Product Detail

1. Employ data from the literature to assure evidence-informed practice for psychological needs likely for persons with a diabetic foot ulcer
2. Perform a foot exam using visual cues, circulation assessment and a monofilament
3. Design an educational intervention for diabetics based on knowledge of how poorly controlled diabetes physically affects the nerves, bones and microcirculation
4. Examine the effects of neuropathy in the lower extremity: sensory, motor, autonomic
5. Identify methods of protecting a neuropathic foot ulcer from infection
6. Summarize the pros and cons of various off-loading methods for neuropathic foot ulcers
7. Paraphrase data from recent literature reporting effectiveness of modalities such as negative pressure wound therapy (NPWT), hyperbarics, electrical stimulation, pulsed lavage, light and ultrasound therapies for diabetic foot ulcers
8. Evaluate appropriate uses of advanced therapy such as living skin equivalents, platelet rich plasma (PRP) and stem cell applications

Understanding the Impact of Neuropathy in the Lower Extremity

• Sensory nerve damage
  • Neuropathic pain
  • Effect on balance and sensation
  • Lack of awareness of a break in skin or infection
  • Lack of awareness of footwear proper fit
• Motor nerve damage
  • Change in gait (slapping)
  • Increase in flexor tendon strength causing deformities in toes and metatarsals
• Autonomic nerve damage - peripheral and central
  • Lack of sweating, so skin excessively dry
  • Decrease in vasomotor control
• Gastroparesis with resulting nutritional deficiencies

Diabetic Foot Exam Techniques

• Strategies to identify the visual cues signifying an abnormal exam
  • Xerosis
  • Foot Shape and color
  • Toenails
  • Evidance of previous ulcers
  • Callus formation
• What can we learn from foot pulses and temperature variation?
• Screening tools
• When to refer a patient

Strategies to Protect a Neuropathic Foot Ulcer from Infection

• Hyperglycemia impact on immune response
• Prevention, Prevention, Prevention!
  • Proper cleansing techniques
  • Product selection strategies - utilizing germ reducing dressings such as silver, cadexamer iodine, PHMB, methylene blue/gentian violet, salt, sugar, honey and sodium hypochlorite
  • Ways to break biofilm
    • Ultrasound
    • Sharp or mechanical debridement
    • Pulsed lavage
  • Debridement - when and what type
    • Mechanical
    • Sharp
    • Biological
    • Enzyme
    • Autolytic
  • Negative pressure wound therapy.

Off-Loading Methods: Pros and Cons

• Healing boot or shoe
• Total contact cast and TCC EZ
• Bedrest
• Kneeling walker or crutches

Treatment Modalities: What is the best for YOUR Patient?

• Negative Pressure Wound Therapy
• Hyperbaric
• Electrical Stimulation
• Pulsed Lavage
• Light & Ultrasound Therapy

Advanced Therapies

• Living Skin Equivalents
• Platelet Rich Plasma
• Stem Cell Applications

Assessing for and Meeting the Diabetic Patient’s Psychological Needs

• Depression’s impact on patient adherence and outcomes
• Depression screening
• Interventions that release endorphins
• Tips to improve patient health education and compliance

Joan Junkin, RN, MSN, was introduced to wound care as a research analyst for the AHCPR (now AHRQ) panel that created the first ever pressure ulcer treatment guideline. After wound education and certification, she was the wound clinical nurse specialist for a 500-bed hospital and spent 10 years building an outpatient and inpatient program to improve wound outcomes. She conducted and published the first research documenting incontinence associated dermatitis prevalence in acute care and has published in several nursing and wound journals. Since 2008 she has devoted her time to teaching in 49 states and 5 provinces in Canada. This, along with her wound consulting business gives her a broad perspective. Joan is passionate about sharing essential information for healthcare providers with just enough humor to help navigate this challenging topic. Speaker Disclosures:
Financial: Joan Junkin is an independent contractor and has an employment relationship with UNMC College of Nursing. She receives a speaking honorarium from Sage, a Stryker company. Joan Junkin receives a speaking honorarium and recording royalties from PESI, Inc. All relevant financial relationships with ineligible organizations have been mitigated.
Non-financial: Joan Junkin is a member of the Association for Advancement of Wound Care.

For U.S. and Canadian customers, a CE test is available for $9.99 USD per participant. International CE rates may vary; please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion may be emailed, faxed or mailed to participants completing the post-test/evaluation and paying the CE fee.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

---

Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 7/24/2018
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.3 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Occupational Therapists & Occupational Therapy Assistant: PESI, Inc. is an approved provider with the Florida Board of Occupational Therapy. Provider Number 50-399. This self-study course qualifies for 6.3 continuing education credits.

---

Physical Therapists & Physical Therapist Assistants
This self-study course consists of 6.25 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary by state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.

California Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the Physical Therapy Board of California as an approval agency to approve providers. This self-study lecture qualifies for 6.25 continuing competency hours.

Illinois Physical Therapists & Physical Therapist Assistants: PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270. This self-study course qualifies for 6.0 CE credit hours.

New York Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the New York State Education Department, State Board for Physical Therapy as an approved provider for physical therapy and physical therapy assistant continuing education. This self-study course qualifies for 7.6 contact hours.

---

Other Professions
This self-study activity qualifies for 6.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Nurses, Occupational Therapists & Occupational Therapy Assistants, Physical Therapists/Physical Therapist Assistants, Physician Assistants, and other Healthcare Professionals