Education on Wound Care for Diabetic Patients

Education on Wound Care for Diabetic Patients
Abstract
Non-compliance of wound care management has increased the risk of infection and amputations. Diabetes wound care management is an important and fundamental aspect when it comes to diabetes teaching and education. Assessment of the feet daily and at a primary care office will provide information such as noncompliance, risks for neuropathy, peripheral vascular disease, macro-vascular disease, and possible amputation. Education provided by health care practitioners to the diabetic population will promote decrease in risk for further complications and the patient to be involved in their own care. Assessment, treatment, and education on wound care management with the involvement of the patient will increase the patient’s quality of life and be very beneficial to both the practitioner and the patient.
Keywords: diabetic wound care management, diabetic ulcer care, outpatient diabetes management, diabetic care management

Introduction
Working in a primary care setting will involve a multitude of disease processes- diabetes mellitus being one of them. Diabetes is a disease that is characterized by high levels of blood glucose with a defect in insulin secretion and cell resistance. Without proper management, diabetes may lead to other issues in health. Examples of such, would be, delay in wound healing, leading to foot ulcerations, which thus increases the risk for amputations (Sheridan, 2012).
There is an estimated 15.7 million Americans that are affected by diabetes, with an unknown number of people who have not been properly diagnosed. Many of the ones diagnosed not managing this disease process appropriately (Cash & Glass, 2011). It is important for those that are affected my diabetes mellitus to be educated on proper management of diabetes, as this is a chronic disorder that can lead to multiple other issues. The increasing complications of diabetes leads to a longer hospital stay, possible need of rehabilitation upon hospital discharge, strict wound care management to decrease complications, and even death (Lavery et al, 2012).
This project will provide an educational overview on the management of wound care for diabetic patients. The targeted audience will be for diabetic patients that health care providers will be managing. Education will be provided on ways to check for wounds, manage current wounds, and ways to continue the optimal delivery of care to the diabetic patients. The importance of this education will provide early recognition and management of risk factors, which may prevent or delay adverse outcomes (American Diabetes Association, 2011).
Review of Literature
The online databases, provided by the South University library, that were used for this evidence-based project were CINAHL Plus with Full Text, Ovid Nursing, and ProQuest. Using the key words: diabetic wound care management, diabetic ulcer care, outpatient diabetes management, and diabetic care management, a variety of resources were found that were eligible for this educational project. Approximately 74 hits were found in CINAHL Plus with Full Text, 98 hits from Ovid Nursing, and 54 from ProQuest appeared on the online databases that were related to the keywords. Out of the articles, 94 were within the last 15 years. The evidence-based articles were then narrowed down further by interest of the abstracts, articles being within the last 13 years. The articles were narrowed down to twenty, which was chosen if the title was appealing to the reader.
Assessment
Assessments are the initial evaluation when it comes to diagnosing diabetes or detecting the presence of complications. Assessing an ulcer is determined by five factors that need to be addressed: etiology and the risk factors, ulcer type and the characteristics, location, measurement, and infection (Delmas, 2006). There is close relationship between ulcer duration at referral, ulcer area, and outcome. This emphasizes the importance of early assessment of newly occurring neuropathic ulcers (Ince, Game, & Jeffcoate, 2007). When this is completed, treatment options and education would need to be addressed. Follow-up appointments are also important for assessments and the continuity of care. Depending on the grade of the ulcer, would it determine how much and how frequently patients would follow up. A retrospective cohort study concluded that frequent visits to the wound care clinics provided benefits with lower costs and higher quality of life for the patients (Warriner et al, 2012). In conclusion, wound care needs to start with the appropriate assessment to understand the next step in the patient’s plan of care. Patients should be involved from the time they come in for the management of care.

Treatment
Out of the fifteen articles that were extracted from the online database for eligible use, four were in regards to diabetic ulcer treatment. Two were qualitative studies and the other two were quantitative. The four articles consisted of ways to heal diabetic ulcers with a variety of different techniques to prevent ulcers from forming, manage current ulcers, and to treat chronic diabetic wounds. It is known that diabetes mellitus can cause major complications such as lower extremity ulcers, which can ultimately result in amputation. A descriptive, retrospective study using growth factor therapy and hyperbaric oxygen treatments were investigated and it was examined that there was improvement and progress in wound healing with the use of hyperbaric oxygen (Lyon, 2008). A study that was completed a couple years after provided the efficacy of hyperbaric oxygen therapy for treatment in the lower extremities. This also decreased the risk for amputations (O’Reilly et al, 2011). Negative wound pressure therapy was used to manage foot ulcers and when compared to conventional dressing, it was examined to be more effective. The downfall to this evidence is that there were not enough strong inquiries in outcomes and patient diversities (Noble-Bell & Forbes, 2008). A prevention method that was evaluated to decrease the risk of foot ulceration was between the shear-reducing insoles in comparison to the standard insoles. The results of this single-blinded, randomized trial suggested that the shear-reducing insoles were more effective that the traditional insoles (Lavery et al, 2012). In conclusion, the management for diabetics with foot ulcers and lower extremity complications have been studied and made aware that a variety of treatment options to prevent further complications are available.
Education
Education on the pathophysiologic changes, anatomic deformities, and environmental influences should be understood. This is important for both the practitioner and the patient. Due to the different stages of foot care, research has supported that the effective means of treatment of diabetic foot complications is to use the multidisciplinary approach. Multidisciplinary actions are needed for the mechanical, wound, microbiological, vascular, metabolic, and educational aspects of the disease process (Dinh, 2006). To improve the process in wound healing, patients need to understand the process of glycemic control, nutrition, risks, and complications. This particular randomized controlled study was designed to determine the actual effectiveness of foot care education in the secondary prevention of foot ulcers. It was concluded that there was significant evidence associating clinical benefit when it was compared to usual care (Lincoln et al, 2008). The importance of documentation is crucial for the practitioner when it comes to education. It clarifies organization and clear documentation that education was provided to the patient. The research, created by Lowe et al, in 2013, provided an evaluation to a electronic medical record wound care template. The results of this study showed an improvement of evidence-based interventions and facilitated education, documentation, and wound complexity with procedures. See Appendix A.
Theoretical Framework An educational theory that is used for the theoretical framework of this assignment is the Learning Theory, created by Malcom Knowles. His first book, The Adult Learner, was published in 1973 that explained the adult learning theory. Knowles was considered the father of andragogy. The basic elements of this theory consist of six assumptions: (1) Adults need to first understand why they need to learn something before they are ever ready to learn. This allows them to understand that learning will help them in the real world. (2) They are self-directed learners, which make them resist being dealt with as a child and being told what to do. (3) Adult learners come with a lot of experience, which can make one assume and be biased about new ideas. (4) Adults are motivated to learn as much as they can in order to perform tasks ad solve problems. (5) Response to external motivation is key to adult learners. Examples of these are promotions, better jobs, more money, and many other factors that will keep the adult to grow ad develop (Knowles, 1973). This adult learning theory is appropriate for this project because it provides a foundation to the target audience: adults that are diagnosed with diabetes, learning to manage their own care and practitioners, who will guide and educate their patients for that particular care. The four principles of Knowles’ theory explain why it is important for this educational project. (1) Adults need to be a part of their care and be involved in their own evaluation (Knowles, 1973). Patients will be more willing to care for themselves if they feel that they are being involved in their own healthcare management. Keeping them involved in their own plan of care will provide them with knowledge and the experience. (2) Experience, which is including mistakes, provides the basis of learning (Knowles, 1973). This statement is true. Everything is based on experiences whether it is good or bad, which is another reason that including the patient with their care will improve learning. (3) When the subject has to do with the learner’s personal life or job, this is when the adult learner is most interested, and (4) adult learning is problem-centered rather than content-oriented (Knowles, 1973). This is important because non-compliance is a huge issue to diabetic patients, especially when it comes to wound care and its healing process. Making sure that the patient is aware that this continuity of care is the involvement of their life might create an understanding to the patient.
Standards of Practice
The standards of practice, developed by the American Diabetes Association, have been updated again this year. The current standards to diabetic care begin with the initial assessment and evaluation, management, glycemic control, diabetes education, physical activity recommendations, and of course, foot and wound care guidelines.
The patient should be involved from the very beginning, starting with the initial assessment. During this course, practitioners would be able to educate patients on the type of diabetes, complications, treatment and risk factor control, assist in formulating a management plan, and provide a basis for continuity of care. Blood draws will also be done (American Diabetes Association, 2013). It is important that practitioners will provide optimal management of the patients diabetes form the beginning.
The current standard for diabetic patients with foot conditions should be educated and re-educated frequently in regards to risk factors and the appropriate ways to manage this chronic disease. Patients should understand the implications of decrease sensation, especially in the lower extremities, the importance of monitoring their feet on a daily basis, skin and nail care, and selecting the appropriate shoes. This provides an early surveillance for foot problems. If the patient is not able to do this on their own, it is important that the practitioners involve the family in the patient’s care (Knowles, 1973).
Teaching Plan
The title of my teaching plan is: Recommendations for Preventing, Diagnosing, and Treating Wounds on Diabetic Patients. The sole purpose of this teaching plan is to provide education to the diabetic patient on prevention, diagnosis, and the proper wound care treatment methods. The goal is to provide to the reader, which are the diabetic patients, the education and knowledge that is necessary to care for themselves, as this is a chronic disease. Prevention and treatment are the important necessities of managing diabetes. There would be a total of 60 minutes of contact hours and the total clock hours. As stated above, the current standards to diabetic care begin with the initial assessment and evaluation, management, glycemic control, diabetes education, physical activity recommendations, and of course, foot and wound care guidelines (American Diabetes Association, 2013). With the patient being involved from the beginning, it will provide an early surveillance to wound problems (Knowles, 1973). The learner’s objectives for this teaching plan are to: 1. Describe the pathology of a diabetic wound (cognitive skills), 2. Perform an assessment on a diabetic wound (using psychomotor skills), 3. Understand the diagnostic techniques for a diabetic wound (cognitive skills), 4. Identify the preventative options to decrease the risk of diabetic wounds (cognitive skills), and lastly, 5. Identify treatment options for the diabetic wound (cognitive skills). See Appendix B.
Instructional Strategies
Instructional strategies used to learn these objectives are through Powerpoint lectures, pamphlets, hands-on activities, and videos. Direct instruction is used to meet the objectives: 1, 3, 4, and 5. The strategy used to complete this type of learning is through Powerpoint presentations, pamplets, and videos. Indirect instruction, interactive instruction, and experimental learning are used to meet objective 2. The instructional strategy used to meet these criteria is through hands-on learning. Independent study was not used in this teaching plan. See Appendix B.
Evaluation Methods
The effectiveness of this project will be evaluated through pre and post-tests and return demonstration. Pre-tests will be used to determine the knowledge that the audience has of this particular topic prior to the presentation. Post-tests will determine how much was learned after the Powerpoint presentation was presented. Return demonstration will be completed once the presenter provides a demonstration. This interaction provides hands-on learning and shows the presenter that the audience understands how to assess for the skin and/or ulceration. See Appendix C-H for pre and post-tests.
An evaluation form to evaluate the whole presentation will be provided to the audience. This form is used for outcomes and recommendations for future presentations. See Appendix I.
Conclusion
Education on diabetic wound care management starts with the patient. Being involved in their care increases the patient’s quality of life and is beneficial to both the practitioner and the patient. Compliance of wound care management has decreased the risk of infection and amputations; therefore, it is important and fundamental aspect when it comes to diabetes teaching and education. The importance of this education project will provide early recognition and management of risk factors, which may prevent or delay adverse outcomes (American Diabetes Association, 2011).

References
American Diabetes Association. (2013). Standards of medical care in diabetes-2013. Diabetes
Care, 36(1), 11-66.
American Diabetes Association. (2011). Standards of medical care in diabetes-2011. Diabetes
Care, 34(1), 11-61.
Birke, J., Pavich, M., Patout, C., & Horswell, R. (2002). Comparison of forefoot ulcer healing using alternative off-loading methods in patients with diabetes mellitus. Advances in Skin and Wound Care, 15(1), 210-215.
Cash, J. & Glass, C. (2011). Family Practice Guidelines. New York, NY: Springer Publishing
Company.
Delmas, L. (2006). Best Practice in the assessment and management of diabetic foot ulcers.
Rehabilitation Nursing, 31(6), 228-234.
Dinh, T. (2006). Management and treatment of the diabetic foot. Orthopedics, 29(7), 587-590.
Ince, P., Game, F., & Jeffcoate, W. (2007). Rate of healing neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area. Diabetes Care, 30(3), 660-
663.
Ince, P., Kendrick D., Game, F., & Jeffcoate, W. (2007). The association between baseline characteristics and the outcome of foot lesions in a UK population with diabetes.
Diabetes Medicine, 24(9), 977-981.
Jessup, R., Spring, A., & Grollo, A. (2007). Current practice in the assessment and management of acute diabetes-related foot complications. Austrailian Health Review, 31(2), 217-222.
Knowles, Malcom. (1973). The adult learner. Houston, TX: Gulf Publishing Company.
Lavery, L., LaFontaine, J., Higgins, K., Lanctot, D., & Constantinides, G. (2012). Shear- reducing insoles to prevent foot ulceration in high-risk diabetic patients. Advances in Skin and Wound Care, 25(11), 519-524.
Lincoln, N., Radford, K., Game, F., & Jeffcoate, W. (2008). Education for a secondary prevention of foot ulcers in people with diabetes: A randomised controlled trial.
Diabetologia, 51(1), 1954-1961.
Lowe, J., Raugi, G., Reiber, G., & Whitney, J. (2013). Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?. Journal of Wound, Ostomy, and Continence
Nursing, 40(2), 157-162.
Lyon, K. (2008). The case for evidence in wound care: Investigating advanced treatment modalities in healing chronic diabetic lower extremity wounds. Journal of Wound,
Ostomy, and Continence Nursing, 35(6), 585-589.
McLennan, S., McGill, M., Twigg, S., & Yue, D. (2007). Improving wound-healing outcomes in diabetic foot ulcers. Expert Review on Endocrinology and Metabolism, 2(2), 205-211.
Noble-Bell, G. & Forbes, A. (2008). A systematic review of the effectiveness of negative wound pressure therapy in the management of diabetes foot ulcers. International Wound
Journal, 5(2), 233-241.
O’Reilly, D., Linden, R., Fedorko, L., Tarride, J., Jones, W., Bowen, J., & Goeree, R. (2011). A prospective, double-blind, randomized, controlled clinical trial comparing standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care only for the treatment of chronic, non-healing ulcers of the lower limb in patients with diabetes mellitus: A study protocol. Trials, 12(69), 1-10.
Sheila, D., Akinosun, O., & Abbiyesuku, F. (2007). Effect of increased patient-physician contact

time and health education in achieving diabetes mellitus management objectives in a

resource-poor environment. Singapore Medical Journal, 48(1), 74-79.

Sheridan, S. (2012). The need for a comprehensive foot care model. Nephrology Nursing
Journal, 39(5), 397-400.
Warriner III, R., Wilcox, J., Carter, M., & Stewart, D. (2012). More frequent visits to wound care clinics result in faster times to close diabetic foot and venous leg ulcers. Wound Care
Journal, 25(11), 494-501.

Appendix A Evidence Summary Table of Review of Literature | Study | Design | Methods | Sample | Tools | Findings | Limitations | 1. Birke, Pavich, Patout, Horswell (2002) | QL | Retrospective analysis | 120 consecutive patients with DM referred for treatment of new, nonsurgical forefoot ulceration | Healing time of forefoot ulcers in days and percentage healed in 12 weeks. | The healing rate of forefoot ulcerations in patients with DM using alternative off-loading methods or a total contact cast appeared to be comparable when the method was selected based on location of ulcer, patient age, and duration of ulceration | Further study is needed to determine the separate effect of the accommodative dressing vs. the surgical shoe in ulcer healing | 2. Delmas (2006) | QL | Descriptive | 236 patients with DM, randomized | Interview, Screen of foot ulcers | Evidence supports a preventative strategy of risk assessment and appropriate referral | Not enough research in documentation tools for diabetic foot ulcers | 3. Dinh (2006) | QL | Descriptive | 48 patients with DM and foot ulcerations | Interview | Risk factors for diabetic foot ulceration can be due to: pathophysiologic changes, anatomic deformities, and environmental influences. Proper understanding of how ulcers develop could provide the patient more of an understanding to wound care management | Small sample size | 4. Ince, Game, Jeffcoate (2007) | QL | Observational | 616 DM patients with concurrent or recurrent ulcerations to the LEs | Characteristics at baseline (ulcer size) and clinical outcomes (healing, minor amputation, major amputation, and death) | There is close relationship between ulcer duration at referral, ulcer area, and outcome. This emphasizes the importance of early assessment of newly occurring neuropathic ulcers. | Did not list limitations | 5. Ince, Kendrick, Game, Jeffcoate (2007) | QL | Descriptive | 449 participants with PAD, and peripheral neuropathy | Age, gender, duration of DM, ulcer site, ulcer duration and baseline characteristics were recorded; postcode used to derive an index of social deprivation. Patients F/U up to 1 year; primary outcome measure was time to healing. | No association between age, gender, DM type, deprivation index, peripheral neuropathy or infection; relationship between healing time and ulcer area, peripheral arterial disease and diabetes duration remained significant on multivariate analysis; factors influencing healing are cross-sectional area at presentation and the degree of peripheral arterial disease. | Authors did not list their limitations | 6. Jessup, Spring, Grollo (2007) | QL | Retrospective audit of the medical history | 62 patients that had the ICD code for diabetic feet | Each patient was reviewed by the following: number of admissions, reasons for each admission, timing of admission during the audit period, admitting unit, length of stay, medical history, number of wounds on admission or developed during inpatient stay, documentation wound on admission, documentation of wound during admission, management including surgical interventions, inpatient and outpatient referrals, discharge destination | There needs to be an improvement in management of patients with DM and related complications at the start of admission. This will improve outpatient and follow-up visits, and patient compliance to their own care. | Admissions classified under the codes other than the two ICD codes listed not assessed which suggests that it only captures a samples of admissions for acute-diabetes with foot complications; admission rates for this diagnosis group may be underestimated. | 7. Lavery, LaFontaine, Higgins, Lanctot, & Constantinides (2012) | QL | Single-blinded randomized trial | 299 patients at high-risk for DM foot ulcerations, random | The International Working Group on the Diabetic Foot Risk’s Classification | 2 significant factors from the Cox regression model: insole treatment and history of foot complication; Standard group therapy was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group; shear-reducing insoles are more effective than traditional insoles to prevent foot ulcers in DM patient | Did not have incidence data available for DM foot risk groups | 8. Lincoln, Radford, Game, & Jeffcoate (2008) | QN | Observer-blind, randomized controlled trial | 178 patients with healed ulcers, random | The Diabetic Foot Scale (DFS), Nottingham Assessment of Functional Footcare (NAFF), the Hospital Anxiety and Depression Scale (HADS) | No significant differences between ulcer incidences at either 6 months or 12 months; education had no significant effect on mood, quality of life, or amputations; no evidence that targeted education was associated with clinical benefit in population when comparing it to usual care | Did not list limitations | 9. Lowe, Raugi, Reiber, JoAnne (2013) | QL | Cohort | 27 veterans in the historic control cohort and 49 veterans in the intervention cohort | Diabetic Foot Ulcer (DFU) template | Improving wound care documentation would provide a better understanding to targeting future interventions for optimization of wound care outcomes | Small, single study; unable to know if there was a discrepancy between what was done and what was documented | 10. Lyon (2008) | QL | Descriptive, retrospective review | 89 patients with DM and lower-extremity wounds | Healing rate (% change in wound volume) | Those who received hyperbaric oxygen (HBO) treatments as part of their wound care regimen healed faster than the patients who received standard treatment | Using wound healing in a population that has less access to care and mgmt. of DM | 11. McLennan, McGill, Twigg, & Yue (2007) | QL | Descriptive | 187 patients | Measurement of ulceration | Improving the management of DM will need to start with glycemic control, healing interventions, regular inspections, and debridement. | No limitations were noted in this article | 12. Noble-Bell & Forbes (2008) | QN | Observer-blind randomized trial | 9 met the inclusion criteria and were subject to full assessment | Follow-up, intention-to-treat, ultrasound imaging (to capture wound depth), photographs (to capture wound surface measurements | Negative pressure wound therapy (NPWT) has had positive findings without any adverse events; it is beneficial in relation to wound healing following foot amputation | Paucity of the primary studies with heterogenicity in population, design, application, and outcome measurement being the most important issue; only English papers were included | 13. O’Reilly, Linden, Fedorko, Tarride, Jones, Bowen, & Goeree (2011) | QN | Prospective, double-blind, randomized, controlled clinical trial | 118 patients with non-healing diabetic ulcers of the lower limb | Wound healing, effectiveness, safety, healthcare resource utilization, quality of life, and cost-effectiveness | Leads to important changes in the management of diabetic patients that are at risk of developing amputations due to a non-healing ulceration | No limitations were discussed | 14. Sheila, Akinosun, & Abbiyesuku, (2007) | QL | Cohort, developmental | 105 with type 2 DM, managed in a metabolic research unit (MRU) (managed over 5 year unit); another group of 115 patients with type 2 DM, managed over five-year period in the medical outpatient department (MOPD) | Blood pressure and urinalysis measured; morbidities recorded on recruitment, at each visit, and at the end of the study in each cohort | DM management achieved by increasing patient-physician contact time and providing education, especially in a resource-poor environment | Authors did not list limitations | 15. Warriner, Wilcox, Carter, & Steward (2012) | QL | Retrospective cohort study | 206 patients Wagner grade 1 or 2 diabetic foot ulcer (DFU) and 215 patients with venous leg ulcers (VLU) in LE | DFU- Offloading and standard wound care; VLU- compression and standard wound care; analysis of time to close based on visit frequency | Frequent visits to the wound clinic would promote lower costs and higher quality of life for DM patients | Small sample; for VLUs authors do not know if compression applied was adequate; comorbidities that can factor into the VLUs |

Summary of the Review of Literature

The summary table of the review of literature consists of fifteen evidence-based articles that were retrieved from a variety of nursing databases. Of the fifteen evidence-based articles, twelve are quantitative and three are qualitative. There are a variety of research methods that were used including descriptive, double-blinded randomized studies, cohort and retrospective views. Single-blinded and observer-blinded studies were also included. Sample populations ranged from 9 to 616, which made some of the research’s’ limitations to be the small sample size. Majority of the sample population were diabetic patients that had foot ulcers or were at risk of developing one. Tools to measure variables came in a variety. Some measured the ulcers and the healing time within a certain time frame and others used standardized surveys, scales, and/or interview technique. As stated above, a few of the research articles noted that the small sample study was a limitation. Other factors that were taken into effect were information that could’ve been biased, underestimated, and documentation versus application. In summary, the findings were consistent to the importance of education to the diabetic population in terms of management and care for ulcers and other wound formations. The more education that is received and understood by the patient, the easier it is to heal appropriately and decrease the risk of furthering complications for the diabetic disease.

Appendix B Title of Offering: | Recommendations for Preventing, Diagnosing, and Treating Wounds on Diabetic Patients | Purpose: | To teach wound care to the diabetic patient with skin problems | Goal: | To increase the knowledge and education to a diabetic patient on how to care for themselves when they have a wound | Target Audience: | ARNP’s  Patients Staff | Contact Hours: 60 minutes | Total Clock Hours: 60 minutes | Learner Objectives | Content Outline | Method of Presentation | Time Allotted | Resources | Method of Evaluation | Outcomes | 1. Describe the pathology of a diabetic wound. | 1.1 Pathophysiology | Powerpoint presentation | 5 minutes | Best practice recommendations for DM ulcers | Pre-test Post-test | Audience will achieve a 90% or higher on post test | 2. Be able to do an assessment of a diabetic wound. | 2.1 History taking2.2 Physical examination2.3 Provide a demonstration on how to assess wounds on lower extremities | PamphletHands on interaction | 25 minutes | Pamphlet | Pre-testReturn demonstration | Audience will be able to do an assessment on a lower extremity wound | 3. Understand the diagnostic techniques for a diabetic wound. | 3.1 Appropriate diagnostic tests | Powerpoint presentationVideo | 15 minutes | Videos on diagnostic techniques | Post test | Audience will achieve a 90% or higher on post test | 4. Identify the preventative options to decrease the risk of diabetic wounds. | 4.1 Risk factors related to ulcer development | Powerpoint presentation | 5 minutes | Best practice recommendations for DM ulcers | Pre-testPost-test | Audience will achieve a 90% or higher on post test | 5. Identify treatment options for the diabetic wound. | 5.1 Factors that influence healing5.2 Patient’s bio-psychosocial status | Powerpoint presentation | 10 minutes | Best practice recommendations for DM ulcersROL and surgical algorithms | Post-test | Audience will achieve a 90% or higher on post test | References: | Kravitz, S., McGuire, J., Sharma, S. (2007). The treatment of diabetic foot ulcers: Reviewing the literature and a surgical algorithm. Advances in Skin & Wound Care, 20(4), 227-237.Orsted, H., Searles, G., Trowell, H., Shapera, L., Miller, P., & Rathman, J. (2007). Best practice recommendations for the prevention, diagnosis, and treatment of diabetic foot ulcers: Update 2006. Advances in Skin & Wound Care, 20(12), 655-669. |

Appendix C
Pre-Test
Pathology of a Diabetic Wound

1. T or F: Diabetes mellitus is characterized by lack of glycemic control, which can cause damage to vessels and nerves. 2. Predisposition to a person with Diabetes in developing foot ulcerations is/are: a. Vascular insufficiency b. Infection c. Pressure d. a and c e. b and a f. a, b, and c 3. T or F: Leading cause of non-traumatic amputations is diabetes. 4. List three foot-related risk conditions that are associated with an increased risk of amputation. g. h. i.

Appendix D

Post-Test
Pathology of a Diabetic Wound

1. T or F: Diabetes mellitus is characterized by lack of glycemic control, which can cause damage to vessels and nerves. 2. Predisposition to a person with Diabetes in developing foot ulcerations is/are: a. Vascular insufficiency b. Infection c. Pressure d. a and c e. b and a f. a, b, and c 3. T or F: Leading cause of non-traumatic amputations is diabetes. 4. List three foot-related risk conditions that are associated with an increased risk of amputation. g. h.

Appendix E
Pre-Test
Assessment of a Diabetic Wound

1. T or F: All diabetic patients should receive an annual foot exam from a health care provider. 2. Assessment of the lower extremities include, circle all that apply: a. Sensation b. Foot structure and biomechanics c. Skin integrity d. Vascular status 3. Peripheral vascular disease is ______________________________________________
___________________________________________________________________________________________________________________________________________________________.
4. T or F: Presence of erythema, warmth, or callus damage may indicate possible skin breakdown.

Appendix F

Pre-Test
Risk Factors of a Diabetic Wound

1. T or F: A delay in healing occurs for diabetic patients with wounds. 2. Risk factors of a diabetic wound are, circle all that apply: a. Peripheral vascular disease b. History of ulcers, or amputations c. Severe nail pathology d. Peripheral neuropathy 3. Presence of erythema, warmth, or callus damage may indicate _________________ breakdown. 4. T or F: If a diabetic patient is at risk for diabetic ulcerations/wounds, it is important that these patients are assessing their skin as often as they can.

Appendix G

Post-Test
Risk Factors of a Diabetic Wound

1. T or F: A delay in healing occurs for diabetic patients with wounds. 2. Risk factors of a diabetic wound are, circle all that apply: a. Peripheral vascular disease b. History of ulcers, or amputations c. Severe nail pathology d. Peripheral neuropathy 3. Presence of erythema, warmth, or callus damage may indicate _________________ breakdown. 4. T or F: If a diabetic patient is at risk for diabetic ulcerations/wounds, it is important that these patients are assessing their skin as often as they can.

Appendix H

Post-Test
Treatment for Diabetic Wounds

1. T or F: Significant goal of treatment and removal of calluses is debridement. 2. Why is it important to debride calluses? _____________________________________
______________________________________________________________________________
______________________________________________________________________________ 3. List 2 of the 4 common methods of debridement for diabetic foot ulcers. a. b.

Appendix I

Evaluation Form
Presentation: Recommendations for Preventing, Diagnosing, and Treating Wounds on Diabetic Patients

Criteria for Evaluation | Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | 1. Provides summary overview and introduction of topic. | | | | | | 2. Explains in presentation all of the learner’s objectives. | | | | | | 3. Provides a variety of teaching strategies. | | | | | | 4. The presenter answered majority of the audiences’ questions to the best of her knowledge. | | | | | | 5. Did the presenter seem knowledgeable in the topic presented? | | | | | | 6. Did the presenter have a professional demeanor? | | | | | |

Comments, concerns, recommendations for future presentations: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________