Which is the highest priority intervention for a patient with diabetic neuropathy who has lost sensation in both feet?

Choice A reason: This is an incorrect choice because gently trimming the patient’s toenails after soaking the feet in warm soapy water is not the best intervention of the nurse for a diabetic patient who has rough skin on the feet and thick, overgrown toenails. Trimming the toenails can be risky for the diabetic patient, as it can cause bleeding, infection, or injury to the nail bed or surrounding skin. The nurse should avoid cutting the toenails of the diabetic patient, unless instructed by a podiatrist.

Choice B reason: This is an incorrect choice because using a pumice stone to smooth roughened areas of skin on the patient’s feet is not the best intervention of the nurse for a diabetic patient who has rough skin on the feet and thick, overgrown toenails. A pumice stone is a porous rock that can be used to exfoliate the skin and remove dead cells. However, it can also damage the skin and cause abrasions, irritation, or infection. The nurse should be careful when using a pumice stone on the diabetic patient, and avoid rubbing too hard or too often.

Choice C reason: This is an incorrect choice because liberally applying lotion to the patient's feet especially between the toes is not the best intervention of the nurse for a diabetic patient who has rough skin on the feet and thick, overgrown toenails. Applying lotion to the feet can help to moisturize and soften the skin, but it can also create a moist environment that can promote fungal growth and infection. The nurse should apply lotion sparingly to the feet of the diabetic patient, and avoid applying it between the toes.

Choice D reason: This is the correct choice because obtaining a consultation for a podiatrist to assess the feet and provide nail care is the best intervention of the nurse for a diabetic patient who has rough skin on the feet and thick, overgrown toenails. A podiatrist is a specialist who can diagnose and treat foot problems, such as nail disorders, skin conditions, or infections. The podiatrist can safely and effectively trim the toenails of the diabetic patient, and provide education and advice on foot care and prevention of complications. The nurse should refer the diabetic patient to a podiatrist at least once a year, or more often if needed.

Choice A reason: This is incorrect. Chronic pain is not a type of pain, but a duration of pain. Chronic pain is pain that lasts longer than six months, regardless of the cause or location. It can affect the patient's physical and mental health, as well as their quality of life.

Choice B reason: This is incorrect. Psychogenic pain is not a type of pain, but a source of pain. Psychogenic pain is pain that is caused or influenced by psychological factors, such as stress, anxiety, depression, or trauma. It can affect any part of the body, but it is not related to the patient's heart attack.

Choice C reason: This is correct. Referred pain is pain that is felt in a different location from the actual source of pain. It occurs when the nerve fibers from different parts of the body converge in the spinal cord or brain. The patient's pain is down his left arm rather than in his chest because the heart and the arm share some nerve pathways.

Choice D reason: This is incorrect. Peripheral pain is pain that is caused by damage or dysfunction of the peripheral nervous system, which consists of the nerves outside the brain and spinal cord. It can cause sensations of numbness, tingling, burning, or shooting pain in the affected area. It is not related to the patient's heart attack.