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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
Diabetic Tests and Measures - Osteomyelitis
- ulcer > one month old - probe to bone or bone is palpable - recurrent ulcer in same location - nonhealing with aggressive tx or worsening
26
Diabetic Tests and Measures - Diagnostics (Osteomyelitis)
- Sedimentation rate - X-ray - MRI - Bone Scan - Tagged WBC Study
27
Diabetic Tests and Measures - Treatments (Osteomyelitis)
- Antibiotics (oral or IV) | - Amputation
28
Diabetic ulcer plan of care
- Glucose control - Nutrition - Off-loading - Optimize vascular supply - Foot care - Debridement - Infection control - Moist wound care
29
Protocols for diabetic foot ulcers
- Evaluate for ischemia - Exclude presence of osteomyelitis - Perform sharps debridement - Provide moist wound healing - Provide essential off-loading - Reevaluate after 4 weeks
30
Diabetic Tests and Measures - Glucose Levels
- Essential for wound healing and prevention of progressive diseases associated with diabetes - may be elevated with infection or when taking antibiotics
31
What is a "normal" glucose level?
< 200 mg/dl
32
What glucose level should be encouraged for tight control?
80-120 without highs and lows during the day
33
What is the mechanism of the HgA1C test?
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
What is the essential HgA1C value for wound healing?
Less than 8%
35
What kinds of orthotics and Prosthetics are available for diabetics?
- 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
What are some essential considerations for footwear?
- Good fitting - No slippage - Moisture control
37
What are physical therapy considerations for diabetics?
- Assistive devices - Weight Bearing Status - Mobility Training (Ambulation - Modalities
38
Name aspects of foot care for diabetics.
``` - 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
What does podiatry involve?
- Foot and Nail care - Fungal infections - Debridement of hyperkeratosis - off-loading - surgical intervention
40
Disease Process
- Glycemic control - Pulmonary function - Smoking cessation - Incontinence control - stress management
41
Vascular Needs
- Angioplasty - Venous Repair - Exercise and Ambulation - Foot care - Podiatry - Medication
42
Disease process
- Glycemic Control - Pulmonary function - Smoking cessation - Incontinence control - Stress management
43
Long Term Goals Documentation
- 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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