Endocrine - Lower Leg and Foot Flashcards
Introduction involves?
Hand washing Your ID Patients ID Explanation Consent Asking about pain Exposing patients lower limbs from just above the knee
What should be inspected
General end of bed inspection, AVPU, lines, O2 masks, drains, surrounding medication, vomit bowls or sputum pots
Inspect patients shoes
Skin colour
Soles of feet - charcot’s joint
Between toes and nails - fungal infections, cuts
Lower legs - lift foot to check heel and calf
What should be done after inspection of the feet?
Assess circulation of both toes
Feel for lower limb pulses - dorsalis pedis, posterior tibial and popliteal
What should be done if lower limb pulses cannot be felt?
Assess femoral
What should be done after pulses?
Assess vibration sense in 4 locations:
- Bony prominence of big toe
- Bony bit in between big toe and ankle
- Both sides of ankle
What should be done after vibration sense?
Soft and sharp touch - only on big toe and move proximally if diminished
What is done after soft and sharp touch?
Monofilament test in 5 points
- Big toe
- Middle toe
Triangle shape under toes (check diagram in workbook))
What should be done before using the monofilament pen?
Cleaning it with an alcohol wipe
What is done after monofilament?
Proprioception of big toe - close eyes and move it up or down
Ankle reflexes
What is done after ankle reflexes?
Planter-flexion
Dorsiflexion
Inversion and eversion of ankles
What is inversion and eversion of ankle?
Inversion is pushing soles towards the midline
Eversion is pushing soles away from the midline
What should be done next?
Assess gait
- Walk normally
- Walk heel to toe
- Walk on tip toes
- Walk on heels
- Romberg’s test
How to finish?
Thank and allow them to get dressed
clean hands
