoplásicas, así como de las técnicas y productos destinados para el cuidado de este tipo de lesiones. Por otro lado, debemos ser capaces de proporcionar refuerzos positivos para potenciar el autoconcepto y la autoestima de los pacientes que presentan este tipo de heridas. Este artículo fue expuesto en el VII Simposio Nacional de Úlceras por Presión y Heridas Crónicas y I Congreso Latinoamericano sobre Úlceras y Heridas(AU)

The knowledge which nurses should have regarding the cicatrisation processes for neoplastic ulcers is important, as are the techniques and products designed for treatment of this type of lesions. On the other hand, we should be capable to provide positive reinforcement to increase the self-esteem of patients who undergo this type of wounds. This article was submitted at the VII National Symposium on Bed Sores and Chronic Wounds and at the First Latin American Congress on Ulcers and Wounds(AU)

Atención al paciente con úlceras arteriales / Treatment for patients who have arterial ulcers

Las úlceras arteriales se producen como consecuencia de una isquemia crónica de las extremidades inferiores. Ello produce una disminución progresiva y lenta del flujo sanguíneo y del aporte de oxígeno a los miembros inferiores. El síntoma principal consiste en la claudicación intermitente (dolor muscular durante la deambulación que cesa con el reposo), pero cuando aparecen los síntomas generalmente la enfermedad ya está avanzada y el abordaje se basa fundamentalmente en tratamiento quirúrgico, farmacológico y local o, lo que es lo mismo, cura de la úlcera. A continuación se expone un breve procedimiento sobre diagnóstico, tratamiento y prevención de las úlceras arteriales(AU)

Arterial ulcers are produced due to chronic ischemia in lower limbs. This causes a progressive, slow decrease in blood flow and oxygen supply to lower limbs. The main symptom consists of an intermittent claudication, or muscle pain while walking which ceases upon resting, but, when these symptoms appear, this wound usually is advanced and medical professionals basically use surgical, pharmaceutical and local treatments to cure this ulcer. In this article, the author presents a guide to diagnosis, treatment and prevention of arterial ulcers(AU)

A comparison of inferface pressures of three compression bandage systems.

OBJECTIVE: To measure and compare the interface pressures achieved with two compression bandage systems - a four-layer system (4LB) and a two-layer short-stretch system (SSB) - with a new two-layer system (2LB), which uses an etalonnage (performance indicator) to help achieve the correct therapeutic pressure for healing venous leg ulcers - recommended as 40 mmHg. METHOD: 32 nurses with experience of using compression bandages applied each of the three systems to a healthy female volunteer in a sitting position. The interface pressures and time taken to apply the systems were measured. A questionnaire regarding the concept of the new system and its application in comparison to the existing two systems was then completed by the nurses. RESULTS: The interface pressures achieved show that many nurses applied very high pressures with the 4LB (25% achieving pressures > 50 mmHg) whereas the majority of the nurses (75%) achieved a pressure of < 30 mmHg when using the SSB. A pressure of 30-50 mmHg was achieved with the new 2LB. The SSB took the least time to be applied (mean: 1 minute 50 seconds) with the 4LB the slowest (mean: 3 minutes 46 seconds). A mean time of 2 minutes 35 seconds was taken to apply the 2LB. Over 63% of the nurses felt the 2LB was very easy to apply. CONCLUSION: These results suggest that the 2LB achieves the required therapeutic pressure necessary for the management of venous leg ulcers, is easy to apply and may provide a suitable alternative to other multi-layer bandage systems.

The meaning of caring for people with malodorous exuding ulcers.

AIM: This paper is a report of a study to illuminate the meaning of caring for people with malodorous exuding ulcers. BACKGROUND: Managing ulcers is complicated and consensus on assessment and treatment difficult to reach. Nurses need knowledge and skills to provide good care. They must stay close and be exposed to contamination and suffering. They must provide care without violating patients and we need to further explore this challenge. METHOD: A convenience sample of ten participants was recruited. Participants had experience of caring for people with malodorous exuding ulcers and were employed in primary health or hospital care in Sweden. Narrative interviews were conducted during late 2002 to early 2005 and interpreted using a phenomenological-hermeneutic method. FINDINGS: Themes were formulated: 'Facing the wound' when nurses reveal what is meant to be concealed and perceive patients' vulnerability; 'Facing one's own defencelessness' when feeling invaded, helpless and ashamed; 'Struggling to shield one's own defencelessness' was achieved by striving to be in control, striving to endure and seeking a way out. 'Struggling to shield patients' vulnerability' was about alleviating patients' additional suffering by striving to spare patients, pushing boundaries, making uncomfortable decisions and sharing togetherness. When failing to shield their own defencelessness and patients' vulnerability, nurses run the risk of experiencing desolation. CONCLUSION: Physical proximity and bodily suffering affect nurses. Caring for people with ulcers calls for improved interprofessional cooperation in order to provide the best treatments and care. Further education for these nurses is needed, as well as support from managements and organizations.

Ambulatório de Reparo de Feridas - perfil da clientela com feridas crônicas. Um estudo prospectivo / Ambulatory care of wounds – clients' profile with chronic lesion. A prospective study

This study aims to characterize the clients porters of tissue lesion chronic which are attended in the Repair of Wound Ambulatory of Antonio Pedro University Hospital Aid Center (HUAP), in view of the following variables: age, sex, education, the basic disease, type of wound, time and location of the wound from its beginnings. It is a quantitative, descriptive and exploratory nature study approved by the Ethic in Search Committee (CEP-CCM/HUAP), being developed among 39 injury porter patients attended by the nurse consult, from May 2006 to April 2007. The results show that the population of the study is mostly male (51%), aged from 40 to 59 years (54%) and with incomplete middle (junior high) school (61%). With relation to clinical aspects, 28% get Mellitus Diabetes associated to Systemical Arterial Hypertension, 31% of them presented Mellitus Diabetes and 29% arterial hypertension; 85% having lesion upon the low members, being that 40% were caused by vein ulcers and 33% by diabetes ulcers; 27% showed the lesion from 1 year to 4 year. It was concluded that the systematic monitoring of wounded patients is fundamental not only to treat the wound but also to control basic illnesses and prevent complications. We recommend that new studies be carried out to obtain a more representative profile of this population in the different levels of attention for the health.

O presente estudo tem por objetivo caracterizar a clientela portadora de lesões tissulares crônicas atendida no Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro (HUAP), segundo as variáveis: idade, sexo, escolaridade, doença de base, tipo de ferida, localização da ferida e tempo desde o seu surgimento. Trata-se de um estudo quantitativo de natureza descritiva e exploratória, aprovado pelo Comitê de Ética em Pesquisa (CEP-CCM/HUAP) desenvolvido com 39 pacientes portadores de feridas crônicas, atendidos na consulta de enfermagem, durante o período de maio de 2006 a abril de 2007. Os resultados mostram que no serviço de saúde em questão, o perfil identificado caracterizou-se por indivíduos em sua maioria, do sexo masculino (51%), com faixa etária entre 40 e 59 anos de idade (54%) e primeiro grau incompleto (61%). Quanto dados clínicos, 28% dos pacientes possui Diabetes Mellitus associado à Hipertensão Arterial Sistêmica, 31% deles apresentavam Diabetes Mellitus e 29% hipertensão arterial; 85% com lesão nos membros inferiores, sendo que 40% eram de úlceras venosas e 33% de úlceras diabéticas; com um tempo de evolução superior a um ano e inferior a quatro anos, em 30% dos casos. Concluiu-se que o acompanhamento sistemático do paciente com lesão é fundamental para que se estabeleça não só o tratamento da ferida, mas o controle das doenças de base e prevenção de complicações. Recomenda-se a realização de novos estudos para se obter um perfil mais representativo desta população nos diversos níveis de atenção à saúde.

The meaning of living with malodorous exuding ulcers.

AIM: This study illuminates the meaning of living with malodorous, exuding ulcers. BACKGROUND: Difficulties for patients with chronic ulcers and the ulcers' impact on patients' daily life are described in the literature. Suffering and consolation are also addressed in the literature as important issues in nursing care. DESIGN: The first author interviewed seven women and two men, aged 41-95, with various diagnoses. METHOD: We interpreted the transcribed interviews using a phenomenological hermeneutic method. RESULTS: Two processes were identified: 'being struck down'- themes: feeling dirty, being trapped, losing confidence, losing hope, becoming frustrated and protecting oneself; and 'finding consolation'- themes: experiencing kinship, encountering genuineness and gaining control. The meaning of living with malodorous and exuding ulcers can be understood as being trapped in a debilitating process that slowly strikes one down. There is a longing for purity and wholeness and for one's life to improve. When people with malodorous, exuding ulcers encounter genuineness and feel loved, regarded and respected as fully human despite their ulcers, they feel purified. The contaminated body no longer contaminates their self-image and self-esteem and they feel restored and fully human again. Only when they feel fully human can they regain control and see life beyond their ulcers. CONCLUSION: Although nurses cannot make ulcers or smell disappear, they can contribute significantly to improve the patients' life. Finding consolation makes patients feel purified despite their contaminated body. RELEVANCE TO CLINICAL PRACTICE: This study points to the importance of seeing the human being beyond the ulcer and considering not only the body but the whole person.

Eficacia de la terapia larval en el desbridamiento de heridas crónicas. Revisión bibliográfica / The effectiveness of larval therapy in the debridement of chronic wounds; a bibliographical review

La terapia larval o biocirugía ha sido introducida de nuevo en Europa tras evidenciarse que las secreciones de las larvas de la mosca Lucilla sericatta (Phaenicia sericatta) favorecen el crecimiento del tejido de granulación y tienen un efecto antibacteriano. El objetivo de esta revisión bibliográfica es analizar la eficacia de la terapia larval para desbridar tejido necrótico en úlceras de diferente etiología. Se recurrió a las siguientes bases de datos para obtener evidencias científicas: PubMed, AMED, CINAHL, la Cochrane Library y OVID Full Text. La búsqueda fue limitada a artículos escritos en inglés y castellano entre 1995 y 2005

Larval therapy or bio-surgery has been reintroduced in Spain after it has been observed that the secretion of the "Lucilla sericatta" (Phaenicia sericatti) fly favour the growth of granulation tissue and have an anti-bacterail effect. The objective of this bibliographical review is to analyze the efectiveness of larval therapy to remove necrotic tissue in ulcers having diverse etiology. The authors checked the following data bases in order to obtain scientific evidence: PubMed, AMED, CINAHL, the Cochrane Library and OVID Full Text. The search was limited to articles written in English or Spanish between 1995 and 2005

A influência da dor na qualidade de vida do paciente com lesão crônica de pele / The influence of pain in the quality of life of patients with chronical skin injury

Trata-se de um levantamento bibliográfico realizado na Biblioteca Regional de Medicina sobre a produção científica acerca da temática qualidade de vida e como ela é influenciada pela dor proveniente de lesão crônica de pele em pacientes portadores de úlceras venosas e de pressão. O objetivo foi analisar os artigos que se referiam à influência da dor na qualidade de vida de pacientes portadores de úlceras venosas. O levantamento se realizou em Agosto de 2004 nas bases de dados Medline 1993-2004. A metodologia estabelecida para definir os critérios de inclusão dos artigos foi: os artigos deveriam ser de pesquisa de campo; deveriam correlacionar claramente os descritores: qualidade de vida, dor, ulceras venosas e ulceras de pressão; os resultados deveriam estar detalhados. Os resultados mostram que a dor é um importante fator que afeta a qualidade de vida dos pacientes com lesões como aqui foram estudadas.

Calidad de vida y cicatrización son posibles / The quality of life and healing are possible

Objetivos. Aumentar la calidad de vida de las personas con úlceras vasculares. Evitar el dolor. Disminuir el tiempo de cicatrización. Espaciar las curas. Disminuir costes. Diseño. Caso clínico: mujer de 55 años con diabetes mellitus tipo 2, hipertensión arterial, hipotiroidismo, obesidad, síndrome depresivo e insuficiencia venosa crónica desde 1990 e insuficiencia en cayado de safena interna desde 1999.Ha presentado múltiples episodios de úlceras en las extremidades inferiores, en las que se han realizado diversos tratamientos para su curación, tanto en el centro de atención primaria como en su domicilio, al no poder desplazarse debido a la afección de su estado general y a la pérdida de autonomía. En el momento de iniciar el tratamiento, presentaba diversas úlceras vasculares en distintas fases de aparición y cicatrización, con presencia de placas necróticas, esfacelos y tejido de granulación muy lábil, con eritema y reacción de tipo alérgico periulceral. Emplazamiento. Área Básica de Llefià (Badalona).Metodología. La valoración continua de enfermería nos ha permitido identificar los problemas que presentaba la paciente, determinar los diagnósticos de enfermería y establecer un plan de cuidados adecuado a su problema de salud. Se inicia el tratamiento, previo cultivo de los exudados de las úlceras (con resultado negativo) y nueva oscilometría (extremidad inferior derecha, 0,7), y se instaura el siguiente protocolo de actuación: limpieza de las úlceras con extracción de esfacelos y costras, hidratación con abundante crema en las 2 extremidades inferiores y aplicación del vendaje multicapa. Semanalmente, se mide y fotografía la extensión de las úlceras, así como la circunferencia de los tobillos y la aparición del dolor, valorando la hora de aparición, las características y la intensidad. Se indica tratamiento dietético y se controla el peso y la glucemia. Resultados. Las úlceras cicatrizan a los 78 días, con ausencia de dolor y buena perfusión hística. Se produce un aumento de la autoestima y una mejora del estado anímico de la paciente (según escala de Hamilton). Al año, la paciente no ha presentado ningún indicio de úlceras, lesiones de rascado ni edemas, y ha mejorado en su autocuidado. Las manifestaciones externas son indicativas del cambio de actitud ante la vida: ha aumentado su grado de conocimientos dietéticos, se le han normalizado los valores de glucemia y ha mejorado en el control de sus múltiples afecciones, algunas de las cuales se han obetivado mediante escalas de medición (AU)