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Neuropathic patient with ulcer - anymore I could do?
Hello Miss B
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Re: Neuropathic patient with ulcer - anymore I could do?
Originally Posted by MissB
Hey everyone, I’m in private practice and newly qualified. A lady who did not speak English attended yesterday evening with her daughter. She was a type II diabetic on insulin and another medicine for her diabetes (but she didn’t know the name). She was on lots of other medication also, but did not know what they were for, or their names. She had a heart op a few years ago, but couldn’t tell me anymore.
She did not know when her last foot screen was, or her last HbA1C.
The lady complained of hot and itchy feet all over, all the time. She also had what I was told was a blood blister that had popped two weeks ago on her little toe. On examination she had a neuropathic ulcer on the base of the left fifth toe. The wound was not infected. Neurological assessment was negative on all tests. Vascular assessment: I did not have a Doppler but both DP pulses were palpable. PT was not palpable. Feet were warm to the touch and she had hair growth on the toes.
I cleaned and dressed the wound, explained the findings, and advised she visit her GP ASAP. I wrote a letter and faxed it to her GP for immediate referral to foot protection team. This morning I contacted GP to find out status – they have no record of the patient. I contacted the patient on the number provided – the number was ‘unavailable’.
My question is: is there anything else I could have done??? I am really concerned about this patient.
A neuropathic ulcer on a foot that is warm could suggest sympathetic neuropathy which you see regularly with Charcots foot. You were right to refer back to the GP and we can not be held responsible for patients giving incorrect information about GPs etc. I suspect as there is no record of this lady with the GP she may be illegally here. I which case you have done the best you could do.