Infection Control, Vascular, and Neurological Assessments
Infection Control Precautions: Tier 1 and Tier 2
Tier 1 and Tier 2 are two levels of infection control precautions. Tier 1 precautions are the basic, standard precautions used in all healthcare settings, while Tier 2 precautions involve additional measures for suspected or confirmed outbreaks of infectious diseases. Tier 2 precautions include all Tier 1 precautions plus additional measures such as wearing extra personal protective equipment (PPE), restricting patient movement, and using airborne infection isolation rooms for patients with airborne diseases.
Vascular Assessment in Healthcare
A vascular assessment is used to evaluate blood circulation and the function of blood vessels in the body. To conduct the assessment, the examiner takes the patient’s history, observes skin color and temperature, palpates pulses, checks capillary refill time and for edema, performs the ankle-brachial index (ABI) test, and performs the Trendelenburg test if varicose veins are present. The assessment helps diagnose peripheral arterial disease (PAD) and venous disease and determines appropriate treatment options.
Peripheral Arterial Disease (PAD)
Peripheral arterial disease (PAD) is a condition that occurs when the arteries in the legs or arms narrow or become blocked, reducing blood flow to the limbs. Some of the typical symptoms of PAD include:
- Pain in the legs or arms: This may be intermittent or constant and may worsen during physical activity such as walking or using the affected limb. The pain may also be described as a cramping, burning, or aching sensation.
- Numbness or tingling: This may occur in the legs or arms, particularly in the hands or feet, and may be a sign of reduced blood flow.
- Weakness in the legs or arms: This may result from decreased blood flow and reduced oxygen supply to the muscles.
Starting a Patient Consultation
To start a consultation with a patient, greet them warmly, introduce yourself, and explain the purpose of the consultation. Establish rapport with small talk and encourage the patient to talk by using open-ended questions. Listen actively and clarify your understanding of their concerns to build a positive line of communication based on the Cambridge interview model.
Neurological Assessment in Podiatry
A podiatrist may perform a brief neurological assessment during a physical examination. During the examination, the podiatrist may observe and test various sensory and motor functions, including checking reflexes, muscle strength, coordination, and sensation. Some common tests might include:
- Babinski reflex: This test involves stroking the sole of the foot to see if the toes curl downward or upward. An upward curling of the toes may indicate a neurological problem.
- Muscle strength testing: The podiatrist may ask the patient to try to move their foot or toes in certain directions, while the podiatrist applies resistance. This can help assess muscle strength.
- Sensory testing: The podiatrist may use a tuning fork or other instrument to check the patient’s ability to feel vibrations or touch in their feet or toes.
- Coordination testing: The podiatrist may ask the patient to perform certain movements or tasks to assess their overall coordination and balance.
Overall, the purpose of a neurological assessment is to identify any potential issues with the nervous system that may be contributing to foot or lower leg problems.
Skin Characteristics in Health Assessment
What could you monitor in terms of skin characteristics when assessing the health and wellbeing of a patient?
- Texture
- Temperature
- Color
- Hair growth
- Pigmentation
Monofilament and Tuning Fork Tests
Neurological tests with a monofilament and tuning fork are commonly used during a foot examination. The monofilament test checks for sensation by using a small, flexible thread to touch the feet. The tuning fork test checks for vibration sense by striking a tuning fork and placing the vibrating base on bony prominences on the feet and legs. These tests can help identify potential neurological problems.