A 50 y/o female patient with Type 2 diabetes complains of leg pain She states sh
ID: 305275 • Letter: A
Question
A 50 y/o female patient with Type 2 diabetes complains of leg pain She states she has been having this achy pain for many years. She works in retail and is "on her feet all day", The only relief she gets is by lying down or elevating her legs which is impossible to do at her work. She has also noted a brownish discoloration of her lower legs and swelling of ankles and feet at the end of the day. She also frequently gets "charlie horses" in both calves and occasional thighs which disrupt her sleep. Recently she noticed a tiny draining sore near her inner ankle bone. On the basis of this history you interpret the patient is most likely experiencing which type of insufficiency? What contribution does history have, What physical exam techniques would you use to assess these clients. Describe your expected physical exam findings in each case. A 50 y/o female patient with Type 2 diabetes complains of leg pain She states she has been having this achy pain for many years. She works in retail and is "on her feet all day", The only relief she gets is by lying down or elevating her legs which is impossible to do at her work. She has also noted a brownish discoloration of her lower legs and swelling of ankles and feet at the end of the day. She also frequently gets "charlie horses" in both calves and occasional thighs which disrupt her sleep. Recently she noticed a tiny draining sore near her inner ankle bone. On the basis of this history you interpret the patient is most likely experiencing which type of insufficiency? What contribution does history have, What physical exam techniques would you use to assess these clients. Describe your expected physical exam findings in each case.Explanation / Answer
Based on the history, the patient is suffering from magnesium insufficiency. As magnesium is essential for neuromuscular transmission, insufficiency of magnesium results in leg pain and cramp which will be experienced more at night times. When blood glucose level is high, it excretes in the urine along with water and electrolytes as a result of osmotic diuresis. The increases osmolarity of ECF shrinks the cells which make electrolyte imbalance. Further, prolonged standing on her feet leads to the narrowing of arteries and decreased blood flow results in sudden muscle cramp(charlie horses).
The physical assessment techniques include
Inspection:
Careful inspection of both legs shows discoloration, temperature changes, dry scaly skin, draining sore present on inner ankle. Loss of hair growth shows poor vascular perfusion. Inspect between the toes for any ulcer and discharge.
Percussion:
A 128 HZ tuning fork is placed in the fifth metatarsal to detect the degree of sensory loss. Monofilament is done at several locations of the leg to detect loss of sensation and neuropathy.
Palpitation:
The skin is palpated for edema. The Ipswich touch test is done by placing the index finger on each leg of the patient's first, third, and fifth toe to know the responses of the patient to touching. This neurological test is done at 6 palpable points help to detect the patient's level of sensation.
Auscultation:
Auscultate for femoral, popliteal, dorsalis, tibial, and pedal pulse. Absense of pulse indicates vascular disturbances.
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