Diabetic Ulcers Flashcards
What are the etiologies of Diabetic ulcers?
- hyperglycemia- alters blood flow and damages and thickens arteries
- glycosylated proteins cause tissue trauma
- accumulation of sorbitol due to breakdown of glucose, results in tissue destruction
What part of foot are most DU present?
forefoot accounts for 93% but can also occur on any part of plantar surface of foot
T/F- Forefoot ulcers healed faster than mid foot ulcers.
True, due to more blood supply to forefoot
What is the Wagner Classification scale?
0- open lesion 1- superficial ulcer/ partial thickness 2- deep ulcer to tendon, capsule, bone 3- deep ulcer with accesses, osteomyelitis 4- localized gangrene 5- gangrene of entire foot
What kind of healing rate would you want in 4 weeks?
50%
What is the leading risk factor for getting a diabetic ulcer?
not PVD but neuropathy
What is sensory neuropathy?
most pts unaware they have it, leads to lack of protective sensation, can still feel pain
What monofilament level can’t diabetic pts feel?
if unable to percieve 5.07 of pressure thet lack protective sensation and are at risk for ulceration
Will a patient have signs and symptoms of neuropathy in the sub clinical stage?
No. they probably have them but they won’t know
What is Claw toe deformity?
causes muscle atrophy, motor neuropathy, imbalances, creates a huge imbalance which redistributes weight
What are risk factors contributing to delayed healing?
impaired healing, poor vision, diabetes disease characteristics, inadequate care and education
What are sensory tests that can be done for pts with DM?
monofillament, vibratory testing, pain assessment, temperature
What motor tests can be done for pts with DM?
MMT, ROM
What degrees of PF and DF should a patient have?
25 PF
7 DF
What does it mean if patient can’t feel 7/10 of 4.17?
they have decreased sensation
What does it mean if patient can’t feel 7/10 of 5.07?
they have loss of protective sensation
What does it mean if patient can’t feel 7/10 of 6.10?
they have absent sensation
What are autonomic assessments that can be done for DM pts?
skin, hair nail changes, temp
What are blood flow circulatory/ vascular tests?
ABI, pulses, doppler
How do DM wounds presents?
rounded, calluses rim, minimal drainge, little to no eschar
What are signs of an infected DM wound?
changes in temp, high blood sugar, pain, changes in wound (exudate)
What is average time of healing for DM wounds?
12-14 weeks
What should blood glucose levels be before and after eating?
before- 80-120
after- 140 for age 50+
150 for 60 +
What are main treatments for DM?
treat underlying diabetes, correct arterial blood flow, relieve pressure at ulcer
What is the purpose of off loading device for ambulation?
redistributes weight bearing pressure over entire plantar surface of foot
increases surface area
protect foot from other trauma
What is Total contact casting for?
modified short leg casts used for Wagner stage 1 or 2
which lasts 7-10 days
What are contraindications to TCC?
OM, gangrene, fluctuating edema, active infection, ABI less than 0.5 (absolute)
T/F: Soft leather shoes breathes and allows for absorption of perspiration.
True, covered by medicare if impaired monofilaments
How to treat the actual diabetic ulcer?
can sharp decried, manage and avoid infection , topical application, dressing dependent on amount of drainage/infection
What other methods can be used for local wound care?
NWPT, ultrasound (non thermal), E stim, growth factors
What are key factors for Pt education?
regular foot exams, protect foot, keep feet moisturized bt in between toes dry, maintain proper diet
What are some things to never do?
- never soak feet
- no heat applied
- never go barefoot
- don’t perform own foot surgery
What are some there a pt can do?
address great toe extension, talocrural, DF, subtler jt motion
aerobic exercise- asst with glycemic control and weight loss
