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Help with a neurovascular Case Study assignment

Discussion in 'Diabetic Foot & Wound Management' started by Lenore Smith, May 12, 2019.

  1. Lenore Smith

    Lenore Smith Welcome New Poster


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    I am writing a case study and I need some help on settling on the details. This is my first exposure to neurovascular and the tutorials and powerpoint slides have been slight on info. I could so a lot of research to get to a place where I understand all this but it would take me time that I most definitely don't have!

    We have been provided with only an extract of the case via a GP referral and so need to provide any further details ourselves.

    So lack of hair on lower limb, history of diabetes, hypetension and cholesterol medication suggests testing for PAD.
    Fine, I can't find the pedal pulse due to oedema so I do an API
    Do I do a finding indicating possible arterial calcification from diabetes score over 1.4 and confirm with an x-ray? Or am I safer to stick to a reading that just indicates peripheral arterial disease?
    I've not done toe pressures yet but could I look at that also?
    Someone suggested a Duplex Scan but what I've read says it has good specifity for femoral or popliteal disease but is less reliable for tibial and peroneal arteries. Another test recommended?
    Do I add in claudication found during the patient history

    Does she just have lymphoedema due to chronic venous stasis? List the skin discolouration as erythema, haemodiserin and skin having venous eczema.
    I understand that cellulitis and lymphoedema have a strong association so can talk about risks etc
    How do I then discount DDx of cellulitis? Limb is warm and swollen and there is sign of an infection entry point. She could have no general malaise or flu-like symptoms maybe? Cellulitis mainly occurs unilaterally but the bilateral swelling puts me in a bind.

    I've found a paper that discusses PAD being a risk factor for chronic venous insufficiency so could talk about that in the context of both conditions happening concurrently.
    An obvious venous wound so assess and then work out treatment and management plan
    What about the rheumatoid arthritis/ She's on Azulfidine. Any research I look at says lymphoedema is a rare complication and tends to occur in the upper limbs so....what do I do to weave that into the story? Lymphangitis? Seems to occur unilaterally so....

    Diabetes has caused the autonomic neuropathy and so feet very anhidrotic? Fissues a danger so use of urea cream and emollient important. Cant reach her feet though due to RA....

    Include mobility issues with RA and living alone so self-care is not ideal. Found something called NSW Gov.Hospital in Home service program. Would that be something I could refer her to as a Podiatrist or is this for her GP

    A vascular team referral? Me or pass to the doctor?
    Diabetes management? What's the best to due here? Diabetes educator? District Nurse? What if her blood sugar is well controlled? (speak with GP to confirm?)

    I've added a daughter who lives nearby and suggest she has been doing her toesnails, checking her feet etc. Is this adequate?

    Mulitdisciplinary approach so is there anyone else I should refer her to? Professional education best as she doesn't speak english?

    So diagnosis....PAD due to assessment findings (which I make up). Chronic venous stasis due to? peripheral neuropathy due to combined PAD and diabetes? Anhidrosis and plantar foot surface due to complication of Type 2 diabetes causing nerve damage and autonomic neuropathy?
    Cellulits discounted due to?

    Any help or input at all would be greatly appreciated as I have 2 OSCE's coming up as well and I dying slowly under the weight of all this.

    Cheers

    Lenore

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