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Med/Surg II Wound Care Unit > Diabetic Foot Ulcers > Flashcards

Diabetic Foot Ulcers Flashcards

1
Q

Neuropathic/Diabetic ulcers - etiology

A

combination of factors:

  • neuropathy
  • ischemia
  • structural changes
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2
Q

Regarding the etiology of neuropathic/diabetic ulcers, neuropathy, ischemia, and structural changes lead to

A

abnormal pressure points and repeated trauma

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3
Q

80% of diabetes related amputations in the US follow a

A

foot ulceration

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4
Q

What percentage of diabetes related amputations in the US follow a foot ulceration?

A

80%

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5
Q

50% of pts with diabetes related amputations will develop what? Within what time frame will this happen?

A

contralateral foot ulceration; 18 months

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6
Q

What percentage of pts with diabetes related amputations will develop a contralateral foot ulceration?

A

50%

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7
Q

Neuropathic/Diabetic ulcers - risk factors

A
  • Hx of diabetes
  • Poor glucose control
  • Loss of protective sensation
  • Failure to accommodate abnormal foot shape and progressive shape changes
  • Decreased cutaneous microcirculation
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8
Q

Types of neuropathy

A
  • Peripheral
  • Autonomic
  • Proximal
  • Focal
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9
Q

According to the ADA, what percentage of people with diabetes have mild to severe forms of nervous system damage?

A

60-70%

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10
Q

According to the ADA, 60-70% of people with diabetes have

A

mild to severe forms of nervous system damage

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11
Q

Sensory Neuropathy - test for loss of protective sensation

A
  • 10g monofilament

- test both feet

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12
Q

Sensory Neuropathy - test for vibratory

A
  • tuning fork - great toe and malleolus
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13
Q

Sensory Neuropathy - test for reflexes

A

absent or diminished

  • ankle
  • knee
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14
Q

Sensory Neuropathy - test for temperature

A

hot/cold

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15
Q

Sensory Neuropathy - test for

A
  • loss of protective sensation
  • vibratory
  • reflexes - absent or diminished
  • temperature
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16
Q

Autonomic neuropathy - trophic changes

A
  • toenails

- anhydrosis

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17
Q

Charcot’s aka

A

Neuropathic Osteoarthropathy

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18
Q

Neuropathic Osteoarthropathy aka

A

Charcot’s

19
Q

Motor Neuropathy

A
  • Bony deformities
  • Decreased ROM
  • Decreased strength
  • Loss of balance and coordination affecting gait
20
Q

With a motor neuropathy, what bony deformities are typically seen?

A

claw or hammer toes

21
Q

With a motor neuropathy, where is decreased ROM typically seen?

A
  • toes

- ankle

22
Q

What is used to grade diabetic ulcers?

A

Wagner Scale

23
Q

Factors leading o diabetic foot infection

A
  • immunopathy
  • angiopathy
  • neuropathy
24
Q

Common diabetic foot complications

A
  • osteomyelitis
  • Charcot’s foot
  • infection
25
Q

Diabetic Tests and Measures - Osteomyelitis

A
  • ulcer > one month old
  • probe to bone or bone is palpable
  • recurrent ulcer in same location
  • nonhealing with aggressive tx or worsening
26
Q

Diabetic Tests and Measures - Diagnostics (Osteomyelitis)

A
  • Sedimentation rate
  • X-ray
  • MRI
  • Bone Scan
  • Tagged WBC Study
27
Q

Diabetic Tests and Measures - Treatments (Osteomyelitis)

A
  • Antibiotics (oral or IV)

- Amputation

28
Q

Diabetic ulcer plan of care

A
  • Glucose control
  • Nutrition
  • Off-loading
  • Optimize vascular supply
  • Foot care
  • Debridement
  • Infection control
  • Moist wound care
29
Q

Protocols for diabetic foot ulcers

A
  • Evaluate for ischemia
  • Exclude presence of osteomyelitis
  • Perform sharps debridement
  • Provide moist wound healing
  • Provide essential off-loading
  • Reevaluate after 4 weeks
30
Q

Diabetic Tests and Measures - Glucose Levels

A
  • Essential for wound healing and prevention of progressive diseases associated with diabetes
  • may be elevated with infection or when taking antibiotics
31
Q

What is a “normal” glucose level?

A

< 200 mg/dl

32
Q

What glucose level should be encouraged for tight control?

A

80-120 without highs and lows during the day

33
Q

What is the mechanism of the HgA1C test?

A

Measures the average blood glucose levels over 2-3 months. If glucose levels are chronically high, more glucose will bind to RBC.. Normal is 4-6.1%

34
Q

What is the essential HgA1C value for wound healing?

A

Less than 8%

35
Q

What kinds of orthotics and Prosthetics are available for diabetics?

A
  • Shoe inserts
  • Walking CAM boots
  • Surgical Shoes
  • Rocker-bottom shoes
  • 3D wafer boots
  • Felt padding
  • diabetic shoes
  • Darco shoes
  • Therapeutic shoes
  • Total contact casting
  • Posterior Walking Splint
36
Q

What are some essential considerations for footwear?

A
  • Good fitting
  • No slippage
  • Moisture control
37
Q

What are physical therapy considerations for diabetics?

A
  • Assistive devices
  • Weight Bearing Status
  • Mobility Training (Ambulation
  • Modalities
38
Q

Name aspects of foot care for diabetics.

A 
- Daily foot inspection
Wash and dry feet daily
- Moisturize except between toes
- Never go barefoot
- Toenail care
- no bathroom surgery
- Shoe inspection
- Buying shoes
- Wear clean, white socks
No foot soaks, hot water bottles, heating pads, or ice
39
Q

What does podiatry involve?

A
  • Foot and Nail care
  • Fungal infections
  • Debridement of hyperkeratosis
  • off-loading
  • surgical intervention
40
Q

Disease Process

A
  • Glycemic control
  • Pulmonary function
  • Smoking cessation
  • Incontinence control
  • stress management
41
Q

Vascular Needs

A
  • Angioplasty
  • Venous Repair
  • Exercise and Ambulation
  • Foot care
  • Podiatry
  • Medication
42
Q

Disease process

A
  • Glycemic Control
  • Pulmonary function
  • Smoking cessation
  • Incontinence control
  • Stress management
43
Q

Long Term Goals Documentation

A
  • Loading on a body part is decreased
  • Protection of a body part is increased
  • Tolerance to activities is increased
  • Weight bearing status is improved
  • Awareness and use of community resources is improved

Med/Surg II Wound Care Unit (11 decks)

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