Foot Lecture notes Flashcards
We are doing IPPA …inspection and palpation
Inspection…we are looking for injuries blister,ulcer, or crack,anything that’s bleeding or oozing, corns, calluses, cutting straight to prevent ingrown toenails is there any type of fungal infection…_____________… so that fungal infection in the nail….foot structure and biomechanics (things like bunions), skin integrity-looking at bottom of feet as well, any bony prominences that may put folks at increased risk
Onychomycosis
So for our palpation we are doing two for foot exam which is dorsalis pedis and posterior tibial
Doraslis pedis…flexing the big toe follow that ligament up and your on either side of it
Posterior tibial so find the ankle bone and go right behind it…we are also feeling for any bumps…any looking at calluses…we are touching the feet for temperature, warmth which is a sign of circulation
We see any type of infection is it red? Does it look infected? Is it oozing? Is there any pus? Dried blood?
Then obviously temperature we just talked about for circulation, you can add color to inspection.When we did vascular exam, sort of that bluish grayish color we don’t want to see that
We have 2 sensory tests one with tuning fork and one with the 10gram monofilament
The most important thing with the tuning fork is for you to be holding it by the handle not the U of the fork you ask the patient to tell you when its no longer vibrating. When they tell it stops they don’t feel it anymore you then take it to your own finger and sense is it still vibrating…if it continues to vibrate for more than 10 seconds then that means they have decreased sensation to the tuning fork and that your sensing on your finger and they may have both sensation on the left and decrease sensation on the right or vice versa or decrease sensation in both it just depends
In the 10 gram monofilament it’s the bend that gives you the 10 grams of pressure…ask your patient to close their eyes so they can’t see where you are testing and apply it until that filament bends and these are the spots…minimum of the four but those 4 are giving the nerves that innervate the foot….you put + if they feel and a minus sign (-) if they don’t feel it
So in documentation of a SOAP note this is under physical exam you as a healthcare provider are performing the physical exam which would be documented in what section? __________ so you would say full sensation to the 10 gram monofilament bilaterally if they have full sensation on both or it might be reduced vibratory sensation on the right, full sensation on the left
Objective
People with diabetes should not be walking barefoot because if they have neuropathy or nerve damage they are not going to feel what the are stepping on…so they may step on a tack and not even feel it
If you can’t sense water is too hot because of diabetes that could damage the skin that’s why we go with warm water
PHQ-9 tests for what?
Depression
MMSE=
Mini mental state exam
What does the mini mental state exam screen for? Mental stability or instability of _________ so the first type of screening for possible dementia
dementia
Mental Status Assessment
Appearance in terms of hygiene, are they dressing appropriately for the ________ or are they completed ________ and that is not a normal appearance for them, do they look disheveled? Do they look exhausted? Appearance can tell us a lot about someone and where they are at
Level of ________= are they falling asleep as your talking to them, are their sentences not making sense, do they know where they are?,
_________-short term vs long term
SpeechWhat is their speech like….is it racing? Is it fast? Is it making sense? Is it too slow?
Motor behavior(mechanical)…maybe you notice a tremor…anything related to their arms maybe when they are walking or are they walking normally…
their thought processes or are they having normal complete thought process…are they talking about things unrelated and just not relevant to the visitor or what your talking about
Does there affect and their moodseem appropriate? (Some people may have a flat affect which is no emotion, maybe their mood or they are coming in completed amped up,stressed, sometimes might vent for an hour before you even get to talk to them about diabetes
In assessing someone’s mental states your using both your observations and the history that we are taking from the pt
weather
mismatched
consciousness
Memory
When you call 988 there might be a brief hold because they trying to find a counselor to help whoever is calling so its not immediate within a couple minutes or so (suicide prevention phone number
