Cardio 3 9

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Author:
jld15
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305738
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Cardio 3 9
Updated:
2015-07-26 16:40:25
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Cardio 3 9
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  1. Type I
    • Insulin-dependent diabetes mellitus (IDDM)
    • May be genetic (IA) or idiopathic (IB)
    • Do not produce insulin
  2. Type II
    • Overweight (80%)
    • Diagnosed later
    • Insulin resistance; exact cause unknown
  3. Hyperglycemia
    • RBCs become adhesive and less able to release oxygen
    • Platelets become adhesive and stick to endothelial walls
    • Accumulation of sorbitol may cause tissue damage
  4. The Neuropathic Foot- Etiology of Foot Ulceration
    • Cause is multifactorial
    • Peripheral neuropathy is a main cause
    • -----Sensory loss
    • ----Increased mechanical stress
    • Risk of PVD is greater in diabetes
  5. Sensory Component
    • subjective: numbness, paresthesias, cold feet, and pain
    • objective: absence of protective sensation* and impaired vibratory sensation*
  6. Motor Component
    • Weakness of intrinsics first
    • Atrophy predisposes patient to ulceration
  7. Autonomic Component
    • decrease vasomotor regulation
    • decrease tissue hydration
    • increase rate of callus formation
  8. Other Factors: Mechanical Stress
    • Pressure
    • -----Deformity or ¯ ROM ® high plantar pressures (heel and metatarsal heads)
    • Shear
    • ----intrinsic foot stress (e.g. bony prominences)
    • ----extrinsic foot stress (e.g. footwear)
    • Repetitive stress is the most common form of injury
  9. Diabetic wound Other Factors
    • Dry skin susceptible to injury
    • Callus causes increased pressure
    • Obesity
    • Visual loss
    • Joint limitation
    • Foot deformities
    • Previous ulcer or amputation
    • Improper footwear
    • Impaired immune response
  10. Charcot Arthropathy
    • Neuropathic fracture and dislocation
    • Multiple causes: wear and tear, minor repetitive trauma, neuropathy, ¯ blood flow
    • Clinical signs: acute swelling, heat, erythema, subacute decrease in symptoms with ­ deformity after fracture healing
    • Treatment: NWB/cast ® PWB with device ® CROW
    • Arthropathy leads to high pressure in certain areas of the foot predisposing these areas to ulceration
    • Will but a sharko restraint orthotic walker
  11. Characteristics of Diabetic Wounds
    • Round, punched out lesions
    • Plantar location
    • ----Metatarsal heads
    • ----Heel
    • ----Great toe (with hallux rigidus)
    • ----Midfoot (with rocker bottom deformity)
    • Dorsal toes with claw-toe deformity
    • Isolated callus rim
    • Minimal drainage
    • Lack of pain
  12. Classification of Neuropathic Ulcers Wagner System
    • 0 No open lesion; deformity or cellulitis
    • 1 Superficial ulcer
    • 2 Deep ulcer to tendon, bone, capsule
    • 3 Deep ulcer w/ abscess, osteo, or joint infxn
    • 4 Localized gangrene
    • 5 Gangrene of entire foot
    • Grades 4 and 5 require some level of amputation.
  13. UTHSCSA Diabetic Wound Classification System
    • Depth 0-3
    • -----0 = pre or post ulcer with epithelialization
    • ----1 = superficial; not involving tendon or bone
    • ----2 = penetrates to tendon or capsule
    • ----3 = penetrates to bone or joint
    • Infection / Ischemia A-D
    • ----A = non-infected, non-ischemic
    • ----B = infection
    • ----C = ischemia
    • ----D = infection plus ischemia
  14. Neuropathic Foot Examination
    • Circulation: Capillary refill, ABI, pulses
    • Sensory testing
    • Skin inspection/temp
    • ROM exam: Ankle motions, big toe motions ( see if WNL)
    • Intrinsic and extrinsic muscle strength testing
    • Evaluation of footwear

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