Diabetes Mellitus - is classed as a metabolism disorder.

A
person with diabetes has a condition in which the quantity of
glucose in the blood is too elevated (hyperglycemia).
-

DM Type 1 - results from the body's failure to

produce insulin, and presently requires the
person to inject insulin.
DM Type 2 - results from insulin resistance, a
condition in which cells fail to use insulin
properly, sometimes combined with an
absolute insulin deficiency. (
Gestational Diabetes - is when pregnant
women, who have never had diabetes before,
have a high blood glucose level during
pregnancy.

People with long-standing or poorly controlled

diabetes are at risk for having damage to the
nerves in their feet. The medical term for this
is peripheral neuropathy. Because of the nerve
damage, the patient may be unable to feel
their feet normally.
Poor Circulation
- Especially when poorly controlled, diabetes
can lead to accelerated hardening of the
arteries or atherosclerosis. When blood flow to
injured tissues is poor, healing does not occur
properly.
Trauma to the foot
- Any trauma to the foot can increase the risk
for a more serious problem to develop.
-

NURSING CARE OF PATIENT WITH DIABETIC FOOT

c.

d.

e.

Infections
-

Diabetic Foot - is a foot that exhibits any pathology that results

directly from diabetes mellitus or any long-term (or
"chronic") complication of diabetes mellitus.
f.
RISK FACTORS IN DEVELOPING FOOT COMPLICATIONS
a. Footwear
- Poorly fitting shoes are a common cause of
diabetic foot problems.
-

b.

If the patient has red spots, sore spots,

blisters, corns, calluses, or consistent pain
associated with wearing shoes, new properly
fitting footwear must be obtained as soon as
possible.

Nerve Damage

Smoking
-

Athlete's foot, a fungal infection of the skin or

toenails, can lead to more serious bacterial
infections and should be treated promptly
Ingrown toenails should be handled right away
by a foot specialist. Toenail fungus should also
be treated.

Any form of tobacco causes damage to the

small blood vessels in the feet and legs. This
damage can disrupt the healing process and is
a major risk factor for infections and
amputations.

EXAMS & TESTS

a. History & Physical Examination
b. Laboratory Test
a. Hemoglobin A1C
b. Lipid Profile
c. Prealbumin
c. Neurologic Screening

d.

e.
f.

a. 10 g Semmes Weinstein Monofilament

Vascular Evaluation
a. Palpation of pulses
b. Ankle brachial index
X-rays
Angiogram

NURSING CARE
a. Good blood sugar control_________________
______________________________________
______________________________________
b. Inspect feet daily________________________
______________________________________
______________________________________
c. Wash and Moisture feet daily______________
______________________________________
______________________________________
d. Smooth corns and calluses________________
______________________________________
______________________________________
e. Trim toenails regularly____________________
______________________________________
______________________________________
f. Never go barefoot_______________________
______________________________________
______________________________________
g. Avoid thermal injury_____________________
______________________________________
______________________________________
h. Dont constrict circulation_________________
______________________________________
______________________________________
i. Exercise_______________________________
______________________________________
______________________________________
AMPUTATION - is the removal of the body part, usually an
extremity. Amputation of a lower extremity is often necessary

because of progressive peripheral vascular disease (often a

sequel of diabetes mellitus).

Above knee amputations

-

1.

Even after a forefoot amputation where all the

toes are removed, walking is usually
straightforward. This sort of operation is
performed frequently for foot infections in
patients with diabetes.
After minor amputations the wound is not
always closed completely with stitches.

Major amputations
-

c.

d.

Below knee amputations

-

Amputations through the knee joint or just

above
the
knee
joint
(Gritti-Stokes
amputation) can also sometimes are
performed.

Minor amputations
-

2.

Occasionally an amputation of just the foot

can be performed with a cut through the ankle
joint (Symes amputation). This is not suitable
for the majority of patients, but can rarely be
an option in some patients with diabetes. It is
particularly important for this amputation that
the posterior tibial artery is patent and has a
reasonable blood flow. This artery is found on
the inside of the foot just below the ankle. The
surgeon may advise the patient if this
operation may be possible.

In this operation the bone in the thigh (femur)

is divided about 12-15 cms above the knee
joint and the muscle and skin closed over the
end of the bone.

_____________________________________________
____________________________________________

This operation can be performed using 2 major

techniques. The most common technique is
the posterior myoplastic flap (Burgess
technique) where the skin and muscle from
the calf are brought forward to cover the shin
bones after they have ben divided. The other
main technique is the skew flap (Kingsley
Robinson technique) in which the muscles of
the calf are brought forward in the same way
as in the posterior technique but the skin flaps
are skewed in relation to the muscle.

Complications of Amputation

It is usually possible before the operation

(although not always) for the surgeon to
decide at what level the amputation will be
performed (above knee or below knee).

Phantom limb pain pain appearing to come from

where an amputated limb used to be is often
excruciating and almost impossible to treat. The pain is
described in various ways: burning, aching, 'as if the
hand is being crushed in a vice,' etc.
Infections - It is a frequent complication of amputation.
Patients who have undergone traumatic amputation
have a contaminated wound.
Fat Emboli - An embolus is an air bubble, amniotic fluid,
a clump of bacteria, chemical, drugs, blood clot or a
globule of fat. Fat emboli occur when fat enters the
circulatory system after amputation or trauma and
blocks a blood vessel.

Nursing Management for Amputation

a.

b.

Relieve Pain__________________________________
_____________________________________________
____________________________________________
Minimized Altered Sensory Perception______________

e.

f.

Promote wound healing__________________________

____________________________________________
_____________________________________________
Enhancing body image___________________________
_____________________________________________
_____________________________________________
Resolve Grieving________________________________
_____________________________________________
_____________________________________________
Promote independent self care____________________
_____________________________________________
____________________________________________

NOTES:
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Prepared by: Mark Anthony L. Yabres SN/SUCN