Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention
Abstract
:1. Introduction
2. Significance
3. Discussion
Exam | Instruments/Issues | Goal |
---|---|---|
Assess for Sensation | 5.07 Semmes-Weinstein Monofilament128 mHz Tuning Fork | Determine loss of protective sensation and position of toe in shoe |
Assess Pulses and Blood Flow | Doppler Posterior Tibialis and Dorsalis PedisConduct an Ankle-Brachial Index or Toe Pressure | Determine if compromised blood |
Assess for Musculoskeletal Deformities | Hyperkeratotic lesions and balance issues | Determine pressure points, fall risk, and safety issues |
Assess for Dermatologic Conditions | Malignant melanoma, Tinea Pedis, Onychomycosis | Determine and treat major / minor skin and nail conditions |
Low Risk | High Risk |
---|---|
Low Risk (all must be present qualify low risk) | High Risk (any one qualify high risk) |
Intact protective sensation | Loss of protective sensation |
Adequate blood flow | Inadequate blood flow |
No severe deformities | Severe deformity |
Interventions | Rationale |
---|---|
Debride toenails-reduce height and length | Safety, comfort, prevention of injuries to feet or legs |
Reduce hyperkeratotic lesions | Prevention of fissures, corns, calluses, wounds, promotion of comfort |
Monitor HbA1C—tight glucose control | Prevention of loss of protective sensation, wounds, falls, and amputation |
Monitor foot wear and sock use—reduce edema, facilitate therapeutic shoes and inserts | Reduce wounds related to edema and pressure on feet due to ill-fitting shoes leading to wounds and amputations |
Education Interventions | Rationale |
---|---|
Daily inspection of feet | Prevent minor condition lead to major issue |
Self-care foot care | Daily basic hygiene and moisturize, avoid bathroom or kitchen surgery |
Aging related foot changes and pathology | Normal vs abnormal changes |
Problems to report | Report any abnormal changes in timely manor |
4. Conclusions
5. Key Messages
- Amputations, falls, and wounds are related to poor or lack of foot care, lower extremity deformities, and loss of protective sensation.
- Lack of foot and nail care is the most neglected area of health care in every setting.
- The two most important components of a lower extremity assessment is determining loss of protective sensation and compromised blood flow.
- Amputations, falls, and wounds are costly in resources utilized, admissions, readmissions, and treatment.
- A Certified Foot and Nail Care Nurse (CFCN) is a proactive provider to case manage high risk individuals, monitor glucose control and foot wear, and provide basic foot and nail care.
Acknowledgments
Conflicts of Interest
References
- WOCN. Best Practice Guidelines Management of Wounds in Patients with Lower-Extremity Arterial Disease; WOCN: Mount Laurel, NJ, USA, 2014. [Google Scholar]
- WOCN. Best Practice Guidelines Management of Wounds in Patients with Lower-Extremity Neuropathic Disease; WOCN: Mount Laurel, NJ, USA, 2012; p. 100. [Google Scholar]
- Driver, V.R.; Fabbi, M.; Lavery, L.A.; Gibbons, G. The costs of diabetic foot: The economic case for the limb salvage team. J. Vasc. Surg. 2010, 52, 17S–22S. [Google Scholar] [CrossRef] [PubMed]
- Alvarsson, A.; Sandgren, B.; Wendel, C.; Alvarsson, M.; Brismar, K. A retrospective analysis of amputation rates in diabetic patients: Can lower extremity amputations be further prevented? Cardiovasc. Diabetol. 2012, 11. [Google Scholar] [CrossRef] [PubMed]
- Press-Ganey. The relationship between HCAHPS performance and readmission penalties. Available online: http://omg.en25.com/Web/PressGaneyAssociatesInc/PerformanceInsights_Readmissions_7871.pdf (accessed on 1 March 2015).
- Armstrong, D.G.; Kanda, V.A.; Lavery, L.A.; Marston, W.; Mills, J.L., Sr.; Boulton, A.J. Mind the gap: Disparity between research funding and costs of care for diabetic foot ulcers. Diabetes Care 2013, 36, 1815–1817. [Google Scholar] [CrossRef] [PubMed]
- Gallagher, D. The certified foot care nurse and the importance of comprehensive foot assessments. J. Wound Ostomy Cont. Nurs. 2012, 39, 194–196. [Google Scholar] [CrossRef] [PubMed]
- Aalaa, M.; Tabatabaei Malazy, O.; Sanjari, M.; Peimani, M.; Mohajeri-Tehrani, M.R. Nurses’ role in diabetic foot prevention and care; a review. J. Diabetes Metab. Disord. 2012, 11. [Google Scholar] [CrossRef] [PubMed]
- Chan, H.Y.L.; Lee, D.T.F.; Leung, E.M.F.; Man, C.W.; Lai, K.M.; Leung, M.W.; Wong, I.K.Y. The effects of a foot and toenail care protocol for older adults. Geriatr. Nurs. 2012, 33, 446–453. [Google Scholar] [CrossRef] [PubMed]
- Etnnyre, A.; Zarate-Abbott, P.; Roehrick, L.; Farmer, S. The role of certified foot and nail care nurses in prevention of lower extremity amputation. J. Wound Ostomy Cont. Nurs. 2011, 38, 242–251. [Google Scholar] [CrossRef] [PubMed]
- Howett, M.; Conner, A.; Downes, E. Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations. J. Holist. Nurs. 2010, 28, 244–250. [Google Scholar] [CrossRef] [PubMed]
- AHRQ. Guide to Patient and Family Engagement in Hospital Quality and Safety. Retrieved from US Department of Health and Human Services. 2013. Available online: https://innovations.ahrq.gov/profiles/daily-text-messages-and-nurse-followup (accessed on 13 June 2013).
- Institute of Medicine. Crossing the Quality Chasm; National Academy Press: Washington, DC, USA, 2010. [Google Scholar]
- Healthy People 2020. Diabetes, Co-Leaders Centers for Disease Control and Prevention and National Institutes of Health. Available online: http://healthypeople2020.gov (accessed on 2 March 2015).
- Lower Extremity Amputation Prevention (LEAP) Retrieved from Health Resources and Services Administration. 2013. Available online: http://www.hrsa.gov/hansensdiease/leap (accessed on 2 March 2015).
- Bakker, K.; Apelqvist, J.; Schaper, N.C. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab. Res. Rev. 2012, 28, S225–S231. [Google Scholar] [CrossRef] [PubMed]
- Meaney, B. Diabetic foot care: Prevention is better than cure. J. Ren. Care 2012, 38, S90–S98. [Google Scholar] [CrossRef] [PubMed]
- Mustapha, J.A.; Heaney, C.; Clark, M.; McGoff, T.; Peterson, A.; Finton, S.; Fox, C.; Cusack, K. Building a successful amputation prevention program. Available online: http://evtoday.com/2013/05/building-a-successful-amputation-prevention-program/.
- Peterson, J.M.; Virden, M.D. Improving diabetic foot care in a nurse-managed safety-net clinic. J. Am. Assoc. Nurse Pract. 2013, 25, 263–271. [Google Scholar] [CrossRef] [PubMed]
- Chin, Y.F.; Huang, T.T. Development and validation of a diabetes foot self-care behavior scale. J. Nurs. Res. 2013, 21, 19–24. [Google Scholar] [CrossRef] [PubMed]
- Gravely, S.S.; Hensley, B.K.; Hagood-Thompson, C. Comparison of three types of diabetic foot ulcer education plans to determine patient recall of education. J. Vasc. Nurs. 2011, 29, 113–119. [Google Scholar] [CrossRef] [PubMed]
- Woodbury, M.G.; Botros, M.; Kuhnke, J.L.; Greene, J. Evaluation of a peer-led self-management programme PEP talk: Diabetes, healthy feet and you. Int. Wound J. 2013, 10, 703–710. [Google Scholar] [CrossRef] [PubMed]
- Matricciani, L.; Jones, S. Who cares about foot care? Barriers and enablers of foot self-care practices among non-institutionalized older adults diagnosed with diabetes: An integrative review. Diabetes Educ. 2015, 41, 106–117. [Google Scholar] [CrossRef] [PubMed]
- U.S. Department of Health and Human Services; Health Resources and Services Administration. ACT Report Diabetes HBA1c. 2002. Available online: http://www.hrsa.gov/quality/toolbox/508pdfs/diabetesmodule.pdf ACT Report (accessed on 11 June 2012).
- Christman, A.L.; Selvin, E.; Margolis, D.J.; Lazarus, G.S.; Garza, L.A. Hemoglobin A1c is a predictor of healing rate in diabetic wounds. J. Invest. Dermatol. 2011, 131, 2121–2137. [Google Scholar] [CrossRef] [PubMed]
- Wu, S.V.; Tung, H.H.; Liang, S.Y.; Lee, M.C.; Yu, N.C. Differences in perceptions of self-care, health education barriers, and educational needs between diabetes patients and nurses. Contemp. Nurse 2014, 46, 187–196. [Google Scholar] [CrossRef] [PubMed]
- Sibbald, R.G.; Ayello, E.A.; Alavi, A.; Ostrow, B.; Lowe, J.; Botros, M.; Goodman, L.; Woo, K.; Smart, H. Screening for the high-risk diabetic foot: A 60-second tool (2012). Adv. Skin Wound Care 2012, 25, 465–476. [Google Scholar] [CrossRef] [PubMed]
- Miller, J.D.; Carter, E.; Shih, J.; Giovinco, N.A.; Boulton, A.J.M.; Armstrong, D. How to do a 3-min diabetic foot exam. J. Fam. Pract. 2014, 63, 646–656. [Google Scholar] [PubMed]
- Aliberti, E. The domino effect: The Risk of falls in older adults with diabetes. Available online: http://www.lifelinessystems.com (accessed on 2 March 2015).
- Eckles, R. The biomechanics of aging. Available online: http://www.podiatrym.com (accessed on 2 February 2012).
- Kruse, R.L.; LeMaster, J.W.; Madsen, R.W. Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: “Feet first” randomized controlled trial. Phys. Ther. 2010, 90, 1568–1579. [Google Scholar] [CrossRef] [PubMed]
- Richie, D.H. Preventing Falls in the Elderly. Available online: http://www.podiatrytoday.com/preventing-falls-elderly-where-dpms-can-have-impactCyrus (accessed on 2 March 2015).
- Cyrus, O.; Vanderstrasse, A.; Gilliss, C.L.; Lesueur, B. Improving diabetes self-management through telephonic education: A quality improvement study. Pract. Diabetol. 2014, 33, 6–11. [Google Scholar]
- Sumpio, B.E.; Armstrong, D.G.; Lavery, L.A.; Andros, G. The role of interdisciplinary team approach in the management of the diabetic foot. J. Vasc. Surg. 2010, 51, 1504–1506. [Google Scholar] [CrossRef] [PubMed]
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Burdette-Taylor, M.S. Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention. Healthcare 2015, 3, 586-592. https://doi.org/10.3390/healthcare3030586
Burdette-Taylor MS. Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention. Healthcare. 2015; 3(3):586-592. https://doi.org/10.3390/healthcare3030586
Chicago/Turabian StyleBurdette-Taylor, Michele Shelly. 2015. "Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention" Healthcare 3, no. 3: 586-592. https://doi.org/10.3390/healthcare3030586