Diabetic Ulcers Flashcards

1
Q

What are the etiologies of Diabetic ulcers?

A
  1. hyperglycemia- alters blood flow and damages and thickens arteries
  2. glycosylated proteins cause tissue trauma
  3. accumulation of sorbitol due to breakdown of glucose, results in tissue destruction
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2
Q

What part of foot are most DU present?

A

forefoot accounts for 93% but can also occur on any part of plantar surface of foot

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3
Q

T/F- Forefoot ulcers healed faster than mid foot ulcers.

A

True, due to more blood supply to forefoot

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4
Q

What is the Wagner Classification scale?

A
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
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5
Q

What kind of healing rate would you want in 4 weeks?

A

50%

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6
Q

What is the leading risk factor for getting a diabetic ulcer?

A

not PVD but neuropathy

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7
Q

What is sensory neuropathy?

A

most pts unaware they have it, leads to lack of protective sensation, can still feel pain

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8
Q

What monofilament level can’t diabetic pts feel?

A

if unable to percieve 5.07 of pressure thet lack protective sensation and are at risk for ulceration

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9
Q

Will a patient have signs and symptoms of neuropathy in the sub clinical stage?

A

No. they probably have them but they won’t know

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10
Q

What is Claw toe deformity?

A

causes muscle atrophy, motor neuropathy, imbalances, creates a huge imbalance which redistributes weight

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11
Q

What are risk factors contributing to delayed healing?

A

impaired healing, poor vision, diabetes disease characteristics, inadequate care and education

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12
Q

What are sensory tests that can be done for pts with DM?

A

monofillament, vibratory testing, pain assessment, temperature

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13
Q

What motor tests can be done for pts with DM?

A

MMT, ROM

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14
Q

What degrees of PF and DF should a patient have?

A

25 PF

7 DF

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15
Q

What does it mean if patient can’t feel 7/10 of 4.17?

A

they have decreased sensation

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16
Q

What does it mean if patient can’t feel 7/10 of 5.07?

A

they have loss of protective sensation

17
Q

What does it mean if patient can’t feel 7/10 of 6.10?

A

they have absent sensation

18
Q

What are autonomic assessments that can be done for DM pts?

A

skin, hair nail changes, temp

19
Q

What are blood flow circulatory/ vascular tests?

A

ABI, pulses, doppler

20
Q

How do DM wounds presents?

A

rounded, calluses rim, minimal drainge, little to no eschar

21
Q

What are signs of an infected DM wound?

A

changes in temp, high blood sugar, pain, changes in wound (exudate)

22
Q

What is average time of healing for DM wounds?

A

12-14 weeks

23
Q

What should blood glucose levels be before and after eating?

A

before- 80-120
after- 140 for age 50+
150 for 60 +

24
Q

What are main treatments for DM?

A

treat underlying diabetes, correct arterial blood flow, relieve pressure at ulcer

25
Q

What is the purpose of off loading device for ambulation?

A

redistributes weight bearing pressure over entire plantar surface of foot

increases surface area

protect foot from other trauma

26
Q

What is Total contact casting for?

A

modified short leg casts used for Wagner stage 1 or 2

which lasts 7-10 days

27
Q

What are contraindications to TCC?

A

OM, gangrene, fluctuating edema, active infection, ABI less than 0.5 (absolute)

28
Q

T/F: Soft leather shoes breathes and allows for absorption of perspiration.

A

True, covered by medicare if impaired monofilaments

29
Q

How to treat the actual diabetic ulcer?

A

can sharp decried, manage and avoid infection , topical application, dressing dependent on amount of drainage/infection

30
Q

What other methods can be used for local wound care?

A

NWPT, ultrasound (non thermal), E stim, growth factors

31
Q

What are key factors for Pt education?

A

regular foot exams, protect foot, keep feet moisturized bt in between toes dry, maintain proper diet

32
Q

What are some things to never do?

A
  • never soak feet
  • no heat applied
  • never go barefoot
  • don’t perform own foot surgery
33
Q

What are some there a pt can do?

A

address great toe extension, talocrural, DF, subtler jt motion

aerobic exercise- asst with glycemic control and weight loss