Diabetic Foot Ulcers Nursing

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DIABETIC FOOT ULCERS:

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May start small, but they are a significant cause of amputation and death for people with diabetes.

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DIABETES THAT LOOSE ONE LEG:

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Over half of diabetics that loose one leg, will loose the other within 5yrs. Only about 40% of patients who've had a foot or leg amputated live for another 5 years.

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DIABETIC PATIENTS AT A HIGHER RISK FACTOR FOR FOOT ULCERS AND AMPUTATIONS:

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Male/sex, smoking, having diabetes for more than 10 years, poor blood glucose control, previous foot ulcer or amputation, other complications of diabetes such as peripheral neuropathy.

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PERIPHERAL NEUROPATHY AND PERIPHERAL NERVOUS SYSTER:

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Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness.
The Peripheral nervous system resides or extends outside the "CNS" central nervous system (the brain and spinal cord) to serve the limbs and organs. Unlike the central nervous system, however, the PNS is not protected by bone, leaving it exposed to toxins and mechanical injuries.

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DIABETIC AND PERIHPERAL NEUROPHATHY:

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About half of all diabete patients have PNS, especially in their feet. Both large and small nerve fibers are effected in diabetes associated with Peripheral Neuropathy.

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AUTONOMIC NEUROPATHY: (VISCERAL NEUROPATHY)

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Autonomic neuropathy (also called visceral neuropathy) is a disease of the non-voluntary, non-sensory nervous system (i.e. the Autonomic Nervous System) affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. They do not run through the spinal cord.

Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2.

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AUTONOMIC NEUROPATHY, (VISCERAL NEUOPATHY):

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In the skin affects the sweat glands, reducing , or eliminating perspiration and leading to dry, atrophic skin and encouraging callus formation.

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PERIPHERAL ARTERIES:

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Peripheral Arteries are the arteries (specifically arterioles and capillaries) which are furthest from the heart (mouth, hands, and feet). In some cases blockages in the peripheral arteries may be treated with catheterization and balloon dilatation instead of surgery.

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PERIPHERAL ARTERY DISEASE:

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Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs.

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RISK FACTORS FOR PERIPHERAL ARTERY DISEASE:

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Factors that increase your risk of developing peripheral arterial disease include:

Smoking
Being older than age 50
Having diabetes
Being overweight
Having high blood pressure or a family history of it
Having high cholesterol or a family history of it or high triglycerides, a blood fat
People who smoke or have diabetes have the greatest risk of complications from PAD - such as tissue death (gangrene) in a leg due to reduced blood flow.

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DIABETES AND PERIPHERAL ARTERIAL DISEASE:

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The disease is 4X more prevalent in patients with diabetes than in thos without.
Nearly half of patients who've had diabetes for 20 years or more have Perhpheral Arterial Disease, (PAD), usually below the knees.
The reduced blood flow robs the feet of nutrients needed to maintain healthy tissue and to heal ulcers.

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CHARCOT'S FOOT IN DIABETES:

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Neuropathic osteoarthropathy refers to progressive degeneration of a weight-bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. Onset is usually insidious. It is also known as Charcot joint.

If this pathological process continues unchecked, it could result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst case scenario: amputation. Early identification of joint changes is the best way to limit morbidity.

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ASYMPTOMACTIC:

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In medicine, a disease is asymptomatic while the patient does not experience any noticeable symptoms. Asymptomatic diseases may not be discovered until the patient undergoes medical tests (X-rays or other investigations). Some diseases remain asymptomatic for a remarkably long time, including some forms of cancer. If a patient is asymptomatic, precautionary steps must be taken.

A patient's individual genetic makeup may delay or prevent the onset of symptoms.

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THE SEMMES WEINSTEIN MONOFILAMENT TEST:

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Is simple, inexpensive, and reliable for sensory neurophay. To preform this test, clinician places a 10 gram filament against the skin with just enough pressure to cause the filament against the skin with just enough pressure to cause the filament to bend.
A patient with normal sensation will feel the pressure, a patient with neurophathy wont.

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TOE/ANKLE INDEX (TBI):

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Because calcification is less common in toe arteries, this measurement is more reliable in patients with diabetes and PAD. A TBI greater than 0.9 indicates that arterial flow is sufficient to heal a foot ulcer.
Thoroughly document your assessment findings.

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EXUDATE:

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An exudate is any fluid that filters from the circulatory system into lesions or areas of inflammation. Its composition varies but generally includes water and the dissolved solutes of the blood, some or all plasma proteins, white blood cells, platelets and (in the case of local vascular damage) red blood cells.

Pus is an example of exudate found in infected wounds that also includes bacteria and high concentrations of white blood cells. Clear blister fluid is an example of an exudate that contains water (and solutes) together with some plasma proteins, but not many blood cells.

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TYPICAL PLACES TO FIND HEEL ULCERS ON DIABETICS:

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Heel ulcers on diabetes are difficult to manage and are more likely to result in limb amputation.
You'll typically find these ulcers on the medial, lateral, or posterior aspect of the heel.

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REVASCULARIZATION:

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Revascularization is the process of restoring the functionality of an affected organ. The term derives from the prefix re-, in this case meaning "restoration" and vasculature, which refers to the circulatory structures of an organ.

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APLIGRAF:

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A human skin substitute, is in