Diabetic Neuropathy and Risk for Amputation (Nursing)

00:01 Now let's talk about neuropathy.

00:03 We introduced it in the beginning, but this is a life changer for Mr. Sanchez.

00:09 My dad had neuropathy and I watched him suffer with this, it broke my heart.

00:14 See high blood glucose from diabetes can damage those vessels, we know that and the nerves and that's what we're going to focus on both of those.

00:22 Now, there's four different types of neuropathies.

00:25 I'm going to show you what those are but just kind of have that framework before we start.

00:29 There are four different types of neuropathies.

00:32 So high glucose leads to neuropathy.

00:35 That's why our picture there, we have those aren't super powers, those lightning bolts on the side of our patient are not superpowers, their pain.

00:45 Let's take a look at these categories because neuropathies can cause weakness numbness and pain.

00:52 I mean it was the weirdest thing when my dad would try to describe it to me.

00:55 It's like his legs were on fire yet at the same time he had no sensation.

01:00 They were numb, it was like his foot had been asleep for a couple years.

01:04 So it was miserable how you can have intense pain and numbness feel like fire.

01:09 It's really bizarre.

01:11 But that's because your nerves are incredibly complex and when they're damaged, they just they go haywire.

01:19 So what we have here is this neuropathy is dysfunction or one or more of the peripheral nerves.

01:26 Now what makes a peripheral nerve.

01:28 Well central nerves go right down the middle brain, spinal cord, what branches off your spinal cord are the peripheral nerves.

01:37 When these guys become damaged because of high blood sugar, you're going to see these horrible effects, weakness, numbness and pain, how many times am I going to say that till it becomes a priority.

01:49 Because this is a phenomenal quality of life issue.

01:54 Imagine what it would feel like if you were trying to drive and you couldn't feel your feet.

02:00 I wouldn't be safe for you to drive would it because you would know how far you're pushing the gas pedal or how hard you're pressing the brake? Why do you think a lot of people end up in accidents before they acknowledged the challenge? What about walking around your house.

02:14 Now you might think hey, that'd be a cool thing if I stepped on something and I didn't even feel it.

02:18 It's not.

02:20 Remember that puts me at an increased risk for infection because I won't even know that I did that, I have pain but I don't have the right type of sensation that can tell me, what just happened or that was focused in that one area.

02:33 So these four categories we've got peripheral, autonomic, focal and proximal.

02:39 I'm going to give you more details between the differences in these four and our other presentations, but for now remember, that nerve damage leads to loss of sensation, motor control and intense pain.

02:52 Loss of sensation, motor control, and intense pain.

02:57 Okay, so high glucose higher blood sugar's is going to lead to neuropathy.

03:01 We know we've got these four different types, we'll go into more detail later.

03:05 But my patients can experience loss of sensation, motor control, and intense pain.

03:10 So if Mr. Sanchez is experiencing this, ask him Have you noticed when you're putting on your socks that you don't feel your toes as much as you used to? Any pain in your legs or in your hands, your arms? Ask him again for those clinical cues because high glucose increases the risk of amputation.

03:31 See unfortunately, Mr. Sanchez has already lost his right leg below the knee.

03:38 Because the nerve and vessel damage really wreak havoc on his body.

03:42 He had decreased sensation in his feet.

03:44 He wasn't aware of when he got an injury.

03:46 He had really decreased blood flow, so they couldn't nourish that tissue or get meds down to it like antibiotics.

03:54 And he ended up losing that portion of his leg.

03:57 So see he's kind of already bought into it, in fact, Mr. Sanchez is either going to be at one or two places when you deal with someone who's had an amputation.

04:06 They may be very open to your teaching or they may be extra defiant because they are angry, because of the loss.

04:13 Either way still my patient, still my job, still my role, still my profession to intervene with him and help him move toward the next level of stuff that he's willing going to take.