Case 2: Diabetic Foot Care
The lessons learnt from foot care of persons with diabetes include identification of the at-risk foot, regular inspection and examination of the at-risk foot, education of the patient, family and healthcare providers, routine wearing of appropriate footwear and treatment of pre-ulcerative signs. The afore-mentioned were the preventive measures for foot problems in diabetics (Armstrong, Boulton & Bus, 2017). The resources for this case were the New England Journal of Medicine, the Annals of New York Academy of the Sciences, and the Association of South East Nations Management of Diabetic Foot Wounds. The evidence-based practice studies consisted of Cochrane reviews pertaining to diabetic foot ulcers, some of which directed the international guidelines. The reviews analyzed several reports on foot care in persons with diabetes and compared to the International Working Group on the Diabetic Foot to provide guidance in scenarios devoid of expert advice.
New skills learnt in the diabetic foot case are as follows: relieving the pressure while protecting the ulcer, restoring the skin perfusion, treating any underlying infection and improving the metabolic control while treating existent co-morbidities. Also, local wound care approaches, educating the patient and relatives; and measures to prevent recurrence were learned (Everett & Mathioudakis, 2018). In my opinion, I would do several things differently. First, in relieving the pressure, I would recommend the non-removable casts as recent evidence proves them to be more effective than dressings alone or removable casts. Also, in treating infections, I would begin with a broad-spectrum antibiotic before the definitive cause of the infection is identified by laboratory culturing, microscopic and biochemical analysis. Once the results are available, I would start the patient on medication which is specific for the identified organism, to provide optimum treatment and more efficacious effects.
The management of patient flow and volume was also challenging. Nonetheless, I achieved by integrating a mutli-disciplinary team that attended to different aspects of patient needs at particular times. For instance, while one patient was undergoing the consultation process with the clinician, I took the vitals: blood pressure, temperature and pulse rate for another patient. At the same time, another patient was having his random blood glucose being tested while yet another patient with a diabetic foot ulcer was having a sample of the ulcer taken for microscopy, culture and biochemical analysis.
The importance of appropriate communication and feedback cannot be overlooked. I practiced communication skills by maintaining appropriate eye contact with the patient, assessing the non-verbal cues of communication such as facial expression, posture and gestures and engaged in therapeutic conversation. Also, I educated the patient and family on the measures of preventing diabetic foot ulceration.
Improving my skills and knowledge would be possible via attending seminars and workshops relating to diabetes and diabetic foot ulcer. Also, working closely with diabetic foot ulcer specialists would prove to be resourceful, besides reviewing emerging studies pertaining to the presentation, complications and care of diabetic wounds (Nather et al., 2015). These perspectives could be communicated to my Preceptor through a formal email with an attached presentation of the subject. At the moment, I am actively analyzing recent trends and international guidelines on management of diabetic wounds. My Preceptor is providing trustworthy feedback that my learning process is commendable. However, the feedback also points out other areas that I need to improve on such as patient motivation and what details to include or exclude in patient education.
References
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