Thank you for getting this discussion thread started. You made a valid point about the dangers of Ms. G, a diabetic, applying an external heat source to her affected extremity.

She may have decreased sensation due to diabetic neuropathy which is common in the diabetic population. Therefore, Ms. G's altered sensation may affect her ability to recognize burns, such as from the heating pad, or pain, such as the open wound that is on her left lower extremity.

The prevalence of neuropathy in diabetics is alarmingly high as "neuropathy produces symptoms in 60% to 70% of individuals with diabetes and is responsible for 6.8 per 1000 diabetic population hospitalizations" (Copstead-Kirkhorn & Banasik, 2014, p. 828).

You listed great ways for the nurse to educate the patient on preventing the complications of neuropathy such as examining the feet daily and contacting a healthcare provider about any breaks in the skin.

In the teachings, you may find it relevant to include additional information such as keeping the feet clean and dry, assuring shoes have a proper fit, and not walking barefoot. It is important for diabetics to actively attempt to avoid foot injury.

Any break in the skin or wound puts them at risk for infection and the ensuing complications since "diabetes alters the host's ability to resist infection (Copstead-Kirkhorn & Banasik, 2014, p. 143). Overall, I found your post very educational, Edwige.

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