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
how does a total contact cast offload weight?
by bearing weight to the shift of the calf, not the sole of the foot
how long is a total contact cast kept on?
7-10 days
what is the pt position during fitting of a total contact cast?
prone with 90 deg flexion at the knee and ankle
what is the gold standard timeline for healing with a total contact cast?
12-20 weeks
what is a total contact cast typically made of?
fiberglass or plaster
how does the total contact cast provide optimal wound healing conditions?
by ensuring that the ulcer isn’t further traumatized and also prevents development of new ulcers in the bony prominences of the foot
what does the evidence tell use about total contact casts for DFUs?
they improved wound healing better than removable cast walkers, therapeutic shoes, or conventional therapy
what muscles are the body’s “2nd heart”?
the calf muscles
why are the calf muscles considered the body’s second heart?
bc their use improves blood circulation when exercising, usually by walking
what kind of exercises training increases calf ms pump fxn, lower limb circulation, and walking capacity for those with limited ambulation due to peripheral arterial disease (PAD) or venous insufficiency
structured exercise training (SET)
Medicare/Medicaid will reimburse up to how many 30-60 min , properly supervised hospital, outpatient, or office-based SET sessions over 12 weeks to treat intermittent claudication for pts with PAD?
36
t/f: exercise program results are better than surgery for claudication
true
what are the benefits of exercise for wounds?
rapid wound healing
reduced oxidative damage
healthy lifestyle
a study in older adults found that regular exercise can speed up wound healing by ___%
25
t/f: a study found that physical exercise training shows healing in older adults
true
exercise plays a major role in prevention and control of ____ resistance and different types of DM
insulin
how does exercise aid in delivery of more oxygen, which is critical for healing?
it upregulates blood flow
exercise is essential for the formation of _____
collagen
t/f: exercise increases inflammation
false, it decreases inflammation
exercise can reduce the risk of what kind of mortality?
CV mortality
treadmill training for individuals with claudication pain should be done _____x/week (supervised)?
3-5
how long should the warm-up/cool-down be in treadmill training for claudication pain (supervised)?
5-10 min
what speed should be used in treadmill training for claudication pain (supervised)?
speed enough to elicit claudication pain within 3-5 min
what are the guidelines for treadmill training for claudication pain (supervised)?
At least 3-5x/week
5-10 min warm p and cool down
Set speed to elicit claudication pain within 3-5 min
Pt rests until pain subsides
Repeat cycle during exercise session
what are the treadmill training guidelines for claudication pain (unsupervised)?
Begin at 35 min and increase by 5 min to 50 min
Modify speed and grade so pain (8/10 VAS) always occurs during workout session
Monitor vitals
Continue 2-3 months until goals are met and pt is educated to exercise w/o direct supervision
unsupervised treadmill training for claudication pain should begin with ___ min and increase by 5 min to ___ min
35, 50
in unsupervised treadmill training for claudication pain, what grade of pain should always occur?
8/10
how long should pts do unsupervised treadmill training for claudication pain?
2-3 months
what is the Ohio protocol for exercise for non-healing wounds?
Warm up 10 min with stretches
Ride stationary bike 30 min (hard enough to maintain goal HR)
Walk briskly and/or jog 15 min
Use exercise equipment to strengthen arm muscles
Cool down for 5 min
3x/week for 3 months
if the Ohio State protocol for exercise for non-healing wounds reimbursed by insurance?
yup
generally, we should use ____ reps, ____ weight
high, low
