Tidak Setuju 2. Tidak pasti 3. Setuju A Latihan

344 Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting C Masa Tempat 1. Anda mempunyai masa yang mencukupi untuk memberi penerangan dan latihan penjagaan kaki kepada pesakit anda ? 1 2 3 2. Klinik anda mempunyai ruang yang sesuai untuk menjalani latihan penjagaan kaki? 1 2 3 D. Komunikasi 1. Komunikasi dari aspek bahasa dengan pesakit diabetis merupakan kesukaran dalam memberi penerangan dan latihan kepada mereka. 1 2 3 Jika setuju , sila nyatakan sebab ............................................................................................................................................................

E. Kerjasama

1. Anda mendapat kerjasama yang baik daripada pesakit setiap kali latihan penjagaan kaki dijalankan ? 1 2 3 2. Anda juga mendapat kerjasama yang baik daripada rakan sekerja semasa latihan penjagaan kaki dijalankan ? 1 2 3 3. Pada pandangan anda bilangan staff yang diperuntukan setiap kali sessi latihan penjagaan kaki mencukupi ? 1 2 3 4. Program penjagaan kaki diklinik anda mendapat pemantauaan yang secukupnya daripada pihak atasan Pakar Perubatan KeluargaPegawai Perubatan dsb 1 2 3 5. Sila senaraikan masalah cadangan lain yang anda hadapi semasa mengendalikan program penjagaan kaki Sekiranya ada. ............................................................................................................................................................ ............................................................................................................................................................ 345 Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting Appendix D Check-list on diabetic foot care demonstration All staff must follow below points in sequence manner A. Introduction Yes No Staff must do all the following by demonstration or in running commentary - ask the patient to sit, remove hisher shoes - exposed both feet under good lighting - asking foot history – numbnesspricking sensationpain B. General examination of both foot Yes No Staff must examine both feet. Check for – - skin color - cornulcer formation - infection - amputation all done in running commentary C. Vascular system Yes No Checking for all pulses for both feet staff must demonstrate - dorsalis pedis artery - posterior tibialis artery D. Neurological examination Yes No Staff must perform below test for both feet using proper tools as stated in bracket - sensation - vibration test using 128 Hz tuning fork - pinprick sensation test using monofilament - ankle reflex using tendon hammer 346 Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting E. Patient education Yes No 1. Daily foot care - wash your foot daily - do not soaked your foot more than 5 minute - give more attention to the web space - dry your foot with soft and dry cloth 2. Daily foot examination - usage of mirror to check for calluscornulcercrack 3. Always protect your foot - do not walk with out shoes inside and outside house - wearing stockings 4. Clip your nail correctly 347 Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting Appendix E MODULE FOR DIABETES FOOT CARE MANAGEMENT INTRODUCTION Whether you are rushing to a business meeting or standing in line at the post office,you depends on your feet to keep you moving. Diabetes increase your chances of developing foot problems,so you can’t afford to take for granted. Give them the special care they need. Foot problems won’t just go away. As diabetic, your feet have fewer defenses against everyday wear tear. Nerves damage may mean that you can’t feel injuries. Reduced blood flow may prevent injuries from healing. Even minor injuries may quickly progress to serious infection. MODULE 1 LIST OF EQUIPMENT TOOLS REQUIRED overall examination Tools needed: · Glucometer set · Lancet pen · BP set · Stethoscope · Cholesterols meter set · Weighing macine with height measurement · Sneelen chart pin hole · Opthalmoscope · CNS Diagnostic set tendon hammer,cotton wool,pin · Tuning fork C128 · Urine albumin strips Dip sticks · Mydriacyl eye drops · Tool for foot examination: - Foot model normal, with complication foot toe infected - Tuning fork - Hammer toe - Monofilament ______.cm - Complication foot card information - Others: ________________________________________________________ · HBA1c machine strips quantitative · Microalbumin machine strips quantitative · BMI chart · ECG Machine · Chemistry Analizer · Computers · Fundus Camera 348 Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting MODULE 2 INSPECTING FOR YOUR FEET Look for: 1. Colour changes a. redness with streaks means sign of infection b. pale blue toes means poor circulation c. darkened sign means tissue has died

2. Swellling

a. swelling with colour changes means sign of poor sirculation or infections b. symptoms include tenderness an increase in the size of your foot

3. Temperature changes

a. warm areas means your feet are infected b. cold feet means feet aren’t getting enough blood

4. Sensation changes

a. “ods sensations” like pin pricks,numbness,tingling,burning,or lack of feeling means nerves are damaged

5. Hot spots

a. red “hots spots” are caused by friction or pressure. b. hots spots can turn into blister,cornsthick skin or toes or callusesthick skin on the bottom of the feet

6. Cracks Ulcers

a. cracks sores are caused by dry or irritated skin b. they are signs that skins is breaking down which could lead to ulcers

7. Ingrown Toe Nails

a. often caused by tight fitting shoes or incorrect nail trimming b. symptoms include nails that are growing into the skin,swelling,redness or pain.

8. Drainage Odour

a. may develop from untreated ulcers b. white or yellow moisture,bleeding odour are often signs of infections or dead tissue

9. Call your doc immediately if you notice

a. redness or steaking b. swelling c. increased heat d. fever chills 349 Efectiveness of the Diabetic Foot Care Programme in a Primary Care Setting MODULE 3 KEEPING YOUR FEET HEALTHY

1. Check Your Shoes Socks

- shoes socks that fits properly can prevent foot problems - when buying a socks check that the toe box is roomy enough so u can wiggle you toes - avoid open-toed or pen- heeled shoes - inspect your shoes socks or for anything that could rub against your feet

2. Exercise Your Feet

- exercising regularly can help the blood flow into out of your feet increase your flexibility. - suggesting exercises: walking frequently,swimming bicyling, doings ABCs with each foot by spelling out the alphabet in the air.can increase blood flow keep feet flexible - take immediate action if these happened: redness,burning or tenderness during after exercise.

3. Take Special Care: self-care tips

- use warm water mild soap to wash feet. DON’T SOAK. Dry well - inspect feet daily for cracks, scratches or dry skin. - avoid heating pads hot water bowls - don’t cross your leg can reduce blood flow to you feet - don’t uses razors or over-the-counter medications to treat corns calluses could damage your feet - don’t smoke. reduce blood flow to your feet - never walk barefoot MODULE 4 PROVIDING ROUTINE FOOT CARE Routine foot care helps keep thick ingrown nails,blisters,corns,calluses other skin irritations from developing into infections or ulcers. Educate on: · trim or thin your nails to keep them from becoming ingrown or thick · treat blisters so they won’t become infected · trim corns calluses so they won’t develop into blisters or infections