Lecture 6 - Neuropathic Ulcers Flashcards

1
Q

what is a common characteristic of diabetic ulcer periwound?

A

callous around the wound bed

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2
Q

characteristics of the neuropathic ulcer periwound

A
  • callous
  • thickened toenails
  • edema, if autonomic neuropathy
  • microvascular changes
  • warm or cool
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3
Q

when the body does not have enough glucose for energy, burns fats instead, resulting in a build up of acids

A

ketosis

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4
Q

risk factors for T2 DM in childhood

A

> 85% body weight for age/sex
120% ideal weight
relative w DM
high risk ethnicity
mother w gestational DM

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5
Q

how does DM relate to neuropathic ulcers

A

hyperglycemia -> more glucose -> more sorbitol made -> more damage

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6
Q

how does high glucose lead to tissue damage

A

glucose will bind to proteins= glycosylated proteins
these cause tissue damage and form free radicals

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7
Q

sorbitol results from what?

A

breakdown of glucose

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8
Q

neuropathic ulcer risk factors

A
  • vascular disease
  • neuropathy
  • mechanical stress
  • impaired healing
  • poor vision
  • inadequate care and patient education!
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9
Q

is neuropathic ulcers a micro or macro vascular disease?

A

microvascular- below the knee

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10
Q

macrovascular diseases, with regards to ulcers, are usually where?

A

above the knee

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11
Q

DM causing thickening of _________ ________, leading to decreased ___

A

thickening of basement membrane, decreased O2 and nutrients

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12
Q

3 types of neuropathy

A

sensory, motor, autonomic

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13
Q

what is the most common complication of DM T2

A

neuropathy

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14
Q

inability to accurately perceive trauma to an affected area, usually no idea of loss

A

sensory neuropathy

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15
Q

paralysis of the intrinsic muscles

A

motor neuropathy

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16
Q

motor neuropathy in the feet:
___________ plantar pressure
_________ sheer forces
_________ stability in stance
hallux _______
claw toe deformity

A

increased plantar pressure
increased shear forces
decreased stability in stance
hallux valgus
claw toe deformity

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17
Q

motor neuropathy in the hand:
__________ grip
_______ fine motor
_________ injury
hand deformity

A

decreased grip
decreased fine motor
increased injury hand deformity

18
Q

autonomic neuropathy skin changes

A

sweating mechanisms (decreased) , callus formation (increased) , disturbed blood flow

large contributor to neuropathic ulcers!

19
Q

what leads to charcot foot?

A

shoving deformed foot into footwear that doesnt work anymore

uncontrolled vasodilation -> increased blood flow -> more Ca -> predisposed for fracture -> charcot foot

20
Q

will DM T2 patients always have an immune response with infection?

21
Q

hyperglycemia:
______ collagen synthesis, phagocytosis, angiogenesis, fibroblast proliferation
______ tensile strength

A

decrease collagen synthesis, phagocytosis, angiogenesis, fibroblast proliferation
reduced tensile strength

22
Q

an ulcer that is larger, deeper, or older will take ____ to heal

23
Q

midfoot ulcerations heal _______ than forefoot

A

midfoot ulceration heal faster than forefoot

24
Q

fasting glucose versus A1C

A

fasting- snapshot, fast for 12 hours beforehand
A1C- aggregate of how they have managed glucose over the past 3 months.

25
review (idk if this will be on the test)
26
what are tests to assess circulation?
capillary refill, doppler US, ABI, TBI, arteriography, transcutaneous O2 measurement
27
tests to assess sensory integrity
monofilament test 1st, 3rd, 5th digit 12t, 3rd, 5th met heads medial and lateral midfoot calcaneus test each 3 times
28
for local neuropathic ulcer wound care, should the callus be removed?
yes- must be removed
29
for local neuropathic ulcer wound care, do you moisturize in between toes?
no! you moisturize the periwound, but not between toes
30
wagner scale/ UT scale is for
grading neuropathic ulcers
31
will calluses heal?
no
32
what is the gold standard of care for neuropathic ulcers
total contact casting
33
benefits of TCC
**off loads** ulcer by spreading pressure, helps with **edema management**, **decreased shear** and protects
34
contraindications of TCC
non compliance, infection, edema fluctuations ABI <0.45
35
what does gait and mobility help with for neuropathic ulcers?
mobilize while safely eliminate pressure on the ulcer
36
what does ROM exercise help with neuropathic ulcers
limitations in ROM can increase pressure, addresses this issue
37
aerobic exercise can help with what in neuropathic ulcers
glycemic control, help patient to understand ways to do this without walking
38
good glycemic control can reduce DM complications: __% decrease in microvascular complications __% reduction in amputations
25% decrease in complications 36% reduction in amputations
39
surgeries for neuropathic ulcers
* surgical debridement * incision and drainage (abscesses) * address foot deformities (decrease pressure points) * amputation
40
with infection there is a ___ x increased risk of amputation
154 x
41
does medicare cover footwear?
yes- if patients have documented lack of protective sensation qualify for 2 pairs of DM shoes
42