Neuropathy Flashcards

1
Q

How should screening take place?

A

Use a 10g monofilament or vibration using 128Hz tuning fork.

**can help identify asymptomatic patients

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2
Q

What is the only preventative measure for onset and progression?

A

Intensive glycemic control

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3
Q

What four classes are used to treat neuropathic pain?

A

Anticonvulsants
Antidepressants
Opioids
Topical nitrate spray

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4
Q

What are 5 risk factors for development of peripheral neuropathy?

A
High BG
HIGH TG
Smoking
HIGH BP
High BMI
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5
Q

What reduction in pain from baseline is considered clinically meaningful response?

A

30-50% reduction.

Few patients will have complete relief.

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6
Q

Is surgical release of distal

Lower limb nerves a recommended treatment?

A

No. Lack of evidence and foot and ankle surgery is risky for patient with diabetes.

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7
Q

When should screening start for peripheral neuropathy?

A

At diagnosis for type two.

Type one After 5 years diagnosis and those 5 years are past puberty

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8
Q

What percentage of D patients will Develop neuropathy?
In how many years?
Is this type one or two?

A

40-50%

10 years after diagnosis (type one OR two same)

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9
Q

What are the three most common manifestations of autonomic neuropathy?

A

Cardiovascular
Gastrointestinal
Genitourinary.
Can affect ANY part of the systems.

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10
Q

What percentage of pts are asymptomatic?

A

50%

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11
Q

How often should a patient with diabetes have their feet checked by a professional?

A

At least yearly

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12
Q

Should diabetics soak their feet?

A

No

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13
Q

What 2 conditions predispose a diabetic for foot ulceration?

A

Neuropathy and peripheral arterial disease

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14
Q

What test is a significant and independent predictor of future foot ulceration and possible amputation?

A

Loss of sensation to 10g monofilament on dorsal plantar surface.

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15
Q

Which characteristics are risk factors for foot ulceration?

A
Peripheral neuropathy 
Peripheral arterial disease
Previous ulceration 
Structural deformity 
Limited joint mobility
High A1C
Microvascular complications 
Onchomycosis
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16
Q

Wound classification uses A to D and 0 to 3.

Describe

A

A. No infection.
B. Infection
C. Ischemia
D. Infection AND Ischemia.

  1. Pre or post ulcer but completely epithelialized.
  2. Superficial wound
  3. Wound penetrates to tendon or capsule.
  4. Wound penetrates to bone or joint
17
Q

Erythema and swelling on the foot may be a sign of what? (2)

A

Cellulitis

Charcot foot

18
Q

Management of foot ulcer should address what 5 areas:

A
Glycemic control 
Off load pressure
Infection 
Lower extremity vascularity status 
Local wound care
19
Q

Foot assessment by a health care provider should include assessment of:

A
Skin changes 
Structural abnormalities 
Skin temperature 
Evaluation for neuropathy and PAD 
Ulcerations
Evidence of infection
20
Q

What is the ankle brachial index used for?

A

Peripheral arterial assessment of thr foot

21
Q

How do foot deformities happen secondary to neuropathy?

A

Poor circulation leads to motor neuropathy which results in weakness and wasting of muscles of foot. This can cause foot deformities such a hammer toe, Charcot, loss of arches, claw toes. Etc.

22
Q

If a patient cuts their foot, how many days so you wait of “not healing” before going to dr?

23
Q

What are the six risk factors for neuropathy?

A
Elevated glucose 
Elevated TG
high BMI
Hypertension 
Smoking
Duration of diabetes
24
Q

Is diabetes the leading cause of neuropathy in North America?

25
What are some signs of cardiac autonomic neuropathy?
Heart rate variability Postural hypotension Testing tachycardia
26
Measuring BP while supine and then while upright, if there is a fall of greater than 20mmHg without an appropriate increase in HR what is this a sign of? AND how do you treat it??
Postural hypotension caused by Cardiac autonomic neuropathy Treat with increase of salt and fluids, reducing exacerbating drugs, compression stockings, elevate head of bed. Meds: midodine. Flodrocortisone.
27
Gastrointestinal neuropathies can show up as
Gastroparesis Constipation or diarrhea Incontinence
28
Bladder dysfunction in autonomic neuropathy can show up as
Loss of sensation Disposition to infection Inability to empty
29
Autonomic neuropathy can show up as sudomotor as normalities which are;
``` Loss of sweating in extremities Inappropriate truncal sweating Dry skin Heat intolerance Gustatory sweating which is excessive sweating in head and neck triggered by food consumption or smell of food. ```
30
What is Charcot foot
Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape.
31
How is Charcot treated?
Immobilization for months | Sometimes surgery
32
What specific dressings are recommended?
None. Use general wound healing principles of moist wound environment and and off loading pressure
33
``` Which test predict micro vascular complications? Which is the best indicator of CVD?? A1c 2hr PP IN OGGT FBG ```
All of them. | A1C.
34
Diet for gastroparesis
``` Lower fibre Cooked soft. More frequent smaller meals Chew good more Basically stuff easier to digest in smaller positions because of delayed gastric emptying ```