D. A. is a 68-year-old man with a history of insulin-controlled diabetes. He has come to the emergency department because of burns on his feet. He soaked his feet in the morning and then put on his socks and work boots. After he returned home and took off his shoes and socks, he discovered that the skin of his feet was completely burned off. He states he did not notice a thing all day because his feet are “always numb and tingling” (Jarvis, 2012).
Type 1 diabetes is considered as insulin-dependent diabetes,
check patient glucose level first and assess the patient wound for
further complication and infection.
Patients with long term diabetes more prone to long term
complications like diabetic peripheral neuropathy due to decreased
sensation and less arterial supply for the foot. After collecting
the history of patient numbness, and pain. Examining the patient
signs of neuropathy and sensory testing through monofilament
testing and tuning fork test can find the patient with progress to
neuropathy. Neurological assessment when there is sensory loss in a
patient with distal polyneuropathy is a non-dermatomal distal loss,
length-dependent affecting all modalities. sock or stocking
distribution with a light touch, pinprick, and temperature can
extend to mid-calf. If it is severe it will extend up to leg, trunk
and upper limbs. pain can be assessed with a light touch with the
use of sharp exam sterile needle or pain and wisp of cotton wool.
In symmetric distal polyneuropathy, there is impairment of
perception of vibration can be assessed by 128Hz tuning fork. deep
tendon reflexes may less or absent with ankle impairment.
subjective data from the patient should include patient habits of
hot water bottles use for the foot to relieve pain, heating pad
foot baths and hot water socks and information regarding glucose
monitoring and insulin followup.
Educate the patient for careful monitoring of blood glucose levels
to improve wound healing. Advice the patient to avoid thermal
injury before water socks check the water temperature with a
thermometer to differentiate hot and warm because the loss of
feeling in the lower extremities can not differentiate the water
temperature. followup with an antibiotic can avoid
infection.prevention of thermal injury and frostbite can promote
healing and infection it avoids further complications.
D. A. is a 68-year-old man with a history of insulin-controlled diabetes. He has come to...
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