A 61-year-old client with diabetes mellitus has physician’s orders for

A 61-year-old client with diabetes mellitus has physician’s orders for meticulous foot care. Which of the following is the best rationale for the order?

1. The aging process causes increased skin breakdown.
2. There is increased neuropathy with this pathology that places the client at risk.
3. The client probably has a history of poor hygienic care.
4. The lower extremities are difficult to see and therefore hard to maintain with good hygiene.

ANSWER

ANS: 2
Vascular changes associated with diabetes mellitus reduce the blood supply to the feet. Sensation in the feet can also be reduced as a result of damage to the nerves (i.e., as with diabetic neuropa-thy). Sensory loss in the feet may result in undetected injuries. These clients are especially at risk for the development of chronic foot ulcers. The best rationale for meticulous foot care for this client is because of the risks associated with the client’s diagnosis of diabetes mellitus. There is no indication the client has a history of poor hygienic care. Poor vision may contribute to diffi-culty in providing foot care, but this client’s greatest risk for developing a foot ulcer is diabetic neuropathy.