bennet

Question 1

reasons for poor quality of life in people with diaetic foot ulcers

Answer 1

• reduced mobility
• change in lifestyle of individual and family
• loss of social role
• unemployment
• reduce social activities

Question 2

what percent of the diabetic population is undiagnosed

Answer 2

27.8%

Question 3

Foot complications bad news

Answer 3

• foot ulcers assocaited with significant morbidity and mortality
• tx of ulcers range from simple to complex
• high rate of recurrence
• leading cause of amputation
  
  • foot ulcerations are MOST COMMON precursor to lower extremity amputation among people with diabetes
  • high risk for further breakdown (change in biomechanics)
• rehabilitation of the BKA or AKA with a prosthetic in diabetic can be extremely difficult
• below knee and above knee amputations put significant stress on heart and lungs

Question 4

what is the FIVE year mortality rates after ne onset of diabetic foot ulceration…

Answer 4

43 to 55% and up to 74% with lower extremity amputation

• higher rates than many common cancers

Question 5

componenets of successful amputations

Answer 5

• remove all necrotic painful or infected tissue
• must be able to fit amputation stump with a functional and easily applied prosthesis
• blood supply at the level of the proposed amputation must be sufficient to allow primary skin healing

Question 6

factors to consider for amputation level

Answer 6

• medical and mental status of the patient
  
  • is the patient medically and mentally stable enough for multipe procedures if needed
• infection
  
  • infection needs to be controlled before definitive amputation, unless proximal amputation is being performed at safe anatomic site

Question 7

views of amputation

Answer 7

• not always considered a fialure
• for many patients it can be relief to pain and suffering
• many patients are ready for definitive procedure versus potential for prolonged treatment course
• howerever, for many considered a major loss, even if it is a minor amputation (ie toe)

Question 8

stages of grieving process for amputations

Answer 8

• denial - before or after
  
  • pts tries to convince themselves that their situation will get better
• anger - inward or outward
  
  • neccessary for the pt not to repress their anger, but experience it while it is happening to deal with it
• bargaining - normally out of order and coincides with denial
  
  • want a last resort or another chance to circumvent the problem
• depression
• acceptance - they start to take control of what will happen in their life from this point
• recovery - physical, social, and psychological rehabilitation and couseling

Question 9

diabetic amputation management

Answer 9

• successful management needs to address pts mental status as well as the amputation managemnt
• if things are progressing well express to patient and congratulate him or her
• if not going well, need to be up front and honest and be clear of tx plan
• consider professional psychological help if significant signs of anxiety and depression