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neuropathic ulcers
WOCN program
| Question | Answer |
|---|---|
| what are the 3 primary causative factors for Lower extremity neuropathic disease | Systemic disease (diabetes) trauma, infectious or autoimmune diseases, Vit. Deficiency, alcoholism |
| xerosis is a sign of what | |
| what is the test for sensory neuropathy | Semester-Weinstein 10g monofilament 9 sites in random order for 1-2 seconds |
| common diabetic foot deformity is called | Charcot |
| name 2 classification systems for diabetic foot ulcers | Wagner (0=at risk, thru 5=gangrene) and University of Texas (grade 0-3, stage A-D) |
| identify the characteristics of a diabetic foot ulcer | edges well defined, round, periwound callus, dry or min exudate, pale, pink or necrotic base |
| what is a method to identify areas of increased pressure and unequal weight distribution of patients feet | Pressure mapping |
| debridement of callus is best accomplished by ___ | Paring or sharp debridement |
| describe the rational for off loading | redistribute pressure exposure, tpressure and shear prevent healing and contribute to deterioration, maintain soft tissue viability and support bony architecture |
| what does "Probe to the bone" indicate | Osteomyelitis |
| What is the most common location for LEND | Plantar surface of foot |
| What are common locations for LEND (other than most common) | Metatarsal heads, dorsal and distal aspects of toes, inter-digital areas, pressure points, bony prominence |
| Describe common wound findings | Pale, pink or necrotic base, sm to mod exudate |
| Describe surrounding skin characteristics | Callus, may have maceration, |
| Complications seen with LEND | |
| Describe pain associated with LEND | Tingling, electric, pins and needles, dysthesia, parathesia |
| Noninvasive tests for LEND | monofilament, vibratory and positional |
| Assessment of LOPS | Semester-Weinstein monofilament, vibratory test, deep tendon and patellar reflexes. |
| Measures to prevent trauma in LEND | Proper fitting footwear, offloading wounds, pressure redistribution, keep feet protected from chemical,thermal, mechanical injuries no bare feet, no toe pads, socks w/shoes, no hot soaks, heating pad |
| Goals of topical therapy in LEND | treat/monitor for infection, maintain physiologic wound bed, |
| Topical therapy considerations/options with LEND | Topical abx based on culture results all night with systemic abx |
| Adjunctive therapy options with LEND | HBOT, NPWT, |
| Types of neuropathy | Sensory, motor, autonomic |
| management of charcot | non wgt bearing during acute phase, lifelong protection and monitoring (for ulceration-pt at higher risk) |
| neuropathic pain management | dysthesia=capsaicin, gabapentin,pregabalin, ssri's paresthesia=tricyclics, opoids both=analgesics=topical, systemic |
Created by:
Beth Perry
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