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Adult Medical-Surgical Nursing Endocrine Module: DM Footcare and Patient Teaching Plan
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“Diabetic Foot”: Definition “Diabetic Foot” is a term given to the condition where chronic infection and progressive gangrene affects the foot and leg of a person with DM This is a chronic but preventable complication of DM It may lead to amputation of toes or even a limb, therefore prevention must be taken very seriously
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“Diabetic Foot”: Aetiology and Contributing Factors Neuropathy: loss of sensation to injury and break in skin Macrovascular disease: Atherosclerosis causing occlusion of large vessels and reduced blood flow to extremities ( ↓ O2 and nutrients to tissues) Hyperglycaemia: An ideal medium for bacterial growth Increases osmolality/ sluggish circulation
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“Diabetic Foot”: Incidence Risk increased with: DM >10 years Age >40 years Smoking Bunions and callouses Reduced peripheral pulses Reduced sensation
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“Diabetic Foot”: Pathophysiology Soft tissue injury occurs when sensation is deficient (often blister, stone in shoe, cut) Infection arises and cellulitis, enhanced by hyperglycaemia Poor circulation therefore poor healing: (lack of nutrients, O2 and inflammatory response to fight infection) Gradual death of tissue: gangrene spreading proximally from toes to leg
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“Diabetic Foot”: Prevention Foot care: daily inspection for blisters, redness, cracks. Regular podiatrist care Daily bathing, drying and lubrication of feet (to avoid cracked dry skin) Protect from hot or cold Check shoes for fit, and rough spots inside Avoid walking barefoot; elevate when sit Monitor blood glucose, ↓ lipids, ↓ smoking
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“Diabetic Foot”: Clinical Manifestations Cool, discoloured extremity (such as toe or heel) or wound which fails to heal ( ↓ pulse) Gangrene (discoloured, blackened, necrotic tissue, maybe wet or dry) May be no sensation or painful, burning *Special advice: Inform physician if cut or blister is not starting to heal after a day*
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“Diabetic Foot”: Diagnostic Investigations Physical examination to assess circulation to extremities: includes peripheral pulses, temperature of limbs and blanching of skin on pressure Doppler assessment of circulation Neurological assessment Blood glucose and lipid profile Wound or skin swab for bacterial culture
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“Diabetic Foot”: Management Bedrest Control blood glucose (may require increased insulin because of infection) Debridement/ sterile dressings Antibiotics: systemic and topical, antifungal agents if necessary If gangrene spreads, amputation may be indicated to control
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Nursing Care Plan for Teaching a Patient with Diabetes Mellitus Diet: controlled CHO, ↓ lipids, ↑ fibre Exercise Regular glucocheck or urinalysis Medication/ insulin (storage, dosage, sites) Awareness of “ hypo ” ; “ Sick Day Rules ” Foot care, hygiene, inspection Keep clinic appointments (HbA 1 C) Regular eye tests, ECG
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Notes on Insulin Types of insulin: Regular: immediate and short-acting Intermediate-acting Long-acting Insulin pen; Insulin implant Insulin pump s/c Storage in fridge/ Subcutaneous inj Injection sites
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Oral Hypoglycaemics *Sulphonureas: stimulate ↑ secretion *Beguinides: facilitate cell membrane receptors (not used if renal disorder) May use the above together Alpha-Glucosidase Inhibitors: delay absorption of glucose in intestine Thiazolinediones Meglinides*most common
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