Neuropathic wounds Flashcards
Neuropathic ulcers risk factors
diabetes mellitus
Impaired healing
vascular disease
tri neuropathy
mechanical stress
Impaired ROM
Foot deformities
pervious ulcer or amputation
Impaired healing and hyperglycemia
Bacteria proliferate rapidly in a high glucose environment
impaired production and migration of neutrophils
Impaired chemotaxis, migration, and mobility of macrophages
Impaired function of fibroblast
Deficient blocking normal physiological enzymes that degrade tissue endothelial cell dysfunction
Impaired epithelial cell migration
Further complicated by underlying decreased blood flow
Slower healing and decreased ability to fight infection
higher risk of local systemic infection
Impaired ability to fight infection once present
Planted signs and symptoms of infection
Difficult to determine
tri neuropathy
sensory motor and autonomic
Usually symmetrical
affects distal nerves first
Severity increases with age, duration, and poor glucose control
sensory effects in trineuropathy
Poor awareness of trauma to the feet
Occurs gradually
Paresthesias burning tingling aching
Painful, debilitating, and false sense of protective sensation
Motor effects of tri neuropathy
paralysis of foot intrinsics
Hallux valgus
claw toe
autonomic neuropathy
altered sweating
Callus formation
Blood flow
ArterioVenous shunting
vasodilation-increases blood to bone, leaches calcium, predisposes bones of the foot to osteopenia and charcot arthropathy
charcot arthropathy
fracture and dislocation= but deformity and abnormal pressure
Suspect if - inflammation edema, warm bounding pulse may have open wound
Temperature 3 to 5° higher without an ulcer and may indicate charcot foot
diagnosis, x-ray MRI
Treatment total contact casting for 3 to 12 months progressed to crow boot or diabetic footwear
Neuropathic ulcer characteristics
round punched out, maybe deep and probe to bone
Periwound callus
Typically on plantar aspect of foot
Minimal to moderate drainage eschar uncommon
red pale granulation
Wound is not painful
Wagner grading scale usage
only used for Neuropathic ulcers
wagner grading scale
0- no open lesions may have deformity or cellulitis
1-superficial ulcer
2-deep ulcer tendon capsule or bone
3-deep ulcer with abscess osteomyelitis or joint sepsis
4-localized gangrene
5-gangrene of entire foot
Interventions for DFUs
aggressive debridement, and callous saucerization
moist wound environment
offloading
monitor for infection
patient education
silver
growth factors
skin subsitutes
offloading
reduce pressure promote slow ambulation facilitate normal gate as possible
Total contact cast or instant total contact cast
Hexagon offloading Walker
Charcot restraint, orthotic walker
Half shoes
Wound care healing sandal
felt Form dressing
assistive devices
Total contact cast
Gold standard of care
forefoot ulceration and charcot foot
requires special training
Forced offloading
Change every 1-2 weeks
Decreases activity level stride length cadence
Exercise for patients with diabetes
avoid if Glucose is greater than 250 with ketosis or greater than 300 without
stress= increased insulin requirements
Hydrate before - 17 ounces
Eat two hours before exercise or exercise one hour after food intake
Eat quick absorbing fruit every 30 minutes
Eat slow absorbing bread, pasta after exercise
Type two- no more than two days between bouts of exercise for best control
Ketoacidosis signs (ketosis)
weak and rapid pulse
Increased thirst
Increase urination
Confusion, nausea abdominal pain
weak or tired
Fruity smelling breath
Type of exercise for diabetes
avoid high impact
Low impact and resistance activities are best
Walking stationary bike, swimming rowing upper extremity exercise
Prediabetes lose 5 to 10% of body weight and at least 150 minutes moderate exercise per week
Focus on overall health and importance of exercise as well as gait balance and fall prevention
