Category: NHS Scotland

Module quiz

Module quiz (NHS Scotland)

Introduction

This is the module test for ‘Diabetic Foot Screening’. It is strongly recommended that you work through the learning materials of the module prior to commencing this test. By going straight to the test you may miss out on valuable learning contained within the module. The answers to all the test questions are contained within the module.

Instructions

You will be presented with 7 individual scenarios, based on the information provided for each individual you will be asked to determine whether each individual is in the Low, Moderate, High, In Remission or Active foot disease category. You must answer all of these scenarios correctly to obtain a certificate of completion and competence. The version of the SCI-Diabetes form in this test is not an exact representation of the form and is purely for learning purposes.

The SCI-Diabetes form is pre populated as if the individual is suffering from no problems and will only need changed if the individual is perceived to be suffering from a problem after carrying out the screening process. The only area which is not pre-populated is whether the individual’s pulses are either present or both absent and this must be filled in when the palpation of pulses has been completed.

The highlighted area on the form on the right hand side of the page will correspond to the area of the SCI-Diabetes form which is being completed.

You should allow approximately 20 minutes to complete the test. You should complete this test in one session.

To gain a certificate in the Diabetes Foot Screening, select the test below. You should allow approximately 20 minutes to complete this quiz.

This certificate can be used as evidence of continual professional development (CPD).

Identifying risk (17/17)

The Diabetic Foot Risk Stratification and Triage chart below has been developed by the Scottish Diabetes Foot Action Group and is included in the SIGN 116 guidelines. Following the foot screening process the individual should be assigned and informed of their risk category and a treatment and management plan introduced according to the chart if required.

Neurological screening (16/17)

There are 5 points tested with the monofilament on each foot:

  • Apex 1st toe
  • Apex 3rd toe
  • 1st Metatarsal head
  • 3rd Metatarsal head
  • 5th Metatarsal head

Neurological screening (15/17)

When performing the monofilament test the filament must be held at a 90° angle to the foot. Contact with the skin should last approximately between 1 and 2 seconds.

Try this out using the interactive simulation below.

Performing the monofilament test

Neurological screening: introduction (12/17)

Some people with diabetes lose their perception of feeling in their feet. This is called Diabetic Peripheral Neuropathy (DPN) and is defined as

“the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes” (Bolton 1998).

Many people will be unaware that any such problems exist and up to 50 % of people at diagnosis may present with some signs of neurological changes.

DPN can lead to various problems.

  1. Lose of protective sensation resulting in the inability to feel pain
  2. Change of shape of the foot such as clawing of the toes resulting in areas of increased pressure which may cause areas of callus especially under the metatarsal heads.

The simplest and most evidence based way to determine if an individual is suffering from DPN is to test them with a 10g monofilament.

First show the individual that the monofilament is not sharp by performing the test on the back of your hand and then on the individual’s forearm. The next stage is to inform the individual that you will be testing each foot with their eyes closed and they have to say yes each time they feel the monofilament touch their foot.

There are 5 areas tested on each foot. They are the apex of the 1st and 3rd toes, the 1st, 3rd and 5th metatarsal heads. These tests are carried out in a random fashion with the monofilament at a 90° angle to the foot. The monofilament showed be depressed with enough force to cause a bend in the monofilament and should be in contact with the skin for between 1 and 2 seconds. The monofilament should not be allowed to slide across the surface of the skin and areas of callus or any breaks in the skin should be avoided.

  • If the individual can not feel more than 8/10 of the tested sites then they can be diagnosed as having PDN and this can put them at risk of developing a diabetic foot ulcer. Any such individual need to be in a managed treatment plan. All individuals identified as Moderate risk should receive an annual assessment by a podiatrist which should include screening and the checking of individuals risk status. This should then lead to the introduction or review of a treatment /management plan, including reinforcement of education, formulated in consultation with the individual and tailored to suit the individual’s needs.

Vascular screening (11/17)

Can you locate the posterior tibial pulse?