podo Flashcards Preview

geriatrics 2 > podo > Flashcards

Flashcards in podo Deck (25):
1

Describe xerosis

- Dry, flaky skin
- Delayed in recovery of stratum corneum's barrier function
- Xerosis in the elderly is HIGHLY LIKELY TO BE CHRONIC ATHLETE'S FOOT (TINEA PEDIS) infection-perform a KOH

2

describe cause of xerosis

- skin dry and flaky due to DECREASE in EPIDERMAL FILAGGRIN (binds keratin into macrofibrils)
- Eccrine glands decline by 15% leading to DECREASE in SPONTANEOUS SWEATING (hydrophobic substances well absorbed, hydrophilic are not)
- Due to autonomic dysfunction in diabetics, there is a decrease in skin moisturization

3

Tx of xerosis

- bag balm - Lanolin
- aquaphilic - water + petrolatum
- carmol 10/20 - urea
- AmLactin-12% - lactic acid
- Aveeno - natural oatmeal
*Add CortAid 10 (1% hydrocortisol) to above mixtures for CRACKED, inflamed skin

4

Onychomycosis

- fungus that can cause tinea pedis can also infect the toenails
--> fungus infects nail bed first, and through the production of KERATINASE, destroys the keratin of the nail plate and allows the nail to become thick, discolored, loosened, and collect subungual debris

5

TOE CLYPT

- THick, yellow nails can be due to (TOE CLYPT)
- Truama
- onychomycosis
- eczema
- circulatory problems
- lichen planus
- yellow nail syndrome
- psoriasis
- tumor

6

Onychocryptosis

- usually the resutl of improper nail trimming, truama, heredity, systemic or local disease
- nails should be CUT straight across ONLY if the nails are normal to begin with
- if there is a chronic problem with ingrown nail, need to REMOVE SOME FROM THE DISTAL CORNER
- some patients do better with in-grown nails if LEFT LONGER THAN NORMAL
- some, but very few need a central V cut into the end of the toenail

7

Paronychia

- infected nail border
- S. aureus most common pathogen, although gram-rods frequent contaminant, but rarely the primary pathogen

8

tx for paronychia

- CONSERVATIVE TX
--> 10 min bid warm, soapy water soak
--> betadine solution and band aid
--> cephalexin (keflex) @ 500 mgs bid
- Surgical
--> I and D
--> bid soaks and betadine solution
--> cephalexin?

9

Hyperkeratosis

- thickened skin is the result of intermittent pressure over prominent bones
- May hide deeper skin ulcerations which will develop if pressure becomes more continuous
- bones become prominent as a result of toe contractures and or loss of fat padding on the ball of the foot
- skin thickens in response to the pressure to form a cushion against the shoe or walking surface, but ONLY THE HARD STRATUM CORNEUM can reproduce (presses against sensory receptors in the underlying dermis)

10

tx for hyperkeratosis

- debridement
- padding
- shoe modifications

11

Bunion

- prominent medial aspect of 1st metatarsal head due to actual medial migration of 1st metatarsal and lateral migration of great toe
- RESULT OF A TENDON IMBALANCE

12

treatment bunion

- extra depth shoes (SAS)
- bunion shield
- toe separator
- surgery* (symptomatic)

13

Hammertoe

- buckling of the toe at the PIPJ and DIPJ of the lesser toes due to a TENDON IMBALANCE around the lesser toe joints that cause ONE BONE TO DORSIFLEX and one or more bones DIstal to it to PLANTARFLEX
- common in flat and high arched feet

14

tx for hemmertoe

- debridement of hyperkeratotic tissue
- padding to limit pressure
- splints to passively plantarflex toes
- extra depth or custom molded shoes (SAS)

15

flatfoot

- common to develop a collapse of the medial longitudinal arch as one ages due to PROGRESIVE LIGAMENTOUS LAXITY of the joints
- also known as pronation or pronated foot type

16

what does flatfoot cause

- leg and low back pain
- capsulitis of MPJ (pain on ball of foot)
- DJD of foot and ankle joints (wear and tear arthritis)
- tendonitis
- inflammation of plantar fascia (plantar fasciitis)

17

tx for flatfoot or plantar fascitus

arch support (orthosis)
--> helps to life arch and limit stress on tendons, ligaments and joints
**spenco arch cushions has best over counter support**

18

vascular disease

- the normal aging process will cause deterioration in the structure of arteries and veins
- can lead to atherosclerosis in arteries and malfunctioning of valves in veins (chronic venous insufficiency)

19

Ischemia result due to vascular disease

- the end result can be tissue ischemia leading to foot and leg pain, ulcerations and gangrene
- increased incidence of diabetes in the elderly ACCELERATES THE AGING PROCESS OF VESSELS (particularly arteries)
- waist size can predict diabetes by 80%

20

tx for vascular changes

- proper shoes (extra depth), shoe inserts to offload pressure ares and very tight regulation of blood sugars
--> HbA1C

21

chronic venous insufficiency

- damage to vein valves prevents efficient pumping of blood back to the heart with resulting congestion of blood in veins which leaks into peripheral tissues and causes hypoxia
- venous ulcers will have redish appearance
- will lead to edema, hemosiderin deposition in skin and ULCERATION
- may predispose to deep venous thrombosis and pulmonary embolism

22

tx of venous disease

- COMPRESSION HOSE at 20-30 mm Hg (older patients cannot tolerate nor apply anything heavier)
- want more compression distally than proximally to create a gradient

23

Numbness, tingling, burning may suggest...

- diabetes
- B12 deficiency
- Thyroid disease (hypothyroidism)
- alcoholism

24

generalities

- 40% of cases of peripheral neuropathy do not have an identifiable etiology
- 10% of diabetic neuropathy is caused by something other than hyperglycemia
- inability to perceive pain or pressure will predispose to ulceration

25

tx for neuropathy

- control blood sugars if diabetic
- no proven medication to reverse anesthetic neuropathy
- Lyrica (pregabalin) is most proven and validated pharmaceutical based on neurology clinical practice guidelines for painful neuropathy