Stidies on risk factors for arteriosclerosis obliterans in diabetes mellitus : with special reference to nursing diagnosis

1999 Fiscal Year Final Research Report Summary

• Project/Area Number: 09672392
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Nursing
• Research Institution: Osaka University
• Principal Investigator: EGAWA Takako Faculty of Medicine, Osaka University Professor, 医学部, 教授 (40193990)
• Co-Investigator(Kenkyū-buntansha): YAMAMOTO Yuko Faculty of Medicine, Osaka University Assistant, 医学部, 助手 (40263272) ; IMAI Yukika Faculty of Medicine, Osaka University Assistant, 医学部, 助手 (10294240) ; OGINO Satoshi Faculty of Medicine, Osaka University Professor, 医学部, 教授 (50124764) ; HANAFUSA Toshiaki Graduate School of Medicine, Osaka University Instructor, 医学系研究科, 講師 (60164886) ; UEHARA Jyunko Faculty of Medicine, Osaka University Assistant, 医学部, 助手 (80314384)
• Project Period (FY): 1997 – 1999
• Keywords: ASO / Diabetic neurophasy / Nursing Diagnosis / Diabetic retinopathy / API / Gustatory sensation

Research Abstract

A study of the nursing assessment, defining characteristics and risk management of diabetes mellitus (Types I and II) patients was performed, with a focus on compliance to treatment and daily activities related to complications in the lower extremities (atherosclerosis obliterans; ASO).
The first year of the present study was based in an analysis of the results of an ongoing survey of lower limb complications in 70 diabetic (Types I and II) patients from a nursing perspective. The following findings were made :
1. Almost none of the patients received information from nurses about self-examination of the legs or proper toenail care.
2. Many of the ASO(+) patients complained of sensations of cold or paresthesias in the legs.
3. However, few of the patients were aware of leg care and examinations. And none of the patients had received instruction on these topics from their nurses.
4. Following the classification of the patients into two groups : ASO(+) and ASO(-), it became clear that the API (Ankle Pressure Index : upper limb blood pressure/lower limb blood pressure) and pulseoximetry were effective non-invasive, nurse-performable examinations of obstructed blood flow in the lower limbs.
The second year of the study continued to focus on lower limb complications experienced by diabetic (I and II) patients. The survey included an interview about daily activities up to the present including the present condition of the legs and patient-recognized symptoms, patient awareness of leg care and the state of care. An evaluation of neurological damage including gustometric measurement of taste perception (which has been linked to sensation in the legs) in the trigeminal and palatal glossopharyngeal nerve regions, and an evaluation of sensation in the legs were also performed. It was found that the range of taste perception in the giant pyramidal and chorda tympani nerve tracts was significantly increased in the ASO(+) compared to the ASO(-) group. It was also found that although ASO(+) patients demonstrated significantly reduced levels of perception in the legs compared to the ASO(-) group, almost none of the patients paid special attention to leg care. From these findings, the following determinations were made :
1. To introduce and support a curriculum of patient awareness and leg care, with a focus on self-care, into the current nurse education program.
2. The use of API and pulseoximetry, gustometry, and evaluation of perception by nurses provided a more objective method of screening patients for obstructed blood flow in the legs than interviewing.
As a result of these findings, we are planning to implement an education program for diabetic patients focusing on leg care, along with screening for complications in the lower limbs.