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Diabetes is a chronic condition that affects body’s organic way of utilizing sugar. With about 29 million people living with this condition, the government has allocated a significant amount of money towards diabetic health management. Because of lifestyle changes and poor health choices, diabetic complications have been increased in the recent past. “In the Unites States, diabetes mellitus is a leading cause of blindness, end-stage kidney disease and foot or leg amputation” (Ignatavicius & Workman, 2006). Nurses, as part of health care team, are actively involved in prevention and early detection of diabetes and its complications.
This includes patient and family education, identifying patients at-risk for foot injury, regular feet inspection and thorough skin assessment, regular wearing of appropriate footwear and treating pre-ulcerative signs.
Patient of interest is 92-year-old male, admitted for exacerbation of congenital heart failure (CHF). He has a history of hypertension, diabetes mellitus, hypothyroidism, Parkinson’s disease, gastroesophageal disease (GERD), anemia. On assessment, his vital signs were; temperature 97.
8, apical pulse 80, respirations, 16, blood pressure 138/78 and oxygen saturation of 96 on 2 of oxygen. His medication includes Insulin, both regular and long lasting, furosemide, levothyroxine sodium, heparin and pravastatin sodium. Head to toe assessment revealed a breakdown of skin tissue on the lower left extremity under the big toe. Subjective data from the patient suggested that patient was not aware of the skin breakdown, as evidenced by lack of sensation due to peripheral neuropathy. Foot inspection showed signs of inspection, redness and swelling. Lab results confirmed that the wound was indeed infected.
Family members lacked the education needed to take care of their loved one. Employing proper interventions could have prevented this occurrence.
Foot injuries can happen to any non-ambulatory patients. However, people living with diabetes are at increased risk due to nerve damage that leads to loss of protective sensation. Additional comorbidities like CHF can further increase the rick of foot injuries due to poor circulation. This knowledge is vital to the nurses in early identifying those who are any risk of foot injuries, and to optimize quality of life as well as avoiding costs that go into wound care. These preventative measures can be initiated as soon as the patient are admitted. (Haesler, Frescos & Rayner, 2018).
Impaired tissue circulation keeps feet and toes from receiving sufficient nourishment, hence weakening them. It also makes it harder for the body to fight infection from microbial contaminants. Diminished blood flow to the lower extremity leads to poor wound healing. Daily feet inspection becomes an integral part of a comprehensive diabetic foot care plan s, especially those who are immobile. According to (Netten & Lazarrini 2017), washing the feet with mild soap, testing the water temperature using thermometer, proper drying and avoiding any lotions between the toes, are evidence bases guidelines in care of diabetic foot. Assessment includes looking for any bruises, noticing any cuts, bruises or areas of redness that may be present, even changes in skin color.
Lack of appropriate footwear is the most common cause of trauma in patients with diabetes. Frequently and properly assessing appropriate footwear is important for protecting the diabetic foot from ulceration. Shoes and socks prevent foot trauma and also protect the foot from extreme temperatures. When choosing footwear shoes, patient and family education should be to ensure that they are well-fitting. Always inspecting the shoes before wearing them, checking any holes or sharp edges. Use of a good fitting, light colored socks can be included in the education. Evidence based practice shows that even in case of any oozing of pus or blood, it would be clearly visible, and hence addressing the issue in a timely manner (Chapman, 2017).
Injuries develop over time, and shows symptoms before becoming fully stageable. One may notice oozing and or lump in the foot area. The repetitive occurrence of corns, bleeding wounds or calluses may also be the warning signs of potential foot ulcers in the future. Diabetic foot injuries most likely form on the soles of the feet, where skin is subject to constant pressure. Under the weight of the body, skin continues to deteriorate and eventually becomes an open sore. These injuries commonly form underneath calluses and cannot be felt as a result of diabetic neuropathy. New onset of swelling or redness on the foot coupled with the odor can also signify an early signs of foot injury (Haesler, Frescos & Rayner, 2018). The most important piece in the prevention diabetic foot ulcers is patient education. This collaborative effort involves the patients, family’s members, and health care team providers. Patient is educated on the proper foot wear, use of diabetic socks for support, reminding patient not walk bare foot and to perform daily inspection of both feet.
A major concern with foot injuries is that the tissue can be become necrotic as a result of lack of proper perfusion. This gangrenous situation is untreatable, and the only viable option that has been practiced for years is amputation. The importance of proper foot care is therefore and a holistic measure in protection, prevention, and early detection of foot injury. More teaching is needed for patient to better manage diabetes. This can be accomplished by regular A1C testing, diet and nutritional teaching and adhering to good dietary practices, regular low-impact exercise are nursing interventions that can be employed. The results will serve in managing the disease, ensuring adequate peripheral circulation. Additional teaching for patient and family includes avoiding smoking, smoking cessation programs for the patients who smoke. Effects of smoking can potential complications of diabetes as circulation is compromised. Regular moving ankle and toes to ensure foot circulation. This is an easy exercise and can be done at the comfort of patient’s home. Avoiding crossed legs for an extended period of time, as blood flow to the lower extremity is compromised by crossing of legs.
Patients can be taught to recognize early signs that may indicate injury to the skin and soft tissue of the foot. These include redness, swelling, skin discoloration, malodorous smell from the feet, alteration in temperature, any oozing of fluid from the foot area. These signs should be promptly reported to the doctor for further evaluation. Diabetic foot injuries are the most common and serious complications of diabetes mellitus. They are a major health concern in the world and if not properly addressed, mostly likely lead to lower extremity amputation. Nurses can multidisciplinary approach to mitigate the complications of foot injuries.
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