PHM 6165: Health Assessment

Session 5: Endocrinology I
Dr. Campbell

Name: .

Session 3: Foot Exam and Preventative Care

Foot Exam
Perform a foot exam (including patient interview, physical assessment, and patient counseling) on a partner using the
below assessment (both should perform).

Section I – Patient Interview

1) Presence of Diabetes Complication (check all that apply) 12) Any symptoms of:
Peripheral Neuropathy Nephropathy CVD (HTN/HLD) a. Burning shooting pain? Y N
Retinopathy PAD/PVD b. Electrical, tingling, or sharp sensation? Y N
Non-traumatic Amputation (limb/date): c. Numbness? Y N
2) Smoker? Y N Former (Quit Date): d. Feet feel dead? Y N
3) Previous Foot Education? Y N 13) Pain or discomfort in your leg(s) when walking? Y N
4) Established with a podiatrist? Y N Visits/year: (If NO, skip questions 14-16)
Name: Last Visit: 14) Does this pain occur when you are:
5) Feet regularly examined by PCP? Y N Exams/year: a. Sitting/standing still? Y N
6) Any problems since last visit? Y N b. Walking uphill or in a hurry? Y N
7) Frequency of self-foot check? Daily 2-3x/wk c. Walking at a normal pace on level ground? Y N
2-3x/month Once monthly Other: 15) What happens when you stand still? Continues >10 minutes
8) Any shoe problems? Y N Disappears ≤10 minutes
9) Any discharge/blood in shoes/socks/hose? L R B N/A 16) Where is the pain located?
10) Current or history of foot ulcer? Y N Calf L R B Buttocks L R B
11) Experienced non-healing wounds? Y N Thigh L R B Other:

Section II – Physical Assessment

1) Is footwear appropriate? Y N Describe:
2) Dermatological Assessment 3) Musculoskeletal Assessment 4) Neurological Assessment
Closely examine dorsal, plantar, medial, lateral, a. Toe Deformities (claw or hammer) a. Monofilament
and posterior surfaces. Check behind the L R B None Please label sensory level with a “+” in the
patient's heel, between the toes, and each Describe: five CIRCLED areas of the foot if the patient
toenail. Indicate any findings using the bolded b. Bunions / Overlapping toes can feel the monofilament and a “-“if the
letter on the diagram below. L R B None patient cannot feel the filament.
a. Temperature (warm/cold areas) Describe: b. Tuning Fork
b. Edema c. Prominent metatarsal heads Please label sensory level with a “+” in the
c. Nails (capillary blood flow, infected, L R B None SQUARE area if the patient can feel the
Describe: vibration and “-“ if the patient cannot feel it
ingrown)
d. Muscle wasting (guttering between toes) or loses sensation and examiner can still feel.
d. Blisters/Ulcers
L R B None 5) Vascular Assessment
e. Redness Describe: Pedal Pulses:
f. Infection (check between toes) e. Suspected Charcot foot (A: absent, P: present; U: undetected)
g. Excessive Moisture/Dryness L R B None Dorsalis Pedis Right ___ Left ___
h. Fissures (cracking) Describe: Posterior Tibial Right ___ Left ___
i. Calluses/Corns

Notes: Right Notes:

Left

Section III – Patient Counseling

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PHM 6165: Health Assessment
Session 5: Endocrinology I
Dr. Campbell

Read the patient education on “Diabetes and Your Feet” at: https://www.cdc.gov/diabetes/library/features/healthy-
feet.html and list at least 6 counseling points you would give to a diabetic patient about caring for their feet.

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 Types of insulin and how they work in your body
How long it takes to How long it lasts Examples
start working
Rapid-acting insulin 15 minutes 2 to 4 hours Insulin aspart
(Novolog)
Insulin lispro
(Humalog)
Insulin glulisine
(Apidra)

Regular insulin 30 minutes 3 to 6 hours Insulin regular

(Novolin R)
Intermediate-acting 1 to 2 hours 12 hours NPH (Novolin N)
insulin
Long-acting insulin 2 to 4 hours 24 hours Insulin detemir
(Levemir)
Insulin glargine
(Lantus, Basaglar)
Ultra-long-acting 6 hours 36 to 42 hours Insulin degludec
insulin (Tresiba)
Insulin glargine U300
(Toujeo)
Inhaled insulin 12-15 minutes 3 hours Inhaled insulin
(Afrezza)

https://www.goodrx.com/blog/insulin-types-how-to-use/
Blood Glucose Station PHM 6165: OSCE

Student Name: ______________________ Evaluator: _______________________________

Completed
Demonstration
Introduces self to patient
Cleans hands prior to demonstration
Verbalizes they would avoid calluses and/or scars
Cleans the area with an alcohol swab
Prepares lancing device (twist and pulls out tab)
Prepares glucometer by inserting test strip into meter
Appropriately punctures the finger by
□Holds the lancing device firmly against the pad of the finger
□Pushes the release button
□Remove from finger
Applies drop of blood on strip appropriately
Stops bleeding with cotton swab and bandages finger
Disposes of lancet in sharps container
Throws other trash in trash can
Patient education
Verbalizes result
States whether they are fasting or not
Educates patient on fasting plasma glucose diagnostic for diabetes
Educates patient on 2-hr post-prandial plasma glucose diagnostic for diabetes
Educates patient on recommended fasting plasma glucose goal for patients with diabetes
Educates patient on recommended post-prandial plasma glucose goal for patients with diabetes
Educates on signs and symptoms of high blood sugar (4/7)
□ increased thirst
□ increased urination
□ increased hunger
□ fatigue
□ dry skin
□ fruity breath odor
□ blurred vision
Educates on signs and symptoms of low blood sugar (4/7)
□shaking
□sweating
□fast heartbeat
□confusion
□blurred vision
□irritability
□hunger

Total Score:_________/18