Diabetes Flashcards
A patient has a neuropathic ulcer with dry, cracked skin and a history of poor glycemic control. What interventions are essential to promote healing?
Interventions: Tight glycemic control, aggressive debridement, off-loading with a total contact cast or appropriate footwear, and addressing dry skin with moisturizers.
How would you modify interventions for a patient with neuropathic ulcers and sensory neuropathy who cannot feel the 10g monofilament test?
Modifications: Emphasize off-loading to prevent unnoticed trauma, ensure caregiver involvement for foot inspections, and educate on daily protective measures.
A patient with a Wagner grade 1 ulcer has been prescribed a total contact cast. What are the contraindications to consider?
Contraindications: Osteomyelitis, gangrene, fluctuating edema, active infection, or an ABI less than 0.45.
A patient presents with recurrent ulcers despite off-loading interventions. What additional evaluations should be performed?
Evaluate for vascular insufficiency, infection, foot deformities, and compliance with the care plan.
Consider revascularization or corrective surgery if needed.
How do motor neuropathy and autonomic neuropathy contribute to the development of diabetic foot ulcers?
Motor neuropathy: Causes intrinsic muscle atrophy, leading to foot deformities and increased pressure.
Autonomic neuropathy: Leads to dry, cracked skin and impaired vasodilation, reducing tissue perfusion.
A diabetic patient with Charcot foot is in the acute phase. What are the priorities for intervention?
Control inflammation, immobilize the foot with a total contact cast or CROW boot, and prevent further trauma or deformity.
What steps would you take to educate a patient with recurrent diabetic ulcers on daily foot care?
Steps: Teach daily foot inspection, proper nail and skin care, appropriate footwear selection, and the importance of glycemic control and off-loading techniques.
What are the common locations of neuropathic ulcers?
Locations:
- plantar aspect of metatarsal heads
- tips of toes
- plantar midfoot in Charcot deformities
- areas of pressure/friction from improper footwear
What is the 5PT method for characterizing neuropathic ulcers?
Pain: Absent or reduced due to neuropathy.
Position: Plantar surface, under calluses, or at pressure points.
Presentation: Round, punched-out lesions with minimal drainage unless infected.
Periwound: Dry, cracked skin with callus formation.
Pulses: Normal or accentuated with vessel calcification.
What structural changes occur in the periwound area of neuropathic ulcers?
Changes: Dry, cracked skin; callus formation; claw toes; rocker-bottom foot; prior amputations or deformities.
How does vascular disease contribute to delayed healing in neuropathic ulcers?
Mechanism: Accelerated atherosclerosis and thickened basement membrane impair blood flow, reducing oxygen and nutrient delivery to tissues.
What are the key skin changes in diabetic wounds?
Changes: Cracking, callus formation, decreased collagen deposition, inhibited fibroblast activity, and delayed epithelialization.
What are the risk factors for neuropathic ulcers related to mechanical stress?
Factors: High plantar pressures, improper footwear, and abnormal foot biomechanics such as toe deformities or plantar flexion contractures.
What are the typical presentations of neuropathic ulcers in diabetic patients?
Presentation: Even wound edges, well-defined borders, and minimal drainage unless infected.
- Eschar is uncommon unless infected.
What are the implications of autonomic neuropathy in neuropathic ulcer development?
Implications: Dry, cracked skin due to decreased sweating, increased callus formation, and impaired vasodilation leading to reduced tissue perfusion.
How do impaired healing and immune response affect diabetic wound healing?
Effects: Reduced ability to build new tissue, increased susceptibility to infections, and impaired progression through wound healing phases.
What is the prognosis for neuropathic ulcer healing, and what factors influence it?
Prognosis: Healing takes an average of 12–14 weeks.
- Influencing factors include glycemic control, off-loading adherence, and management of comorbidities.
What is the definition of diabetes, and what are its primary types?
Definition: A group of metabolic diseases with prolonged high blood sugar levels.
Types:
- Type 1 (autoimmune destruction of beta cells, no insulin production)
- Type 2 (insulin resistance, often linked to obesity).
What are the acute and long-term complications of diabetes?
Acute complications: Diabetic ketoacidosis, nonketotic hyperosmolar coma.
Long-term complications: Heart disease, stroke, kidney failure, neuropathic ulcers, and visual impairment.
How does hyperglycemia contribute to tissue damage in diabetic patients?
Mechanisms: Alters RBCs and capillaries, increases microvascular pressure, and causes glycosylation of proteins, leading to tissue trauma and destruction.
What are the primary risk factors contributing to neuropathic ulcers?
Risk factors: Vascular disease (PVD), neuropathy (sensory, motor, autonomic), mechanical stress, poor footwear, impaired healing, and poor glycemic control.
How does sensory neuropathy increase the risk of diabetic ulcers?
Mechanism: Loss of protective sensation allows unnoticed trauma and pressure to cause ulcers. Paresthesia further complicates detection.
What are the impacts of motor neuropathy on diabetic foot health?
Impacts: Muscle atrophy leads to foot instability, deformities, and increased pressure and shear forces on the foot.
What is the significance of autonomic neuropathy in diabetic foot care?
Significance: Causes dry, cracked skin, impaired sweating, and reduced perfusion due to vasodilation issues, increasing ulcer risk.
What role does mechanical stress play in the development of neuropathic ulcers?
Excessive forces, high plantar pressures, and improper footwear lead to tissue overload and ulceration.
How can patient education reduce the risk of diabetic foot ulcers?
Education: Focuses on daily foot inspection, proper footwear, glycemic control, and adherence to off-loading techniques to prevent trauma.
What are the goals of physical therapy interventions for diabetic ulcers?
Goals: Improve glycemic control, reduce pressure with off-loading, enhance circulation, and facilitate wound healing through proper dressing and debridement.
What is total contact casting, and when is it used?
Definition: A molded cast that redistributes weight-bearing forces, controls edema, and protects ulcers. Indications: Wagner grade 1 or 2 ulcers.
What are the contraindications for total contact casting?
Contraindications: Osteomyelitis, gangrene, fluctuating edema, active infection, or an ABI less than 0.45.
What devices are used for off-loading in diabetic foot care?
Devices: Total contact casts, CROW boots, wedge shoes, rocker-bottom shoes, and prefabricated cast walkers.
What is the purpose of a wedge shoe, and how does it function?
Purpose: Reduces forefoot or heel pressure. Function: Shifts weight to midfoot or opposite side to promote healing after trauma or surgery.
What are the essential features of permanent footwear for diabetic patients?
Features: Extra-depth toe box, soft moldable materials, proper length and width, and low heel height (<1 inch).
How is glycemic control monitored, and why is it important in wound healing?
Monitoring: HbA1c provides an aggregate glucose level over 2–3 months. Importance: Better control reduces infection risk and improves healing rates.
What are the benefits of aerobic exercise for diabetic patients?
Benefits: Enhances glycemic control, promotes weight loss, and improves circulation, aiding wound healing.
What wound care techniques are essential for diabetic ulcers?
Techniques: Debridement, use of antimicrobial dressings for infection, moisture balance in dressings, and padding to protect wounds.
What are the indications for surgical intervention in diabetic foot care?
Indications: Debridement of necrotic tissue, correction of foot deformities, revascularization, or amputation in severe cases.
How does poor vision impact diabetic foot care?
Impact: Increases risk of unnoticed trauma and reduces the ability to perform effective foot inspections and care.
What is the role of orthotics in diabetic foot care?
Role: Corrects foot deformities, redistributes pressure, and prevents ulceration in high-risk areas.
What are the clinical signs of infection in diabetic ulcers, and how should they be managed?
Signs: Increased drainage, redness, warmth, and delayed healing. Management: Culture and sensitivity testing, appropriate antibiotics, and surgical intervention if needed.
What are the risks of delayed treatment for neuropathic ulcers?
Risks: Progression to infection, osteomyelitis, amputation, and systemic complications affecting overall quality of life.
What are the key steps in creating a treatment plan for a diabetic foot ulcer?
Steps: Glycemic control, off-loading, wound debridement, appropriate dressings, and patient education on preventive care.
