Diabetic peripheral neuropathy: Person-centered care.

ABSTRACT: Patients with diabetes mellitus may experience painful and nonpainful diabetic peripheral neuropathy (DPN). This article offers an overview of DPN and the clinical assessment and management of patients with DPN, as well as the nurse's role in supporting these patients.

Valoración del riesgo de neuropatía periférica diabética: diseño y validación del procedimiento para cribado enfermero NeuDiaCan / Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure

Objetivo: Diseñar y validar un procedimiento enfermero de cribado de la neuropatía periférica diabética en atención primaria. Método: El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente. 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras. 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera. Resultados: El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, la validez de criterio y la validez predictiva alcanzaron valores aceptables. Conclusiones: NeuDiaCan como procedimiento de cribado enfermero de la neuropatía periférica diabética en atención primaria resulta válido, fiable y de fácil empleo

Objective: To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. Methods: The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. Results: The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. Conclusions: NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use

Diabetes-associated cardiac autonomic neuropathy.

Cardiac autonomic neuropathy (CAN) is an underdiagnosed cardiovascular complication associated with diabetes. NPs are in a pivotal position to screen patients for CAN. As the incidence of diabetes increases in an aging population, NPs can help prevent complications associated with diabetes and CAN.

Diabetic autonomic neuropathy resulting in sexual dysfunction.

Although diabetic autonomic neuropathy (DAN), a complication associated with diabetes, is increasing in prevalence, it is often overlooked. Knowledge regarding the development and progression of this complication is limited. NPs are in a key position to prevent complications of DAN, including sexual dysfunction, in this vulnerable population.

Diagnosis and Treatment of Common Pain Syndromes and Disorders.

Management of chronic pain has become a significant challenge for primary care providers, and the population of patients with chronic pain is expected to increase. Common syndromes seen in the primary care setting include myofascial pain syndrome, fibromyalgia, chronic postsurgical pain, complex regional pain syndrome, and painful diabetic neuropathy. This article describes these syndromes and presents current treatment options.

O registro do enfermeiro na assistência ao usuário com neuropatia diabética na atenção básica / Nurses record in the user assistance with diabetic neuropathy in primary care

O registro do enfermeiro na assistência ao usuário com neuropatia diabética na forma de polineuropatia sensório-motora- simétrica, requer do profissional responsabilidade, atenção e conhecimento. Este estudo objetivou analisar o registro da atuação do enfermeiro na assistência aos usuários com neuropatia diabética periférica. Trata-se de uma pesquisa descritiva e exploratória, com abordagem qualitativa, do tipo documental. Realizada em uma unidade de Atenção Básica, na Região Metropolitana do estado do Rio de Janeiro. Através de 50 prontuários de clientes, que realizava seu tratamento nessa instituição com visitas pré-agendadas. Os resultados mostram que 100% dos registros não apresentavam nenhum relato sobre a mensuração da úlcera e sobre os sinais objetivos de neuropatia diabética periférica. Apenas 16% dos registros apresentavam uma das cinco etapas do processo de enfermagem, o histórico de enfermagem. Identificando assim a inobservância do registro do enfermeiro na assistência ao usuário com neuropatia diabética periférica...

Nurses record in user assistance with diabetic neuropathy as sensory-motor-symmetric polyneuropathy, requires professional responsibility, attention and knowledge. This study aimed to analyze the record of the work of nurses in assisting users with peripheral diabetic neuropathy. It is a descriptive and exploratory research with a qualitative approach, the document type. Held in a unit of Primary Care in the Metropolitan Region of the state of Rio de Janeiro. Through 50 customer records, which held its treatment in this institution with pre-scheduled visits. The results show that 100% of the records had no report on the measurement of ulcer and on the objective signs of peripheral diabetic neuropathy. Only 16% of the records had one of the five steps of the nursing process, the nursing history. Thereby identifying the failure of the nurse's record in assisting the user with peripheral diabetic neuropathy...

Enfermeras récord en asistencia al usuario con la neuropatía diabética como sensorio-motor-simétrica polineuropatía, requiere la responsabilidad profesional, la atención y el conocimiento. Este estudio tuvo como objetivo analizar el registro del trabajo de las enfermeras en la asistencia a los usuarios con la neuropatía diabética periférica. Se trata de una investigación descriptiva y exploratoria con enfoque cualitativo, el tipo de documento. Celebrada en una unidad de la Atención Primaria de la Región Metropolitana del Estado de Río de Janeiro. A través de 50 registros de clientes, que celebró su tratamiento en esta institución con visitas pre-programado. Los resultados muestran que 100% de los registros no tenía ningún informe sobre la medición de la úlcera y de los signos objetivos de la neuropatía diabética periférica. Sólo el 16% de los registros tenía uno de los cinco pasos del proceso de enfermería, la historia de la enfermería. De esta manera la identificación de la falta de registro de la enfermera en la asistencia al usuario con la neuropatía diabética periférica...

Identifying early signs of peripheral neuropathy among patients with diabetes mellitus.

This article aims to help nurse practitioners develop a best practice algorithm to identify the early signs of peripheral neuropathy (PNP) among individuals living with diabetes mellitus. This literature review also seeks to determine if there are better clinical testing methods than the Semmes-Weinstein monofilament examination to detect diabetes-related PNP.

A Nurse's Guide to the Prevention of Neuropathic Ulcers in Patients with Diabetes.

Neuropathic ulcers present a significant issue for patients with diabetes. Neuropathic ulcers reduce mobility and increase the risk for infection and other complications. Prevention of ulceration is a primary nursing goal in the care of patients with diabetes.

Peripheral diabetic neuropathy or restless legs syndrome in persons with type 2 diabetes mellitus: Differentiating diagnosis in practice.

PURPOSE: Restless legs syndrome (RLS) affects 8% of the population and is identified in 21% of individuals with type 2 diabetes (T2DM). Symptoms of RLS manifest as discomfort in the legs (e.g., numbness, tingling, electrical stimulations), usually occurring at night or at rest (sitting or lying), resulting in the need to move the legs. Peripheral diabetic neuropathy (PDN), which has symptoms similar to RLS, is a common consequence of T2DM. The purpose of this article is to provide nurse practitioners (NPs) with (a) an overview of RLS, (b) the association of RLS with T2DM, (c) the defining characteristics that differentiate PDN from RLS, and (d) implications to improve health outcomes of persons with T2DM. DATA SOURCES: The literature was reviewed for the most current data on RLS and the defining characteristics of PDN. CONCLUSIONS: PDN is a common consequence of T2DM and is described as numbness, tingling, or discomfort in the lower extremities, symptoms that are similar to RLS. Differentiating the symptoms of PDN and RLS may be confusing and result in misdiagnoses, lack of treatment, and poor outcomes. IMPLICATIONS FOR PRACTICE: It is essential that NPs are knowledgeable about the diagnostic and defining features of RLS as well as the characteristics of other conditions, specifically PDN, which mimics RLS.

[Guided clinical practice guidelines: how to blunt the weapon of evidence]. / Linee Guida guidate. (Come spuntare le armi dell'evidenza).

The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. However, the process of development of clinical practice guidelines is fraught with problem, conflicts and controversies. A few examples, starting from the guidelines on osteoporosis are presented and commented on.

Diabetic worker with history of falls: a case study.

A 58-year old male employee presented to the occupational health clinic for evaluation after experiencing several falls. He had been diagnosed as having type II diabetes 5 years earlier. The physical examination noted peripheral neuropathy. This article reviews the effects of diabetes on peripheral nerves and discusses interventions that the occupational health nurse may use to monitor workers with diabetes.

Peripheral neuropathy: evidence-based treatment of a complex disorder.

Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat.

Isolated use of vibration perception thresholds and semmes-weinstein monofilament in diagnosing diabetic polyneuropathy: "the North Catalonia diabetes study".

Several systems are used for the diagnosis of diabeticpolyneuropathy (DPN). We analyzed the isolated use of vibration perception thresholds (VPTs) or monofilament (MF) for the diagnosis of DPN. A group of 400 patients who had type 2 diabetes was selected from the North Catalonia Study Group. A clinical neurologic evaluation was performed based on three categories of the San Antonio Consensus. Neurothesiometer and quantitative tuning fork explored VPT, and MF was assessed by Olmos and Michigan Diabetic Neuropathy Score (MDNS) criteria. The use of VPT and MF showed a high specificity and low sensitivity. MF, by MDNS criteria, was more sensitive and specific, and showed more accurate positive and negative predictive values. The predicted probability of DPN diagnosis was higher with a tuning fork evaluation.

Diabetes and peripheral neuropathy: keeping people on their own two feet.

Peripheral neuropathy is one of the most common forms of diabetes-related neuropathy, and most commonly affects the feet. Loss of sensation leaves the feet at risk of damage--from environmental hazards, incorrectly fitting footwear or un-felt pressure damage--which can lead to the need for amputations. This article discusses how to reduce the risk of peripheral neuropathy through glycaemic control, and the steps that need to be taken to reduce the risk of injury on the neuropathic foot.