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.
To pass the test and gain your certificate you need to answer all the questions correctly. The ‘Proceed to next section’ button will only appear when you have answered all the questions/fields in that section correctly.
This certificate can be used as evidence of continual professional development (CPD).
Aim and equipment (1/17)
Aim
The aim of carrying out a foot screening is to identify the presence of risk factors for diabetic foot complications which could lead to ulceration and subsequent amputation such as – Neuropathy, Peripheral Arterial Disease (PAD), Significant structural abnormalities, Significant callus, previous ulceration and the inability to self care. These risk factors should be explained to the individual in a way that they understand them and know what they mean to them.
Equipment
The only piece of equipment that is required to carry out a simple, evidence based, foot screening is a 10g monofilament. The monofilament used should be of good quality such as those manufactured by Bailey Instruments or Owen Mumford and should be used and replaced as per manufacturers instructions to ensure that the monofilament remains accurate. The length of time a monofilament will remain accurate will vary according to it’s frequency of use but Bailey Instruments and Owen Mumford recommend changing the monofilament after approximately 6 months of use. Many clinics use monofilaments much longer than this which can result in less accurate testing.
Neurothesiometer
The Neurothesiometer is a device that tests an individual’s vibration perception threshold (VPT) and monitors diabetic neuropathy by measuring vibration sense. The device graduates in vibration intensity which ranges from 1 – 50 volts.
If a value of <25 volts is entered in the box provided on the SCI-Diabetes form individuals risk will not change but if a value of >25 volts is entered then the individuals risk will change in the same way as if they could not feel 8/10 of the monofilament sites.
Some clinics use the Neurothesiometer as part of the screening process but although it can be used it is not routinely required for screening but can be useful as part of a more ‘in depth’ assessment in specialist centres.
Introduction
Diabetic foot screening is the cornerstone of good diabetic foot care.
The purpose of diabetic foot screening is to carry out a quick, simple, and evidence based screening to determine at what risk an individual is of developing a diabetic foot ulcer, which may lead to an amputation. The individual should be made aware of their foot risk status and have an appropriate treatment/management plan agreed with the individual and implemented if/when required.
The Scottish Intercollegiate Guidelines Network (SIGN 116) is produced in Scotland to guide clinicians on the most up to date, and evidence based practice. This guideline will mainly be of interest to all healthcare professionals/workers involved in the care of individuals with diabetes. The target users are, however, much broader than this, and include individuals living with diabetes, their carers and those who interact with individuals with diabetes outside of the NHS. It will also be of interest to those planning the delivery of services in NHS Scotland and beyond.
The guideline states that:
‘Diabetic foot screening is effective in identifying the level of risk of developing foot ulceration in patients with diabetes’.
It also focuses on keeping the screening process simple and ensuring that all the main risk factors are screened for:
‘Simple tests such as the use of 10g monofilament, palpation of pulses, neuropathy disability score, presence of significant structural abnormality and previous ulceration, when routinely used during screening are effective at predicting ulceration’.
Based on United Kingdom population surveys, diabetic foot problems are a common complication of diabetes with prevalences of;
- 23-42% for neuropathy
- 9-23% for vascular disease
- 5-7% for foot ulceration
Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005 Nov 12;366(9498):1719-24.
Amputation rates are higher in individuals with diabetes than individuals without diabetes.
Individuals with diabetes are at increased risk of developing Peripheral Arterial Disease (PAD), especially when other associated risk factors are present, for example smoking, hypertension and hypercholesterolaemia. Diabetic foot ulceration is principally associated with PAD and peripheral neuropathy, often in combination. Other factors associated with increased risk include;
- Previous amputation
- Previous ulceration
- The presence of significant callus
- The presence of significant structural abnormality
- Visual/Mobility problems
What is diabetes?
Diabetes mellitus, often simply referred to as diabetes, is a common life – long condition where the amount of glucose in somebody’s blood is too high. This is either because their body does not produce enough insulin, or because cells do not respond to the insulin that is produced, known as insulin resistance.
Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so someone can work, play and generally live their lives. It is vital for life. Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel.
Individuals with diabetes cannot make proper use of this glucose so it builds up in the blood and isn’t able to be used as fuel.
Complications may be associated with both low blood sugar and high blood sugar. Low blood sugar may lead to seizures or episodes of unconsciousness ( Hypos) and require emergency treatment. High blood sugar may lead to increased tiredness and can also result in long term damage to organs.
When an individual has high blood glucose it can produce some of the classical symptoms of diabetes:
- Frequent urination (polyuria)
- Increased thirst (polydipsia)
- Dry mouth
- Loss of weight
- Weakness or fatigue
- Blurred vision
There are two main types of diabetes, Type 1 and Type 2:
