Inlow’s Diabetic Foot Screen Parameter
| Parameter | Assessment and Rationale |
| Skin and Nail Changes
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· Skin is dry; some callus build-up may be noticed.
· Open skin ulceration present. · Nails unkempt and rugged. · Nails damaged. Rationale: Changes in skin and nails can be seen (Orsted and Botros, 2018). Open skin ulceration increases the risk of full-blown ulceration and eventually amputation. |
| Peripheral Neuropathy and LOPS | · Peripheral neuropathy detected.
· There was no sensation. Rationale: Ulceration can be seen on the foot’s periphery (Orsted and Botros, 2018). The presence of peripheral neuropathy and a lack of sensation would increase the risk of ulceration. |
| Peripheral Arterial Disease | · Pulse absent
Rationale: The ABPI is 1.1 after palpation on the dorsalis pedis (Orsted and Botros, 2018). The absence of pulse means the nerves are inactive, increasing the risk of ulceration. |
| Bony Deformity and Footwear | · Deformity
· Footwear inappropriate Rationale: There is a raised metatarsal head and also a chronic Charcot change. Besides, trauma from footwear can be seen (Orsted and Botros, 2018). The patient risks ulceration by a continued wearing of shoes as it will further damage the metatarsals. |
Orsted, H. L., & Botros, M. (2018). Inlow’s 60-Second Diabetic Foot Screen Gets a New Look! Wound Care Canada, 16(1). https://footcarekingston.com/photos/custom/WCC%20Summer%202018%20v16n1%20FINAL%20p.26-29%20inlow%20tool.pdf
Case study – Diabetic Foot Wound
| NSWOC Consult Note | |||
| Practice setting | · Hospital | ||
| Client Demographics | · Carlos Mendez
· Male · 50 years |
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| Current Medications
Include allergies/sensitivities |
· Insulin
· Antibiotic cream · Ramipril · Novolog via pen · Lovastatin |
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| Substance Use
ETOH, tobacco, etc. |
· Tobacco | ||
| History of presenting issue and client concerns | · Mendez was admitted to the hospital with the chief complaint of increasing pain secondary to a wound on the foot after an amputation. The wound could not heal as required, raising concerns. | ||
| Relevant Medical History | · Mendez was diagnosed with diabetes 20 years ago. | ||
| Social History Environmental assessment | · He belongs to a middle-economic class category, working in a construction company. | ||
| Assessment
Highlight/circle assessment type Include pain if applicable |
Wound
· Patent A · Lower-extremity neuropathic disease · Plantar foot surface · Surrounding skin calloused · Wound probes to bone · Round · Moderate exudate |
Ostomy
· Loop stoma |
Continence
· Cleanse wound · Consult physician · Use proper footwear · Obtain routine professional callus care |
| Pertinent Test Results | · HbA1c = 9.7
· HR = 100 bpm BP165/90 RR 16 · Temperature = 36.90 c · Toe BPI on the affected limb = 0.56 biphasic · Weight = 190Ibs · Height = 5’10” · Random glucose level = 25 mmol/l |
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| Impressions
Include etiology of presenting condition Highlight/circle goal Include rationale and client goals |
Healable
· Sensory neuropathy · The patient’s HbA1c is 9.7, which promotes wound healing.
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Non-healable
· Patient use tobacco that reduces tissue perfusion |
Maintenance
· Evaluating would healing process on a systematic basis. |
| Comprehensive Treatment Plan
Include all recommendations and referrals Provide directions for topical treatment, include reassessment plan (who, when, why) |
· Use dressings that maintain a moist surface; absorb exudate and allow easy visualization.
· Use occlusive dressings cautiously. · Avoid mechanical, chemical, and thermal injuries. The patient should avoid walking barefoot and no heating pads. · Follow up visits to the hospital within 30 days of the initial visit by the patient. |
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