Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working

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1 Rationale of Module Accurate nursing assessment is the key to effective diabetic foot ulcer prevention, treatment and management. A comprehensive assessment identifies ulcer aetiology and the factors which may prevent or delay healing. Diabetic foot ulcer assessment, management and prevention is a multidisciplinary activity, hence early intervention by the appropriate professionals potentiates the likelihood of a successful outcome for the patient. This module will provide nurses with evidence based information to undertake an in-depth nursing assessment in order to give guidance on best practice in diabetic foot ulcer management. Module Aims This module aims to provide nurses with a structure to the nursing assessment and management of patients presenting with diabetic foot ulceration. Various aetiologies of wounds require individual approaches in terms of nursing assessment, management and prevention. This module also aims to enable students to critically evaluate effective strategies necessary to promote inter-professional, collaborative management of patients affected by diabetic foot ulceration. This module will ultimately support the development of advance cognitive knowledge and critical thinking skills requires to develop critical understanding and competency achievement in relation to the prevention, assessment and management of individuals affected by diabetic foot ulceration and associated conditions. Learning Outcomes On successful completion of this module, the student will be able to: Critically discuss the causes and patho-physiology of diabetic foot ulceration Critically evaluate the epidemiology of diabetic foot ulceration and its impact on health service provision Critically analyse the techniques used in the assessment of individuals at risk of or with diabetic foot ulceration Critically evaluate the strategies in the management of individuals with diabetic foot ulceration Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working Critically discuss the strategies available for the prevention of diabetic foot ulceration Teaching Learning Activities Hours Contact hours 30 Course work preparation 57

2 Independent learning time 160 Assessment 3 Total 250 Indicative Syllabus Overview / epidemiology and costs Incidence and prevalence data for diabetes and diabetic foot complications National/International guidelines and targets (St Vincent Declaration and others) Health needs assessment Economic costs. Anatomy of foot and lower limb Skeletal - foot architecture/ function in health and disease Charcot foot Neurological - neuron-anatomy of the lower limb, nerve fibre types Vascular - macro-circulation, micro-circulation Skin and associated structures. Pathophysiology Neurological pathological changes Vascular macro-circulation, micro-circulation Foot architecture/ function in health and disease Charcot foot Biomechanics of the foot pressure profiling, foot shape, gait / walking pattern, off-loading, and footwear. Lowered immunity Principles of patient care Assessment physical, psychological, social Identification of patient centred management objectives Care planning Evaluation of outcomes Use of evidence based practice/clinical guidelines Referral criteria Interdisciplinary team working.

3 Assessment of the at risk foot General assessment process Wagner classification and other communication aids for assessment of the diabetic foot Differential diagnosis inter-relationship of ischaemia and neuropathy Neurological testing - use of objective measuring tools, monofilaments and the biothesiometer, vibration perception, tactile sensation and discrimination and reflexes Vascular assessment - use of the hand-held Doppler, interpretation of the ABPI and toe pressures, TcPO2 and laser Doppler. Assessing arthropathy - deformities, bony prominences and joint mobility Investigations - plain radiographs, Magnetic Resonance scans and isotope bone scans Assessing skin and callus including nails, presence of dryness, cracking and inter-digital maceration Assessment of footwear and hosiery. Risk factor management Diabetic control Importance of obesity management in prevention of neuropathy and vasculopathy. Nutritional assessment / management Management of oedema - prevention and symptomatic control Neuropathy management - prevention and symptomatic control Vascular management smoking, lipids, hypertension Skin & callus management - prevention of skin cracking and callus formation. Patient education hygiene, inspection, temperature and trauma avoidance. Wound management for diabetic foot ulcers Management strategies for diabetic foot ulcers including the use of wound management products and adjunct therapies The use of guidelines and evidence-based practice to treat diabetic foot ulcers Assessment of wound bed, surrounding skin and associated structures Principles of cleansing

4 Selection of cleansing agents Debridement and wound bed preparation including surgical debridement, dressings promoting autolytic debridement, use of biosurgery and topical negative pressure therapy Dressing selection including product availability relative to local circumstances and different healthcare settings Management of odour / exudate Advanced wound care products/techniques Pain management - importance of pain control, Painful Diabetic neuropathy Care of the surrounding skin - protection and prevention of maceration. Off loading with open wounds - available methods including Scotch cast, windowed casts and Aircast Footwear- appropriateness, shoe shape and fitting. Management of infection Assessment / presentation - clinical signs/symptoms, silent infection Superficial infections and cellulitis Deep infections - surgical drainage Methods of identify infecting agents - culture and swab techniques, rope to bone test for osteomyelitis and biopsy Radiological and other investigations Isotope scans, Magnetic Resonance Scans Antibiotic therapy - indications, type and duration of treatment Use of topical antiseptics - indications, type and duration of treatment Adjunct therapies and their relevance and practical application. Specialist Interventions Vascular investigations and management Corrective orthopaedic surgery Plastic and reconstructive surgery Amputation minor and major? Rehabilitation services.

5 Systematic and local pharmacological management Use of : Steroids ACE inhibitors, anti-platelet agents, Statins Analgesia Antibiotics / antimicrobials Anti- pruritics Emollients and barrier creams. Antidepressants for management of Painful Diabetic Neuropathy? Foot care services Structure and management of foot care services Integrated hospital and community care Database and recall systems Multi-disciplinary, multi-professional approach Follow-up - stratified policy according to risk Patient involvement in care. Psychosocial aspects of care Psychological impact and risk of depression in patients with diabetes Impact of diabetic foot ulceration on individual & society Factors affecting compliance with treatment Effective patient education strategies for prevention and management? - Smoking, diet, lipids, hypertension, foot care, footwear. Examination/ Assessment Method Type of Assessment (Continuous/Terminal) Weighting Assignment Continuous 100%

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