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13 Cards in this Set
- Front
- Back
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3 reasons why healing is impaired in the DM pt |
peripheral vascular disease neuropathy altered infection response |
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peripheral vascular complications |
∆ in vessel walls impairs ability to ↑blood flow d/t temp variance
↓delivery of leukocytes & abx agents
↓O₂ delivery → ↓macrophage mobility, facilitates anaerobes |
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3 types of neuropathy |
onset of neuropathy related to degree of BG control
sensory pt unable to feel pain/pressure, protective response gone
motor denervation of intrinsic sk muscles of lower leg & foot leads to structural ∆ of foot → claw toes, foot drop yields abnormal pressure, callus formation
autonomic ↓integumentary secr (sweat, sebum) → skin dryer & less elastic may result in fissures/cracks infection may follow |
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altered infection response |
inadequate ↑ of WBC, temperature
alterations in systemic SNS response
uncontrolled hyperglycemia often 1° indicator of infection
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neurotrophic foot ulcer |
d/t Charcot foot, claw toes
ischmia, mechanical disruption, ↓inflammation, osteomyelitis
need to manage pt WRT wound |
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Charcot foot |
causative factors incl trauma-related microfractures ligamentous relaxation osteolysis & bone reabsorption venous stasis - check for bounding pulses osteoporosis c abnormal brittleness lack of oxygenation & perfusion
all lead to trophic bone changes navicular breaks away
joints affected tarsometatarsal, metatarsophalangeal, tarsus, interphalangeal |
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Charcot foot treatment |
acute window is short pt may not feel it d/t neuropathy
total contact casting to offload
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claw toes |
MTP dorsiflex c IP flex
may also occur c callus & discolor of hallux tip hallux pronation hallux rigid hallux bunion
check ABI, cap refill, rubor of dependency, venous refill
look for ulcers superior phalangeal joint, toe tip
user rocker-bottom shoe to promote more normal gait |
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4 stressors in limb neuropathy |
ischemia low pressure over extended period common on lateral aspect of foot d/t narrow shoes
mechanical disruption direct high-psi (600) injury - stubbing a toe
inflammatory repetitive mod-psi (400) weakens tissue, prompts callus formation callus obscures signs of infection, prevents epithelialization
osteomyelitis moderate force c infection spreads infection deeper & into bone |
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checking for & educating re neuropathic feet |
use all S-W filaments teach to inspect entire foot MMT for foot/ankle complex |
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Wagner grading system |
applies to diabetic & neurotrophic ulcers
0: skin intact 1: superficial ulcer 2: ulcer penetrates to tendon/bone 3: +for abscess/osteomyelitis 4: gangrene on forefoot 5: gangrene over major portion of foot
Prof sees mainly 2/3 4 sometimes, but surgery impending |
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dressing type & gangrene |
keep it dry - don't hydrate dry gangrene |
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specialized footwear for diabetics |
needed d/t peripheral neuropathy or compensating for differently shaped foot
purpose balance, gait, unload ulcer, reduce pressure & shear force
differences wide toebox, velcro, thicker/stiffer sole, greater depth of nose
shear force can decr time-to-ulcer to as little as 10 min |
