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Integumentary > 8] Diabetic Wounds > Flashcards

8] Diabetic Wounds Flashcards

1
Q

How much % of ppl with DM will develop wounds in their life?

A

15%

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2
Q

85% of those preceded by a

A

Foot ulcer

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3
Q

Mortality rate after amputation

A

50% within 3-5 years

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4
Q

Rate of ocntralateral amputation is

A

50% within 4 years

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5
Q

Of all amputations 86% could have been prevented by

A

Proper footwear and patient education

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6
Q

Diabetic wounds are on legs or feet?

A

FEET

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7
Q

Neuropathic wounds - sensory

A

Loss of protective sensation

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8
Q

Neuropathic wounds- motor

A

Wasting of intrinsic muscles of foot and structural deformities

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9
Q

Neuropathic wounds- autonomic

A

Dry, cracked skin due to decreased sweating, decreased lubrication, fissures

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10
Q

Most commonly affected area of diabetic

A

Great toe

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11
Q

Order of affects with diabetic foot ulcers

A 
Great toe - 30%
1st met head- 22%
Dorsum of digits - 13%
Plantar surface of other toes- 10%
5th met head- 9%
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12
Q

Etiology of diabetic foot ulcer

A

Neuropathy + ischemia + Structural

changes = abnormal pressure points and repeated trauma

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13
Q

Risk factors of diabetic foot ulcer

A
  • Poor glucose control
  • Loss of protective sensation
  • Progressive shape changes of foot
  • Poor foot wear
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14
Q

Wagner is for what?

A

Grading foot ulcers on a scale of 0 - 5

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15
Q

What is Wagner grade 0

A

Damage to foot but skin intact

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16
Q

Treatment for grade 0 Wagner

A

Protection (TCC, orthotic, footwear)

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17
Q

Grade 1 Wagner

A

Superficial or partial-thickness ulcer

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18
Q

Treatment for grade 1

A

Local wound care, manage edema, protect from maceration, foot protection

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19
Q

Wagner grade 2

A

Full thickness wound with subcutaneous involvement

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20
Q

Treatment for grade 2 Wagner

A

Local wound care, manage edema, protect from

maceration, foot protection

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21
Q

Grade 3 Wagner

A

Infection (abscess, osteomyelitis)

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22
Q

Treat for grade 3 Wagner

A

Refer to ortho surgery for I&D or resection of bone

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23
Q

Wagner grade 4

A

Gangrene of forefoot

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24
Q

Treat for grade 4 Wagner

A

Refer to vascular surgeon for re-vascularization or amputation

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25
Q

Grade 5 Wagner

A

Gangrene of most of the foot

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26
Q

Treat for Wagner grade 5

A

Refer to vascular surgeon fr re-vascularization or amputation

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27
Q

Characteristics of diabetic foot wounds

A

Plantar aspect of the foot,
particularly the metatarsal
heads, plantar heels, or toes

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28
Q

Are there tropic changes in diabetic foot wounds

A

Yes

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29
Q

What kind of wound bed with diabetic foot wounds

A

Deep, pale wound bed with some necrotic tissue

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30
Q

What kind of edges?

A

Smoot edges with callus rim

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31
Q

How much drainage?

A

Low to moderate

32
Q

If infection happens, which is common, suspect what?

A

Osteo

33
Q

Risk factors for Charcot foot

A 
Ages 50-60
Diabetic for more than 10 years
Peripheral neuropathy 
Loss of protective sensation 
Nephropathy 
Retinopathy
34
Q

Progressive condition
characterized by joint
dislocations, pathologicfractures, and
deformities.

A

Charcot foot

35
Q

Charcot foot is most common where

A

Foot and ankle

36
Q

Characteristics of Charcot foot

A 
Edema
Erythema
Skin temperature difference of 6.7 degrees
Bony prominences at midfoot
Ulcerations common at 
midfoot
37
Q

When would you suspect osteomyelitis?

A

When they have had an ulcer longer than 1 month

38
Q

What should be palpable with osteo?

A

Bone

39
Q

Recurrent ulcer for osteomyelitis is in ?

A

Same location

40
Q

Osteomyelitis and Charcot foot will both be

A

Red, warm, edematous and painful

41
Q

What’s the biggest difference between osteo and Charcot?

A

A bone scan and bone biopsy will be + for osteomyelitis. Charcot foot would be negative.

42
Q

Elevated WBC count withdifferential

A

Osteomyelitis

43
Q

May have mildly

elevated WBC/ESR

A

Charcot foot

44
Q

Elevated ESR

A

Osteomyelitis

45
Q

Elevation of the foot for 1-2 hours should

eliminate erythema and swelling

A

Charcot foot

46
Q

(+) Bone scan with WBC labeling
 (+)Bone biopsy
 Gold standard

A

Osteomyelitis

47
Q

due to
loss of nourishment to a part, followed by
mummification

A

Dry gangrene

48
Q

necrosisof tissue followed by
destruction caused by
excessive moisture

A

Wet gangrene

49
Q

What accumulates in the tissue of wet gangrene

A

Bacterial gases

50
Q

Line of demarcation isill-defined and limb is painful, purple and
swollen

A

Wet gangrene

51
Q 
pulses/Doppler, 
 rubor of dependency, 
 ABI – not reliable in DM
 history of claudication
 ischemic pain
A

Vascular status

52
Q

24% healed at ?

A

12 weeks

53
Q

47% healed at ?

A

20 weeks

54
Q

If the wound has not healed by 50% in the first4 weeks of treatment, only ???

A

9% chance it will heal in 3 months

55
Q

Treat cuts right away by

A

Washing with soap and water and covering with sterile gauze

56
Q

3 types of debridement intervention

A

Sharp
Enzymatic
Autolytic

57
Q

Scalpel; may be surgical (gold standard)

A

Sharp debridement

58
Q

Uses medication to break down necrotic tissue

A

Enzymatic debridement

59
Q

What increases the chances of DFU healing?

A

Adequate off-loading

60
Q

What’s the preferred method for offloading diabetic plantar foot ulcers?

A

Total contact casting

61
Q

Advanced therapeutics are unlikely to succeed in improving wound healing outcomes unless ?

A

Off-loading is achieved

62
Q

How often are total contact casting replaced?

A

Weekly if theres no swelling or drainage. 2-3 days if there is.

63
Q

Advantages of total contact casting

A

Protects from trauma
Reduces edema
Offloads forefoot and midfoot

64
Q

Is total contact casting removable?

A

NO

65
Q

Disadvantage of total contact casting

A
  • heavy, hot,
    bathing/walking/sleeping difficult
  • Has healing rate of 90% within 6-8weeks
  • its considered a fall risk
66
Q

Contraindications for TCC

A 
- Documented peripheral arterial disease
 ABI < 0.7
 Active infection
 Fluctuating leg edema
 Osteomyelitis
 Necrosis in wound
 Sinus tract with deep extension into foot
67
Q

What does CROW stand for

A

Charcot restraint orthotic walker

68
Q

What is a crow?

A

Rigid polypropylene bootwalker with rocker sole

69
Q

What does a crow do?

A

Reduces pressure and shear

70
Q

What is a DH pressure relief walker?

A

Removable walking boot with rocker-bottom sole

71
Q

Advantage of DH pressure relief walker

A

Easy to apply, adjusts to edema, wound can be inspected regularly, inexpensive

72
Q

Disadvantage

A

No forced compliance

73
Q

Orthowedge healing shoe

A

Removes forefoot weight bearing

74
Q

Orthowedge healing shoe is used for?

A

Forefoot wound or s/p digit or forefoot amputation

75
Q

What angle is the orthowedge healing shoe

A

10 degree DF angle

Integumentary (15 decks)

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