Wound Care Part 3 Flashcards
what is a diabetic foot ulcer (DFU)?
an ulcer on the plantar surface of the foot
a deep neurotrophic ulcer of the sole of the foot resulting from repeated injury bc of lack of sensation in the part
t/f: a DFU results from DM
false, not always the case
although DFUs are often seen in pts with DM, what other disease may contribute to their formation?
RA and other progressive diseases
what are the primary factors associated with DFUs?
peripheral neuropathy
pressure, friction, and shear
peripheral vascular disease
limited joint mobility/foot deformities
loss of protective sensation
diabetes is the ___ leading cause of death in the US
7th
what is the pathophysiology behind DFUs?
a combo of periperhal neuropathy, peripheral vascular disease, and biomechanical abnormalities along with minor trauma
peripheral neuropathy is associated with ____ fold higher risk of ulceration and ____ fold higher risk of amputation
8-18, 2-15
what is an independent predictor of ulceration and amputation?
dorsal foot transcutaneous oxygen tension (TcPO2)
what are biomechanical abnormalities that can lead to DFUs?
foot deformities
limited joint mobility
what are the characteristics of diabetic/neuropathic ulcer?
high morbidity
neuropathy
high infection rate
altered biomechanics and WB distribution
round punched out lesions with elevated rim (like a volcanic crater)
minimal drainage
often deep and infected
painless
what stage DFU is this: pre-ulcerative, healed ulcers, presence of bony deformities
stage 0
what stage DFU is this: superficial ulcer w/o subQ tissue involvement
stage 1
what stage DFU is this: penetration through subQ tissue, may expose bone, tendon, ligament, or jt capsule
stage 2
what stage DFU is this: osteositis, abscess or osteomyelitis
stage 3
what stage DFU is this: gangrene of the digits
stage 4
what stage DFU is this: gangrene of the foot requiring disarticulation
stage 5
when testing for loss of protective sensation (LOPS), what monofilament do we use?
5.07 Semmes-Weinstein monofilament
when you touch the pt’s skin with the 5.07 monofilament, it takes ____ grams of force to bend the filament
10
if the pt cannot detect the 10 grams of force with the 5.07 monofilament, what does this mean?
they have a loss of protective sensation
other than monofilament testing, what neurologic examinations might we use?
vibration testing
LE reflexes
what do we want to include in our pt hx with a DFU?
HbA1c levels
past hx of ulceration
activity levels
other DM complications
what items do we want to include in the exam with a DFU?
pt hx
foot inspection for deformities
foot pulses
ABI if indicated
t/f: no arterial surgery can be done in DM bc of the calcification of the vessels
true
what is a total contact cast?
method used to treat DFU by fitting a non-removable cast around the affected leg to off load weight
