Kevin Woo PhD, RN, FAPWCA Module #5 Foot Ulcers in Persons with Diabetes Mellitus (a.k.a. Diabetic Foot Ulcers) Kevin Woo PhD, RN, FAPWCA Module #5 Revised September 2018

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Objectives Recognize the significance of diabetic foot ulcers Describe risk factors for diabetic foot ulcers Understand the key elements of a lower-leg and foot assessment Integrate patient education to prevent diabetic foot complications. Objectives

What is neuropathy Nerve can be damaged by high levels of glucose in the blood Neuropathy is evident by sensory, autonomic and motor changes. Lack sweating Lack protective sensation Foot deformity © Kevin Y. Woo Used with permission

Patient education Educate to empower your patients to take charge and manage their disease and prevent foot complications.

Patient Education Discuss the importance of: Regular blood glucose monitoring. Checking long-term glucose control (hemoglobin A1c) every 3 months. Checking feet every day for open wounds, scale and callus (a mirror on the floor to check the bottom of the feet may be helpful). Not smoking.

Patient Education Discuss the importance of: Wearing proper-fitting deep-toed shoes with orthotics. Wearing shoes all the time with each step, inside and outside the home. Not walking barefoot or in socks or slippers that have no support or do not protect feet against sharp objects.

- Prevention - Chronic disease management Health promotion Key Concepts - Prevention - Chronic disease management Health promotion

Key Diagnoses - Alteration in Skin Integrity - Impaired Skin Integrity - Impaired Comfort - Risk for ineffective peripheral tissue perfusion - Risk prone health behavior

Key Practice Issues Assessment for foot and lower leg changes due to diabetes mellitus should start immediately following diagnosis and be ongoing. Risk factors and co-morbidities can change with patient status. All disciplines should cooperate to assess patients holistically for glucose control, neuropathy and circulation problems.

Websites for Further Information on Diabetic Foot Ulcer Prevention & Care - Association for the Advancement of Wound Care www.aawconline.net - American Diabetes Association - Living with Diabetes http://www.diabetes.org/living-with-diabetes/complications/foot- complications/?loc=lwd-slabnav Registered Nurses Association Ontario (Guideline) https://rnao.ca/bpg/guidelines/assessment-and-management-foot- ulcers-people-diabetes-second-edition Wound Healing Society (Chronic Wound Care Guidelines) http://woundheal.org/Publications/WHS-Wound-Care-Guidelines.cgi - Wound Ostomy Continence Nurses Society www.wocn.org

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