Class 22 Flashcards

Question

Diabetes Case History Questions - Insulin and Meds Profile (For insulin users:)

Answer 1

• How long have you been using insulin? • How is your insulin delivered? • Have you been using the same insulin type(s) for a while? Does your body tolerate it well? Any side effects? • Have your dosage levels been stable for a while? • Are you stable during exercise? Do you have to adapt your insulin use to exercise? Stress? • Are you regular & compliant in using your insulin?

Answer 2

• Where is cannula currently inserted? • What sanitary practices are required around insertion site? • What do you normally do with it when you sleep? • Are there restrictions on getting area wet?

Answer 3

• Where do you usually inject? Do you have an injection site pattern that you follow? • Where have you injected in past two days? So far today? • Do you ever have irritation reactions at injection sites (inflammation, swelling, rash, etc.) If yes, how long do they last? How are they normally treated? How long does on-site touch/water/oil need to be avoided? • Have you been told to avoid rubbing the tissue after injecting there? To avoid using heat on it? For how long after injecting? • Do you have any old injections sites that are problem for you (painful, stiff, restrict movement, etc.) If yes, where? • Have they received any treatment, massage or other? How did that go?

Answer 4

• What type of oral med(s) do you take? • Have you been on the same drug(s) for a while? •Has the dosage(s) been stable? • When and how often do you take your diabetics medication(s)? • Are there any side effects you have been experiencing?

Answer 5

• In addition to diabetic medication(s), are you taking anything else? Which drugs(s) and why? • Are you having any side effects from any of these medications? • Started any new medication or new dosage recently? Has your diabetic stability been affected? If yes, have you discussed this with your doctor? Is it affecting you right now? Describe.

Answer 6

• Have you had any recent ‘bugs’ or illnesses? Affecting you now? • Have you had any recent injuries? Surgeries? Current status? Is there significant pain or swelling? Are you here for injury or post-surgical treatment? • Do you currently have any infections anywhere? • Any diabetic crisis, or has your diabetic stability been different in the past week as a result of [any of the above]? • Has there been any recent change in your activity or exercise routine? • How is your level of stress? Have there been any recent changes at home/work that are increasing your stress levels? • How are your sleeping habits? Do you tend to become unstable with insufficient sleep? • Do you eat well/regularly? Any recent dietary changes? What time did you have your last meal? • Do you use alcohol/recreational drugs? Within last few days? Have you ever become de-stabilized as a result? • Pregnant? Breastfeeding? Puberty? Menopause? If pregnant, ask about MD monitoring. • How does your body respond to massage? Any instability reactions? If yes, what and when? • Other than those mentioned, do you know of any destabilizing factors present for you right now? • Best sugar source if you destabilize? Do you have sugar with you? If yes, where is it? • What is best way for me to respond if you were to de-stabilize?

Answer 7

• Other than diabetes, do you have any other health conditions? [respond to general case history info with follow-up Qs as appropriate] • History of injuries, surgeries? • Would you say that in general your health is good? How about today (current presentation)? • Do you exercise regularly? How often? How long? Type(s) of exercise (i.e., cardio, weights, etc.)? • Are you seeing other health care practitioners? What have they been doing for you? • Do you get infections easily? Are there specific precautions I need to take/be aware of? • Do you injure easily? Tissues fragile anywhere? How fragile is your skin? Do you have any special needs regarding the type of oil/lotion used? • Do you have delayed healing? How long did it take you to heal from your last paper cut, say? Have you injured a muscle or joint recently, or had a fracture? How long did it take to heal? How well did it heal? • Do you have any skin conditions? Are there specific precautions I need to take/be aware of? • Do you presently have any ulcers/open sores/lesions? Details about location and care. • Do you have any old ulcer sites? Are they well healed? Any ongoing concerns/restrictions? • Do you have any ongoing problems with your feet? Hands? Details.

Answer 8

• Do you have high blood pressure? What is your usual blood pressure? When was your last reading? • Do you have impaired circulation? Where? Any cyanosis? • Do you have any swelling? Where? • Has your doctor given you any restrictions on exercise? • Has your doctor given you any restrictions on bath/shower temp? • Do your hands/feet react adversely to hot/cold temperatures? • Do you hhave any cholesterol problems (i.e., elevated LDL)? Do you have to follow a specific diet as a result? • Have you had an angiogram? Have you been diagnosed with atherosclerosis? (location(s), severity, thrombus risk) • Do you have any history of angina pectoris? Heart attack? • Do you have any history of stroke? TIA? • Have you been told you have heart failure? An enlarged heart? • Have you ever had gangrene? Details about location, surgery, current status. • Do you currently have any body areas that your doctor considers pre-gangrenous? Details, precautions.

Answer 9

• Do you have history of kidney infection or kidney stones? Recently? Currently? • Have you been tested for high protein in your urine? What were the results? • Have you been told your kidneys are affecting your blood pressure? • Do you have full body swelling? • Has your doctor put any restrictions put on your daily activities because of kidney problems? • Have you been told you have kidney failure? Are you using dialysis?

Answer 10

• Has your diabetes affected any other organs or areas of your body that haven’t already been discussed? (i.e., digestion, liver, respiratory) • Are there any problems with your vision? Any adaptations I need to make because of your vision?

Answer 11

• What brings you in for a massage? What are your treatment goals? Priorities? • Have you had massage therapy before? When? What type? • What did the therapist do? What worked and didn’t work? • Did the therapist use hydrotherapy? • Did you ever find you tended to be tired or lightheaded after a massage? • Did your blood pressure go up from massage? • Did you have any adverse reaction to treatment? If yes, details. • Did you find you needed to adapt your insulin/medication for massage therapy? • Did you and the therapist find you needed to make adaptations to the treatment plan? (i.e., lotion/oil application and removal, length of massage, full body or partial, types of hydrotherapy, pressure, techniques) • Are there body areas we should avoid today? In general? (i.e., tender spots, wounds, irritated areas, decubitus ulcers, etc.) • When did you take your insulin/medication most recently today? • What is the best scheduling of your treatments relative to your insulin/medication? • How frequently do you have to urinate? Do you need to use the washroom before commencing treatment? • Will you likely have to go during treatments? • Will you agree to tell me honestly if you have done anything between treatments that you know might be destabilizing (i.e., skipped medication, rushed to get here, drank too much, stayed up all night studying) that might affect our treatments? • Will you agree to make a habit of eating something in the half hour before our treatments? • Will you agree to let me know if you believe it is unwise to have massage on any given day, or that the treatment needs to be modified? • If I need to, do I have your permission to address questions to your doctor?

Answer 12

→ Ask about insulin/medication stability → Evaluate any current destabilization factors → Ensure patient has eaten recently → Ask if patient has exercised in previous few hours

Answer 13

→ Make sure you have current info about site usage & observe current sites for signs of redness/irritation → No onsite massage for 24 hours (at least 10 cm away) → No onsite hydrotherapy for 24 hours (at least 10 cm away) → Wait at least 10 days after discontinuation of site use before focused onsite work

Answer 14

→ Ask where the cannula is inserted & keep at least 10 cm away → All positions okay as long as tubing is not compressed or twisted; pump can sit next to patient on table → When changing patient’s position, remember to move equipment at same time → Wait at least 10 days before focused work on former insertion site

Answer 15

→ Often involve build-up of matted collagenous scarring, altered skin contours, etc. → Degenerative changes in local tissue health & quality → Poor sensation, possible pockets of edema, reduced ROM d/t scar tissue → Scar work strategies will have to be considered case by case depending on tissue health, circulatory integrity, location → Begin conservatively & monitor reaction post-treatment for redness, inflammation, pain, bruising, etc.

Answer 16

→ Stay alert to fact that person is prone to infection → Possible open sores &/or irritated injections sites → If you are sick, use mask, & do not treat patients with advanced diabetes or identified immune impairments

Answer 17

→ Consider patient’s stability & other complications (high BP, CHF, kidney function, neuropathy, etc.) that may be present → Assess capacity of target tissues to handle nature/intensity of proposed treatment before applying (check tissue temperature & colour, reaction to patch test, etc.) → Full body hydrotherapy treatments are not recommended for advanced diabetic conditions → Caution with wet foot hydro applications to avoid drying out skin or promoting skin breakdown → If wet hydro is used, make sure tissues are well dried, especially in extremities → If part is covered with plastic for hydro application, avoid heat temps that would promote perspiration inside plastic → Modify hydro appropriately for injection sites → Sensory impairments require greater therapist monitoring

Answer 18

→ Consider all complications present → Consider tissue quality & resilience → Possible sensory loss, requiring greater therapist monitoring → Talk to patient & have open communication about comfort level, sensation of pressure & temp → Consider vascular and connective tissue fragility that may be present, especially in extremities → Frictioning & deep techniques may need to be modified or avoided based on tissue status, especially in extremities (is tissue resilient? is there sufficient perfusion & drainage? etc.); consider replacing with less intense techniques → If edema present, elevation & lymphatic drainage are indicated but HBP/CHF-related position modification may be needed → Improving circulation to vulnerable tissues is an important treatment goal, but must be approached within context of what can be safely accomplished

Answer 19

→ Begin conservatively & monitor any reactions post treatment → Shorter/partial treatments may be indicated at beginning of new treatment plan to monitor patient’s response → HBP/CHF-related modifications as needed

Answer 20

→ Stay aware of tendency toward promoting hypoglycemic state during & post massage → Advise patient to have snack in half hour before treatment begins & check it has occurred → Watch for signs of changes in heart rate, breathing rate, tissue colour & temp; ask about nausea, etc. → Check in with patient regularly for any changes in wellness → Sensory impairments require greater monitoring, “patch tests” & careful treatment progression → Orthostatic hypotension may occur

Answer 21

→ Always observe feet & legs for areas of redness, irritation &/or edema, cracks or fissures, ulceration; hands can be vulnerable as well in some patients → Do not leave lotion/oil on feet or between toes → If patient is in wheelchair or bedridden, may be susceptible to ulceration in other pressure areas → Different stages of ulcers may be present, beginning with “red spot” & ranging to visible bone in extreme cases → Follow decubitus ulcer guidelines, for prevention & how to respond if present → If gangrene present, only treat with MD consultation → Onsite & distal massage is CI → No oil/lotion nearby (where tissue is susceptible to breakdown) → In general, hypervigilance about hygienic practices around such friable or vulnerable tissues

Answer 22

→ Appropriate regular exercise is very important → Exercise can be destabilizing → Take into consideration patient’s previous experience, current experience, health factors, & build around patient’s lifestyle → If advanced diabetic condition, consult with exercise specialist/physiotherapist &/or medical specialist

Answer 23

→ Patient is currently unstable diabetically → Consider postponing treatment when new meds/dosage being started; MD consultation is appropriate → If gangrene is present, only treat in region with MD consultation; if not yet medically evaluated, postpone treatment → Presence of infection with systemic symptoms, or any new, not yet medically evaluated infection → Very unstable blood pressure or CHF