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PTRS 746 Exam 1 > The Neuropathic Foot > Flashcards

The Neuropathic Foot Flashcards

1
Q

Q: What % of those with diabetes will develop neuropathy?

A

50%

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2
Q

T/F: Neuropathy is implicated in 25% of non-traumatic amputations.

A

False, 50-75%

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3
Q

Q: What are the mortality rates 1 and 5 years after amputation?

A

40%, 80%

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4
Q

Content: Causes of neuropathy (6)

A
  1. Diabetes
  2. Tumor, trauma
  3. Autoimmune disease
  4. Vitamin B, E, niacin deficiency
  5. Exposure to toxins
  6. Infection
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5
Q

Content: 4 types of neuropathy

A
  1. Peripheral - UE/LE
  2. Autonomic - CVS, temp reg, bowel/bladder
  3. Proximal - thigh, hip, core mm
  4. Focal - sudden loss in one n. or group of n.
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6
Q

Content: Foot Examination (3)

A
  1. comprehensive foot exam should be completed at LEAST annually
  2. those with neuropathy should have feet visualized every medical visit
  3. those with diabetes should check their feet each day
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7
Q

Content: Goals of the foot exam (4)

A
  1. Est. history/diagnostic factors
  2. Identify risks
  3. Intervention
  4. Education
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8
Q

Q: _________ involvement in foot neuropathy is __________.

A

Early, crucial

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9
Q

Q: What habit can increase your risk of neuropathy?

A

smoking (current or past)

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10
Q

Content: SE for foot neuropathy (7)

A
  1. Contributing diagnosis
  2. PMH/social factors
  3. Medications
  4. Complications
  5. Hx of LE surgery, ulcer, amputation
  6. Current or past smoker
  7. HbA1c (diabetes)
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11
Q

Content: OE for foot neuropathy (5)

A
  1. Condition of skin, hair, toenails
  2. Deformities
  3. Pulses
  4. Sensation
  5. Shoe wear
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12
Q

Content: Skin (3)

A
  1. Think, shiny, brawny and/or frail
  2. Dry
  3. Calluses/wounds
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13
Q

Content: Hair

A

May be present or absent

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14
Q

Content: Toenails (3)

A
  1. Thickened
  2. Deformed
  3. Ingrown
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15
Q

Content: Four neuropathy deformities (4)

A
  1. Prominent metatarsal heads
  2. Hammer/claw toes
  3. Hallux Valgus/bunions
  4. Charcot Foot
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16
Q

Diagram: Identify the Deformity

A

Claw toes

17
Q

Diagram: Identify the Deformity

A

Hammer toe

18
Q

Diagram: Identify the Deformity

A

Upper = corn

Lower = callus

19
Q

Diagram: Identify the Deformity

A

Hallux Valgus

20
Q

Content: Charcot Arthropathy (4)

A
  1. Progressive bone destruction and ligament damage leading to arch colllapse and impaired skin integrity
  2. Affects abot 9% of those with diabetes
  3. Unclear if etiology is neurotraumatic, neurovascular, or both
  4. Generally treated with complete immbolizations in a total contact cast with protected WB
21
Q

Q: What 3 pulses should you check during a foot exam?

A
  1. Posterior tibilais
  2. Dorsal pedis
  3. Ankle brachial index (ABI)
22
Q

Cotent: ABI Scale (6 parts)

A

> 1.2 = vessels are incompressible, consider toe brachial indexes

  1. 0-1.2 = normal
  2. 9-0.99 = acceptable

< 0.9 = arterial disease

0.5-0.8 = intermittent claudication

< 0.5 = severe arterial disease

23
Q

Content: Sensation assessment (2)

A
  1. Semmes Weinstein Monofilament (10 locations)
  2. Vibratory sensation (128 Hz tuning fork, latency > 10 sec = sensory loss)
24
Q

Content: Assessment - Low Risk Foot Neuropathy (4)

A
  1. Preserved sensation
  2. No defromity
  3. Intact circulation

4 Tx: Annual foot exam, education, good footwear

25
Q

Content: Assessment - High Risk Foot Neuropathy (6)

A
  1. Sensory loss
  2. Deformity
  3. Vascular disease
  4. Callus formation
  5. Hx of ulcer or amputation
  6. Tx: comprehensive assessment, education, diabetic shoe
26
Q

Content: Education (4)

A
  1. General diabetes self care
  2. Foot/skin care
  3. Daily skin checks
  4. Proper footwear (breathable, adjustable, wide toe box, good support)
27
Q

Content: Ulcer intervention (4)

A
  1. Debulk callus
  2. Control moisture
  3. Decrease infection risk
  4. Edema management
28
Q

Content: Offloading (5)

A
  1. Total contact casts (change ever 1-2 wks)
  2. Orthotics/walking boots
  3. Surgical shoes
  4. Dressings
  5. Cutouts
29
Q

Q: How should you elevate a pts. heels?

A

With pillow under calves

30
Q

Content: Foot Care Education (6)

A
  1. Check feet daily
  2. ALWAYS wear shoes
  3. No lotion/oil between toes
  4. Keep nails clipped
  5. Manage calluses
  6. Report changes immediately
31
Q

Content: Exercise recommendations for foot neuropathy

A

At least 30 min most days - consider foot integrity

32
Q

Content: Nutrition recommendations for foot neuropathy (4)

A
  1. Montior BMI - stable or weight loss
  2. Fresh fruits/veggies
  3. Pre meal glucose 90-130 mg/dl
  4. Post meal glucose 180 mg/dl
33
Q

Content: glycemic control recommendations for foot neuropathy

A

HbA1c goal of < 6.5-7

34
Q

Q: What is HbA1c?

A

Average blood sugar over a peroid of 3 months

35
Q

Q: Who could you refer pts. with foot neuropathy to? (4)

A
  1. Podiatry
  2. Wound care
  3. Nurse educator
  4. Dietician
36
Q

Defn: Claw toe

A

Hyper extension of MTP with PIP/DIP flexion

37
Q

Defn: Hammer toe

A

Hyperextension of MTP and DIP

PTRS 746 Exam 1 (9 decks)

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