Week 2 Neuropathic Interventions Flashcards
how do we want to debride and treat
aggressive debridement and removal of callused, depending on vascular status and if there is eschar on the heel (you leave that alone)
TF: you never debride stable callus hard on the heel
true, because the heel is hard to heal
how else can we treat the injuries
moist and warm environment
offloading
monitor for infection
patient education and glucose control
do we use whirlpool
no because they cannot soak their feet, and we should not be allowing germs to spread.
what are some common interventions
silver (antimicrobial) dressings
growth factors
skin substitutes (Apligraft) MD application
what is off loading
reduce the pressure, promote slow ambulation and facilitate normal gait.
what are some things we can use to offload
Total contact cast (TCC) Charcot restraint orthotic walker (CROW) boots half shoes and AFOs AD (FWW, SPC, crutches maybe) wheelchair (last resort)
what does a half shoe look like
heel is only under one part of the foot
what is a TCC
total contact cast, which is the gold standard for forefoot ulceration and Charcot foot. This is forced offloading for 1-2 weeks at a time.
how does TCC affect gait
decreased activity, stride length and cadence
what is the disadvantages of TCC
need special training, hot and heavy and difficult to self-care
what is proper shoe fit without an ulceration
- shape of the shoe should conform,
- you should have 3/8-1/2 inch space between the longest toe and end of shoe
- deep toe box (for toes to spread)
- not pointy or cramped toes
- adjustable aces or straps for a snug fit
- fit snugly around heel
- wear socks
- closed toes
when do we avoid exercise, at what glucose levels
> 250 with ketosis and >300 without
when do we want to hydrate and eat
before, about 17 ounces
eat: 2 hours before exercise, or exercise 1 hour after food intake
what bout snacks
quick absorbing (fruit) every 30 minutes slow (breads, crackers, pasts) after exercise
for type 2, how many days between bouts of exercise
no more than 2 days
TF: it is no better to exercise at regularly and set times than random
false, we want regular and set times. (like around food and injection schedules)
if glucose is <70…
no exercise
do we want to exercise late at night and alone
no, may get a delayed hypoglycemia event during sleep
can we use an injection sites over muscles that will be heavily used that day
no
TF: its ok to do high intensity impact and head down exercises
false, we want low impact and resistance, and walking, stationary bike, swimming, rowing and UE exercise
what is the exercise goal for pre-diabetics
lose 5-10% body weight and at least 150 minutes moderate exercise per week
what is the focus of exercise
overall health and importance of regular exercise and FALL prevention
with neuropathic injuries what precautions must we take with heat application
- faster insulin absorption from the injection site can lead to hypoglycemia
- more likely to burn (decrease blood flow and sensation)
- abnormal cardiac responses
why must we be careful with cold application
slower absorption from injection site (hyperglycemia)
and cold tissue injury
how is the treatment team a multi-disciplinary approach
PCP, Diabetes management, podiatrist, PT, orthotist, ortho surgeon, vascular surgeon