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PT 854 Integument > Diabetic Ulcers- Quiz 3 > Flashcards

Diabetic Ulcers- Quiz 3 Flashcards

1
Q

Why does type 2 DM continue to increase?

A
  • Rising rate of obesity

- Aging population

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2
Q

Foot ulcers precede _____ in ____% of cases?

A

LE amputations, 85

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3
Q

Why do LE amputations happen after foot ulcers?

A

Having one ulcer increases your chance of getting another ulcer. It is harder to manage multiple ulcers… leading to LE amputation.

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4
Q

What percent are non-traumatic cause of LE amputation?

A

50-75%

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5
Q

What are secondary mechanisms that can cause Neuropathic/neurotropic ulcers? (5)

A
  • Peripheral Vascular Disease
  • Peripheral Neuropathy
  • Minor Trauma
  • Structural Deformity
  • Infection
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6
Q

What is the most common type of neuropathic/ neurotrophic ulcer?

A

Diabetic

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7
Q

What are other diagnoses that can cause neuropathic/ neurotrophic ulcers? (5)

A
  • Spina bifida
  • neurologic disorders
  • muscular degenerative diseases
  • alcoholism
  • tertiary syphilis
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8
Q

Why does multi-factorial ulcerations increase risk for amputation? (4 reasons)

A
  • Previous ulcers place pts at higher risk for future ulcers
  • scar tissue builds up
  • skin becomes less elastic
  • cause of initial ulcer may still be an issue
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9
Q

What are the risk factors for diabetic ulcerations? (7)

A
  • Atherosclerosis
  • decreased sensation
  • foot shape (structural deformities)
  • muscle contractures
  • skin changes (autonomic NS and mechanical )
  • immune system impacted
  • Hx of previous ulcers
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10
Q

what is a major risk factor for LE amputation?

A

-PAD (peripheral arterial disease)

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11
Q

Why does PAD lead to amputation?

A

Because it decreases bl flow to LE which causes inadequate oxygenation and tissue perfusion which ultimately impairs wound healing.

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12
Q

What is PAD similar to?

A

atherosclerotic disease (CAD), artery walls thicken and become more rigid

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13
Q

What two proteins is insulin essential for synthesis for?

A

collagen and fibroblastic

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14
Q

What can decreased insulin cause and why?

A
  • skin stiffness and Decreased tensile strength of tissue

- because have diminished collagen synthesis

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15
Q

Why is skin elasticity and increased tensile strength of tissue so important?

A

If you have a decrease in both (skin and tensile strength) you increase likelihood of ulcers and decrease your chance of healing

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16
Q

Who is peripheral neuropathy common in?

A

diabetic pts

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17
Q

What does peripheral neuropathy impact?

A

sensation and strength in LE

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18
Q

what areas of sensation are more likely to be injured with peripheral neuropathy?(4)

A
  • Light touch
  • temperature
  • pain sensation
  • proprioception
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19
Q

Skin with diminished sensation is subject to injury from ______, _______, ________ and ________.

A

trauma, shearing forces, excessive pressure and warm temperature burns

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20
Q

What causes structural deformities?

A

peripheral motor neuropathy (inability to feel your foot…duah)

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21
Q

T/F Equinus contracture is when your stronger dorsiflexions overcome your weaker plantar flexors

A

FALSE, it is when your stronger PF overcome weaker DF

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22
Q

What DF ROM do you normally see with Equinus contracture

A

Less than 0 deg DF

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23
Q

Do you have stronger inversion or eversion with Equinus contracture?

A

stronger eversion

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24
Q

With Equinus contracture what does it result in?

A

Increased pressure on metatarsal and toes

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25
Q

With Equinus contracture do you have pronation or supination?

A

you have both

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26
Q

What is hammer toe?

A

flexion PIP, extension DIP

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27
Q

what is claw toe?

A

flexion PIP and neutral/slight flexed DIP, bearing weight on tip of toe

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28
Q

What is curly toe?

A

flexion of PIP and DIP, literally curled under foot, bearing weight on nail

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29
Q

What is mallet toe?

A

neutral PIP and flexed DIP

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30
Q

Changes in foot/ankle can lead to? (3)

A
  • altered weight distribution
  • increased pressure in areas not ready for that type of load
  • areas of ischemia
31
Q

Why does a callus form?

A

response to pressure overtime

32
Q

callus gets_____ and more resistant to _____ over time?

A

thicker, motion

33
Q

What can happen with a thick, hard, immobile callus?

A

turns into an area of increased pressure and can develop into an ulcer

34
Q

What is charcot deformity

A

progressive degenerative foot deformity on weight bearing joint

35
Q

Charcot deformity affects ___% of DM with neuropathy

A

10

36
Q

what are 2 theories that Charcot deformity occurs?

A
  • increase blood and pooling in feet

- correlated with decreased bone density in pts with charcot

37
Q

What 3 stages does charcot progress in?

A
  • development
  • coalescence
  • reconstruction
38
Q

what are the 6 characteristic of the development stage of charcot deformity?

A
  • joint effusions
  • edema
  • subluxation
  • formation of bone and cartilage debris
  • intra-articular fractures
  • bone fragmentation
39
Q

how is development stage of charcot deformity initiated? and how is it aggravated?

A

minor trauma like walking too long, persistent ambulation

40
Q

What is the coalescence stage marked by for charcot deformity? (3)

A
  • reduction in edema
  • absorption of fine debris
  • healing fractures
41
Q

What happens in the reconstruction stage for charcot deformity? (3)

A
  • further repair and remodeling of bones
  • fusion and rounding of large bone fragments
  • decreased joint mobility
42
Q

what 3 things are crucial for preventing chariot deformity?

A

early detection, diagnosis, and offloading

43
Q

you are __x more likely to develop ulcers once the bones in the foot begin to change (charcot)? why?

A

4, deformities are prone to increased pressure

44
Q

What is present in a majority of diabetics where ulcers have formed?

A

autonomic changes

45
Q

what does the autonomic system do

A

regulates skin perspiration and bl flow to the microvasculature

46
Q

What does a decrease in autonomic system result in? (4 things)

A
  • dry skin
  • cracked skin
  • callus formation
  • frequent toenail infections
47
Q

Altered cross-linkage between ____ and _____ results in predisposed to hyperkeratosis and callus formation

A

collagen and keratin

48
Q

why does the body have decreased immunity with DM?

A
  • poor bl flow

- edematous tissues

49
Q

What is the most common scale used for grading DFU?

A

Wagner grading system

50
Q

T/F once an ulcer is a grade 3 it CAN become a grade 2

A

FALSE, it stays at grade 3 but is referred to as healing grade 3

51
Q

T/F Wagner grading can distinguish ulcers with/without ischemia or tissue infection

A

FALSE, it cannot distinguish

52
Q

What is the range of grades for Wagner?

A

grade 0-5

53
Q

Wagner Grade 0

A

no ulcer but may possess pre-ulcerated lesion; healed ulcer; presence of bony deformity

54
Q

Wagner Grade 1

A

Superficial Diabetic ulcer not involving subcutaneous tissue

55
Q

Wagner Grade 2

A

Ulcer extends through dermis

  • involves ligament, tendon, joint capsule, fascia, or bone
  • no abscess or osteomyelitis
56
Q

Wagner Grade 3

A

Deep ulcer with abscess or osteomyelitis

57
Q

Wagner Grade 4

A

localized gangrene of foot

58
Q

Wagner Grade 5

A

extensive gangrene of foot

59
Q

what is gangrene

A

localized death and decomposition of body tissue rusting from either obstructed circulation or bacterial infection

60
Q

what is osteomyelitis

A

inflammation of bone or bone marrow, usually due to infection

61
Q

Which grading system gives stage and grades for ulcers?

A

university of Texas diabetic wound classification

62
Q

Which grading system acknowledges ischemia and infection

A

university of Texas diabetic wound classification (UTDWC)

63
Q

how many stages are there for university of texas diabetic wound classification ?

A

A-D

64
Q

how many grades are there for university of texas diabetic wound classification ?

A

0-3

65
Q

Texas Stage A

A

no infection or ischemia

66
Q

Texas Stage B

A

infection present

67
Q

Texas Stage C

A

Ischemia present

68
Q

Texas Stage D

A

Infection and ischemia present

69
Q

Texas Grade 0

A

pre or post ulcerative lesion and or completely epithelialized wound

70
Q

Texas Grade 1

A

Superficial wound

71
Q

Texas Grade 2

A

wound penetrates to tendon or capsule

72
Q

Texas Grade 3

A

wound penetrates to bone or joint

73
Q

What is a wound that is categorized as D3 (Texas)?

A

Infection and ischemia present and wound penetrates to bone or joint

PT 854 Integument (11 decks)

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