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8] Diabetic Wounds Flashcards

(75 cards)

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1
Q

How much % of ppl with DM will develop wounds in their life?

A

15%

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2
Q

85% of those preceded by a

A

Foot ulcer

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3
Q

Mortality rate after amputation

A

50% within 3-5 years

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4
Q

Rate of ocntralateral amputation is

A

50% within 4 years

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5
Q

Of all amputations 86% could have been prevented by

A

Proper footwear and patient education

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6
Q

Diabetic wounds are on legs or feet?

A

FEET

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7
Q

Neuropathic wounds - sensory

A

Loss of protective sensation

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8
Q

Neuropathic wounds- motor

A

Wasting of intrinsic muscles of foot and structural deformities

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9
Q

Neuropathic wounds- autonomic

A

Dry, cracked skin due to decreased sweating, decreased lubrication, fissures

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10
Q

Most commonly affected area of diabetic

A

Great toe

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11
Q

Order of affects with diabetic foot ulcers

A 
Great toe - 30%
1st met head- 22%
Dorsum of digits - 13%
Plantar surface of other toes- 10%
5th met head- 9%
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12
Q

Etiology of diabetic foot ulcer

A

Neuropathy + ischemia + Structural

changes = abnormal pressure points and repeated trauma

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13
Q

Risk factors of diabetic foot ulcer

A
  • Poor glucose control
  • Loss of protective sensation
  • Progressive shape changes of foot
  • Poor foot wear
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14
Q

Wagner is for what?

A

Grading foot ulcers on a scale of 0 - 5

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15
Q

What is Wagner grade 0

A

Damage to foot but skin intact

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16
Q

Treatment for grade 0 Wagner

A

Protection (TCC, orthotic, footwear)

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17
Q

Grade 1 Wagner

A

Superficial or partial-thickness ulcer

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18
Q

Treatment for grade 1

A

Local wound care, manage edema, protect from maceration, foot protection

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19
Q

Wagner grade 2

A

Full thickness wound with subcutaneous involvement

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20
Q

Treatment for grade 2 Wagner

A

Local wound care, manage edema, protect from

maceration, foot protection

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21
Q

Grade 3 Wagner

A

Infection (abscess, osteomyelitis)

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22
Q

Treat for grade 3 Wagner

A

Refer to ortho surgery for I&D or resection of bone

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23
Q

Wagner grade 4

A

Gangrene of forefoot

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24
Q

Treat for grade 4 Wagner

A

Refer to vascular surgeon for re-vascularization or amputation

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25
Grade 5 Wagner
Gangrene of most of the foot
26
Treat for Wagner grade 5
Refer to vascular surgeon fr re-vascularization or amputation
27
Characteristics of diabetic foot wounds
Plantar aspect of the foot, particularly the metatarsal heads, plantar heels, or toes
28
Are there tropic changes in diabetic foot wounds
Yes
29
What kind of wound bed with diabetic foot wounds
Deep, pale wound bed with some necrotic tissue
30
What kind of edges?
Smoot edges with callus rim
31
How much drainage?
Low to moderate
32
If infection happens, which is common, suspect what?
Osteo
33
Risk factors for Charcot foot
``` Ages 50-60 Diabetic for more than 10 years Peripheral neuropathy Loss of protective sensation Nephropathy Retinopathy ```
34
Progressive condition characterized by joint dislocations, pathologicfractures, and deformities.
Charcot foot
35
Charcot foot is most common where
Foot and ankle
36
Characteristics of Charcot foot
``` Edema Erythema Skin temperature difference of 6.7 degrees Bony prominences at midfoot Ulcerations common at midfoot ```
37
When would you suspect osteomyelitis?
When they have had an ulcer longer than 1 month
38
What should be palpable with osteo?
Bone
39
Recurrent ulcer for osteomyelitis is in ?
Same location
40
Osteomyelitis and Charcot foot will both be
Red, warm, edematous and painful
41
What’s the biggest difference between osteo and Charcot?
A bone scan and bone biopsy will be + for osteomyelitis. Charcot foot would be negative.
42
Elevated WBC count withdifferential
Osteomyelitis
43
May have mildly | elevated WBC/ESR
Charcot foot
44
Elevated ESR
Osteomyelitis
45
Elevation of the foot for 1-2 hours should | eliminate erythema and swelling
Charcot foot
46
(+) Bone scan with WBC labeling  (+)Bone biopsy  Gold standard
Osteomyelitis
47
due to loss of nourishment to a part, followed by mummification
Dry gangrene
48
necrosisof tissue followed by destruction caused by excessive moisture
Wet gangrene
49
What accumulates in the tissue of wet gangrene
Bacterial gases
50
Line of demarcation isill-defined and limb is painful, purple and swollen
Wet gangrene
51
``` pulses/Doppler,  rubor of dependency,  ABI – not reliable in DM  history of claudication  ischemic pain ```
Vascular status
52
24% healed at ?
12 weeks
53
47% healed at ?
20 weeks
54
If the wound has not healed by 50% in the first4 weeks of treatment, only ???
9% chance it will heal in 3 months
55
Treat cuts right away by
Washing with soap and water and covering with sterile gauze
56
3 types of debridement intervention
Sharp Enzymatic Autolytic
57
Scalpel; may be surgical (gold standard)
Sharp debridement
58
Uses medication to break down necrotic tissue
Enzymatic debridement
59
What increases the chances of DFU healing?
Adequate off-loading
60
What’s the preferred method for offloading diabetic plantar foot ulcers?
Total contact casting
61
Advanced therapeutics are unlikely to succeed in improving wound healing outcomes unless ?
Off-loading is achieved
62
How often are total contact casting replaced?
Weekly if theres no swelling or drainage. 2-3 days if there is.
63
Advantages of total contact casting
Protects from trauma Reduces edema Offloads forefoot and midfoot
64
Is total contact casting removable?
NO
65
Disadvantage of total contact casting
- heavy, hot, bathing/walking/sleeping difficult - Has healing rate of 90% within 6-8weeks - its considered a fall risk
66
Contraindications for TCC
``` - Documented peripheral arterial disease  ABI < 0.7  Active infection  Fluctuating leg edema  Osteomyelitis  Necrosis in wound  Sinus tract with deep extension into foot ```
67
What does CROW stand for
Charcot restraint orthotic walker
68
What is a crow?
Rigid polypropylene bootwalker with rocker sole
69
What does a crow do?
Reduces pressure and shear
70
What is a DH pressure relief walker?
Removable walking boot with rocker-bottom sole
71
Advantage of DH pressure relief walker
Easy to apply, adjusts to edema, wound can be inspected regularly, inexpensive
72
Disadvantage
No forced compliance
73
Orthowedge healing shoe
Removes forefoot weight bearing
74
Orthowedge healing shoe is used for?
Forefoot wound or s/p digit or forefoot amputation
75
What angle is the orthowedge healing shoe
10 degree DF angle

Integumentary (15 decks)

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