Prevention Flashcards
T or F: most amputations are preventable
T
Top cause for amputations?
peripheral vascular disease
*trauma is second
risk factors for vascular disease
- smoking
- HTN
- atherosclerosis
- DM
- high cholesterol
- age older than 60
- black race
what is the classic symptom of PAD?
pain in the legs with exertion that is relieved with rest
T or F: everyone with PAD has leg pain
F: 40% don’t
what are some behaviors that can prevent and reduce symptoms of PAD?
- exercise
- avoid smoking
- control HTN, cholesterol, and DM
what is the leading cause of limb loss
DM
where is DM most prevalent
southeast
is type 1 or 2 DM more common
type 2 90-95% of people
risk factors for DM
- increased age
- lack of exercise
- family hx
- socioeconomic conditions
- obesity
- race/ethnicity
T or F: the incidence of DM has decreased
T: new cases appears to be slowing
pre-diabetes
blood sugar levels higher than normal but not high enough for DM dx
*increased risk of type 2 DM, heart disease, and stroke
T or F: a health care disparity exists for the prevalence of diabetes
T: minority groups more likely to be diagnosed with diabetes
T or F: s higher percentage of those without a high school degree had diabetes compared to those with a degree
T
T or F: type 2 diabetes is decreasing in children
F: its increasing
T or F: preventative methods for diabetes seems to be helping
T: they are helping to decrease the rate of amputation
T or F: end state renal disease is heavily linked with amputation
T
those w/ DM should often be refered to a…
nutritionist
exercise specialist
recommended cardiovascular exercise for those with DM
150 mins of mod to vig PA a week
*RPE can be used to measure
what kind of training can lead to rapid improvements in glucose control in those with type two DM
low volume, HIIT training
what heart rate should you be at for hit
70-90% of max
if your patient has a family and is busy, what is a big benefit of HIIT
time efficient, only takes about ten minutes
what should those with type 2 DM have done before doing vigorous exercise
12 lead ECG screening
_____% of amputations related to DM complication could have been prevented
60%
about _____% of DM related amputations are preceded by a foot ulcer
85%
“at risk” root
pts w/ DM, PVD, and renal disease who are considered highly susceptible for developing a foot ulcer
the presence of a foot ulcer is associated with a ______ fold increase in amputation risk among pts w/ DM
five
“high risk” foot
pts who has had an amputation for any reason and pts with a foot risk score of 2 or 3
a combination of what 3 things usually leads to skin opening
1 - poor circulation
2 - sensory loss
3 - mechanical issues
*skin opening places you at risk for deep infection and then emputation
as you apply higher loads, the chances of ulceration _________
increases
*footwear impacts this
repeated moderate pressure leads to ______ which then leads to ________
inflammation
ulceration
is polyneuropathy or mononeuropathy more common
poly
3 systems affected with neuropathy
sensory
motor
autonomic
neuropathic pain is worst at ______ and relieved with ________
rest
walking and at night
T or F: neuropathy is influenced by elevation
F
________- dysfunction in neuropathy leads to elevated forces and altered area of contact
motor
hammertoes
flattening of distal phalanges
claw toes
hyperextension of the MTP joint and flexion of the PIP and DIP joints
autonomic dysfunction in neuropathy sx
- impaired sweat glands
- reduced sweating
- dry skin and cracks
- altered vasomotor regulation
- dilation of arterioles
- bulging, warm, red foot
2 ADA recommended ways to examine vascular status in feet
- pulses
- ABI
two pulses you check for vascular status
dorsalis pedis
posterior tib
pulse measurement scale
0 - absent
1 - weak
2 - normal
3 - full
4 - bounding
WNL ABI
0.9-1
impaired flow of ABI
<0.9
unlikely to heal distal wound ABI
<0.5
two electro diagnostic tests for sensory fx
nerve conduction velocity
electromyography
4 quantitative sensory measurements
pressure
vibratory threshold
pinprick sensation
ankle reflexes
charcot deformity
- complete collapse of medial arch
- very flat foot
if you have had an amputation, PVD, or an ulcer you are automatically a _______- risk foot
high
what kind of inserts are often used as ulceration/amputation prevention
soft
5 rules for orthotics/shoes
1 - contours of shoes most closely match contours of feet
2 - widest part of forefoot should be widest part of shoe
3 - length should be 1/2 inch between end of the longest and end of shoe
4 - roomy toe box
5 - try on late in the day
3 ways to reduce pressure during gait
- limit push off
- reduce speed
- reduce step length
the VHA developed PAVE. what does it do?
tracks everyday at risk individual from date of entry into the healthcare system through all the appropriate healthcare levels
