Lecture Review About High Risk Foot Here Free Sample

Question: A 60 year-old female patient presents in clinic with a suspected ulcer on her left big toe. She reveals that she is a type II diabetic and has been for over 15 years. She complains of having cold, painful feet. Upon examination, the patient has very cold, very red feet. Her left big toe is especially swollen, with an area of blackened callus on the tip of the toe overlying a suspected ulcer. The toe is very painful. The patient recently went to her diabetic nurse who suspects that she may have osteomyelitis in the distal phalanx of her left hallux. Describe treatment process for this patient, from the history taking through to treatment, management plan and possible referral? Answer: Whenever there is an injury or an illness it should be treated very quickly. When this 60 year old patient suspected that she is having cold and painful feet, she should have immediately consulted a general physician to check what the condition of the toe is and then should have taken ultrasound studies for her feet (Frowen et al., 2010). An ulcer is an open boil or eruption on an internal or external body surface which happens due to break in the mucous membrane or skin which is difficult to heal (Meskell, 2010). The lady here has foot ulcer which is shallow red depression that happens on the surface of the skin. It might also involve bones and tendons. General questions like if she has frequent fever, if the foot hurts, if there is a fluctuation in the blood sugar level should be asked. The doctor will ask to do certain things to the patient to examine the disease and its severity such as: Location of the infection. How deep the ulcer is? Whether the infection has degraded to osteomyelitis? He may check the patients reflexes. Whether there is abnormality of the foot. He may use a tuning fork to see if the patient can feel the vibration. People infected with diabetes and meager circulations are more prone to foot ulcers (Meaney, 2012). Here we find that the lady was infected with type II diabetes. Now what is type II diabetes? It is noninsulin dependent diabetes which is a persistent condition that affects the body. It does not make insulin (Veves, Giurini and LoGerfo, 2006). Either the patients body does not make enough insulin or it cannot use the insulin enough. Instead of going into the blood cells, the glucose builds up in the blood the body cells then are not able to function. This causes damage to the body, dehydration and also leads to diabetic coma (Edmonds and Foster, 2005). The patient should be asked to do simple blood sugar tests; x-ray of the foot is to be done to find out if she has osteomyelitis. Early recognition of osteomyelitis is vital in the diabetic management foot disease. Aids like biochemical, haematology and radiology are very important to assess the infection severity. Osteomyelitis is one of the most serious diseases that is seen in the diabetic foot (Zeller, 2008). It is an inflammation of the bone or the bone marrow and happens due to bacterial localization. This may lead to further destructive illness in the foot. When the patient is aware of osteo, she should go for an ESR if the osteo weight is high after the diagnosis. When it is confirmed then a treatment with high range of antibiotics should be done. A renal panel is to be brought if medicine such as vancomycin renal function is determined. Patients with diabetes having foot infection can have adverse consequences (HESS, 2000). The doctor may treat the patient with foot ulcer with a treatment called debridement which trims the diseased tissue and will remove the callused skin (Dinker R Pai, 2013). He will apply dressing (Baltensperger, 2003). Specialized footwear will be prescribed to remove pressure on the area which is ulcerated. The doctor may say the patient to make frequent visits till the ulcer heals. If the patient has severe circulation problem than she may be prescribed to go for a surgery to operate on one or more blocked arteries (Waldecker, 2012). If there is no or negligible indication of osteomyelitis than the patient should go to a wound care consultant only. If osteo is found than IV ABX should be prescribed. Finally if neither the wound care or the IV ABX has worked than the patient should refer an ortho or a podiatry. If none of the treatment works than amputation is the last choice (Frowen et al., 2010). References Baltensperger, M. (2003). A retrospective analysis of 290 osteomyelitis cases treated in the past 30 years at the Department of Cranio-Maxillofacial Surgery Zurich with special recognition of the classification. [S.l.]: [s.n.]. Dinker R Pai, S. (2013). Diabetic Foot Ulcer Diagnosis and Management. Clinical Research on Foot Ankle, 01(03). Edmonds, M. and Foster, A. (2005). Managing the diabetic foot. Malden, Mass.: Blackwell Pub. Frowen, P., O'Donnell, M., Burrow, J. and Lorimer, D. (2010). Neale's Disorders of the Foot Clinical Companion. London: Elsevier Health Sciences UK. HESS, C. (2000). Managing a diabetic foot ulcer. Nursing, 30(11), p.87. Meaney, B. (2012). Diabetic foot care: prevention is better than cure. Journal of Renal Care, 38, pp.90-98. Meskell, M. (2010). Principles of Anatomy and Physiology. Journal of Anatomy, 217(5), pp.631-631. Veves, A., Giurini, J. and LoGerfo, F. (2006). The diabetic foot. Totowa, N.J.: Humana Press. Waldecker, U. (2012). Pedographic classification and ulcer detection in the diabetic foot. Foot and Ankle Surgery, 18(1), pp.42-49. Zeller, J. (2008). Osteomyelitis. JAMA, 299(7), p.858.