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.
