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yr4s1: theory of pod > wk 3- high risk foot- RA > Flashcards

wk 3- high risk foot- RA Flashcards

1
Q

who is considered high risk foot

A

diabetes
rheumatology (RA, Gout, charcot)
PAD

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2
Q

septic arthritis what is it and who does it affect more commonly?

A

bacterial infection of synovial space

more commonly occurs in people with RA, diabetes or joint prosthesis

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3
Q

risk factors of septic arthritis

A

80 or older
diabetes
RA
prosthetic joint
skin infection
ulcers
IV drug use
alcoholism
joint injection
joint surgery within 3 months

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4
Q

signs and symptoms of septic arthritis

A

-acute joint pain
-swelling
-warmth
-erythema

signs can be subtle with those that are immunocompromised

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5
Q

list of RA medications that affect wound healing

A

NSAIDs- diclofenac
Cytotoxic drugs- MTX
steroids- prednisolone
biologic DMARDs- etanercept, infliximab

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6
Q

Impact of NSAIDs on tissues

A

inhibits platelet aggregration and proper coagulation

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7
Q

impact of cytotoxic drugs on tissue healing

A

impair wound healing and increase infection (immunosuppressant)

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8
Q

impact of steroids on tissue healing

A

thinned abnormal dermis and epidermis

increase risk of infections because it is a immunosuppressant

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9
Q

impact of biologic on tissue healing

A

little is known about the effect on tissues

increased risk of infection

immunosuppressant

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10
Q

what drug is usually stopped when there is signs of infection with an ulcer in RA

A

biologics

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11
Q

consideration with wounds in RA

A

1.pain is a major issue
consider autolytic debridement instead of sharp.

  1. no classic signs of infection: difficult to decide if infection present or flare in disease
    consider: bloods, imaging, swabs.
  2. joint deformity and erosions can make probing to bone difficult to assess for OM
    -x ray imaging
  3. dressings are an issue
    due to rigid deformities and pt ability to redress
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12
Q

wound assessment stage 1 (patient related factors)

A

medical history
medications
wound cause/ wound history
social history
family history
nutrition
pain

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13
Q

medications that affect wound healing

A

steroids
NSAIDs
DMARDS
chemo
antiplatelet
anticoagulents

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14
Q

types of wound causes

A

neuropathic
ischaemic
venous
neuroischaemia

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15
Q

what tool could you use to detect disease related malnutrition

A

MUST- malnurtrition universal screening tool

looks at BMI, rate of weight loos and presence of acute disease

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16
Q

wound assessment stage 2 (wound related factors)

A

wound history

objective:
doppler
photograph
size, depth, location
duration
cause
wound description (exudate, base, edge, SOI, peri wound)
wound classification (SINBAD, WIFI)

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17
Q

WIFI

A

wound-
0-no ulcer/gangrene
1-small ulcer no gangrene
2- deep ulcer or gangrene at toes
3- extensive ulcer or gangrene

ischemia
0->59mmHg
1-40-59
2-30-39
3-less than 30

infection
0-no
1-mild (less than 2cm cellulitis
2-mod greater than 2cm
3- sepsis

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18
Q

SINBAD

A

site- midfoot/hindfoot 1
ischaemia- reduced flow 1
neuropathy- lops 1
infection- present 1
area greater than 1cm 1
depth- muscle, tendon or bone 1

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19
Q

autolytic debridement through what

A

hydrogels
hydrocolloids
honey dressings

20
Q

what treatment for ischaemic wounds

A

keeping it dry

21
Q

TIMERS acynom

A

Tissue
Infection
Moisture
Edge
Regeneration
Scoial factors

22
Q

RA and cardiovascular risk

A

50% increased risk of sudden cardiac event

23
Q

minimum vascular assessment in RA

A
  1. history of modifiable and non modifiable risk factors
  2. palpation of foot pulses
  3. skin, temp and visible clinical features
  4. intermittent claudication and ischaemic rest pain identified
24
Q

disease activity score

A

assessment done by rheumatologist of 28 joints to determine activity of disease

25
IWGDF risk status
Very Low- no LOPS/PAD, every 12 months Low- LOPS or PAD, every 6-12 Mod- 2 of the 3: LOPS, PAD, deformity, every 3-6 High- LOPS or PAD and one more of the following history of FU, lowerleg amputation, end stage renal disease
26
Education for diabetes
- wear shoes indoors - inspect feet and shoes daily - use emollients - cut nails straight
27
Prevention of ulcers
1. Medical grade footwear/ orthoses 2. Treat risk factors 3. Tenotomy (weak, low)
28
Offloading for plantar heel ulcer
Knee high offloading device
29
Mild infection OR ischaemia
Non removeable knee high device
30
Mild infection and mild ischaemia or Mod infection or mod ischaemia
Removable knee high device
31
High falls risk
Removeable ankle high
32
Mod infection and mod ischaemia or severe infection or severe ischaemia
Medical grade footwear with felted foam
33
After how long of no healing do you consider tenotomy
6 weeks and it hasn’t reduced in size by 50%, refer to surgeon
34
ABI
0- more than 0.8 1- 0.6-0.79 2. 0.4- 0.59 3. Less than 0.4
35
Toe pressure
0- 60 or more 1- 40-59 2. 30-39 3- less than 30
36
Case control study
Case- people with a condition / outcome Controls Go back to see what people were exposed to to identify risks Retrospective
37
Matched case control mesns
The controls are as similar as possible to cases
38
39
research question for case control
P E- exposure (risk factors) C O
40
41
What makes a case control study a good design to choose
1. Not as expensive 2. Good start when there’s not enough observational studies out there yet 3. When you don’t have time for longitudinal study
42
More risk factors means
More false positives in p value due to chance
43
Cross sectional study
Outcomes and risk factors are assessed at the same point in time
44
Prevalent v incident
Prev- already have the condition Incident- don’t have it yet and tracking for condition
45
Controls: matched, randomly selected or population based

yr4s1: theory of pod (7 decks)

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