In 2012 American Diabetes Association data showed that 29.1 million Americans or 9.3% of the population had diabetes. This figure includes 11.8 million seniors. (ADA) Seniors often experience many health issues which frequently lead to hospitalization. In fact, additional research done by the ADA found that patients with diabetes were most commonly admitted to the hospital for comorbidities, resulting in diabetic care largely being overlooked. (Linekin) At discharge, these patients are often referred for home care services based on their other health concerns; referrals for diabetes care only are rare. (Linekin) But a diabetes diagnosis can lead to many complications and greatly contributes to health care expenses. “After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.” (ADA) Diabetes comes with several complications and is often not treated as seriously as it should be. While a nurse may be in the home of a patient because of a different health issue, it is important to also perform appropriate diabetic care to avoid further complications.
How Foot Complications Can Occur
Of all diabetes specific hospital admissions, 20 – 25% of them are for foot complications. (Reynolds) These problems can occur frequently in diabetics for several reasons. First, diabetics can suffer from peripheral neuropathy, causing a loss of feeling in their feet. This makes it difficult to recognize cuts or ulcers on the foot because they cannot feel pain as they once did. A cut, callus, or blister can be present and the patient might not have any idea. It may also be hard for an elderly or overweight person to check and clean their own feet easily, meaning they aren’t able to inspect their feet regularly and any injury will continue to go unnoticed. Another issue is peripheral artery disease, which many people with diabetes have as well. This causes decreased blood flow to the extremities, which in turn decreases sensation and healing. (ADA) Thus, diabetics can have foot sores that go unnoticed and untreated for so long and infection can easily occur.
Once a sore or blister requires medical attention, treatment varies depending on the severity of the wound and the infection. X-rays may be needed to see if the infection has spread to the bone. A hospital admission may be required if the wound needs to be cleaned and debrided. Antibiotics will need to be administered. If the would still isn’t healing or if the infection gets worse, amputation of the affected foot can even be necessary. (ADA)
Prevention with Home Care Nursing
Diabetic foot problems are largely preventable with proper diabetes management, including diet, exercise, and carefully monitoring blood sugars. This is where a visiting nurse can assist in preventing these complications. It is important that diabetes management be identified as a concern for the visiting nurse so that maintenance is included in the patient’s plan of care. A diabetes diagnosis is often put on the back burner of elderly care as the focus is placed on other comorbidities. (Linekin) The homecare nurse can address the issues that can help prevent diabetic foot complications while treating the patient for other health issues.
To start, the home care nurse should assess how well the patient is managing the disease in order to try to prevent foot problems from occurring from the start. Make sure the patient is adhering to a balanced diet, getting enough exercise, and adequately monitoring their blood sugars. Education is key to prevention and wellness. Review diet and exercise requirements and make sure the patient knows how to use their glucometer.The following is a list of interventions that should be performed by the nurse or caregiver to prevent and monitor for diabetic foot complications. The patient should also be taught how to do these tasks whenever possible and encouraged to perform them regularly.
- Inspect the feet, examining for any cuts or sores. Look for dry, cracked skin and redness, warmth, or tenderness. Contact the physician if anything is found. Instruct the patient not to self treat any corns or calluses.
- Wash, dry, and moisturize the patient’s feet. Make sure the water is not too hot and pat dry the feet thoroughly when finished. Lotion can be used on dry skin, but avoid the areas between the toes as this could lead to excessive moisture.
- Instruct the patient to avoid walking barefoot.
- Encourage use of comfortable, well fitting shoes that allow the feet to breathe and offer adequate support.
- Wear loose fitting socks made of natural fibers and change them daily.
- Protect the patient’s feet from hot and cold extremes. Tell the patient to avoid heating pads and to double check the temperature of water with a hand or elbow before placing the foot in it.
- Trim toenails straight across. Avoid cutting into the corners. If the patient is unable to do this on their own, instruct them to have their physician take care of it when they are in the office.
- Encourage the patient to stop smoking if applicable.
- Discourage the patient from crossing their legs as this diminishes sensation and blood supply. (NIDDK, Pietrangelo, Ann)
With adequate diabetes management and these preventative steps, it is possible to avoid the serious foot complications that can result from this disease. Even though the nurse may be in the home to provide care for other diagnoses, care for a diabetes diagnosis is also an important part of the nurse’s role.
American Diabetes Association. http://www.diabetes.org/
Hirschman, Karen and M. Brian Bixby. 8/2014. Transitions in Care from Hospital to Home for Patients with Diabetes. http://spectrum.diabetesjournals.org/content/27/3/192?trendmd-shared=0
Linekin, Patricia Landi. 10/2003. Home Health Care and Diabetes Assessment, Care and Education. http://spectrum.diabetesjournals.org/content/16/4/217
National Institute of Diabetes and Digestive and Kidney Diseases. Take Care of Your Feet for a Lifetime. https://www.niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/keep-feet-healthy/take-care-your-feet-lifetime
Pietrangelo, Ann. 4/2016. Diabetes Foot Care. http://www.healthline.com/health/diabetes-foot-care#Healthyfoothabits3
Reynolds, Chelsea. Why Good Footcare is Important for Diabetes.
WebMD. Diabetes Foot Care. http://www.webmd.com/diabetes/caring-feet#1