Cardio 3 10

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Author:
jld15
ID:
305739
Filename:
Cardio 3 10
Updated:
2015-07-26 16:46:07
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Cardio 10
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Cardio 3 10
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  1. Physical Therapy Interventions
    • education
    • wound care
    • total contact casting
    • gait training
  2. ROM/aerobic exercise
    Devices/ equipment
  3. Patient/Client-related instruction
    • Reduction of risk factors
    • Role of exercise
    • Proper foot wear
    • Foot care guidelines
    • Skin inspection and protection
    • Precautions related to lack of sensation
    • Inclusion of significant other
  4. Diabetic other
    • Inspect the feet daily
    • Always wear socks with shoes (take moisture away from the feet, cushions the foot)
    • Wears socks without seams or that are inside out to decrease pressure of the seams
    • Inspect soles and inside of shoes before putting them on
    • Shoes should be carefully sizes etc
    • In cold weather need to have room for heavy socks
    • Don’t walk barefoot
    • Don’t wear hot water bottles or heating pads to warm feet
    • Don’t soak feet because you don’t want to over hydrate or macerate their feet
    • Wash feet daily and wash bwt toes
    • Apply moistures not bet toes
    • Check bath water before getting into the bath
    • Trim nails straight across to prevent in grown toe nails
    • Remove shoe and shoe when seeing do with foot exam
    • Have physician remove callus, in grown toe nails
    • Call health care provider if it is hot, open wound and need to
    • Maintain good diabetes control
    • If smoke you need to quit
  5. Diabetic Precautions
    • May not demonstrate cardinal signs of infection
    • Any patient with diabetes should be educated in foot care guidelines
    • Monitor for signs of hypoglycemia during all treatments ** during exercise
  6. Diabetic Local wound care
    • Trimming of callus
    • Moist wound environment
    • Use toe spacers to absorb moisture and prevent shear forces
    • Control infection if present
    • Modalities such as NPWT, ultrasound, and electric stimulation may be helpful
    • Podiatrist is involved in the callus
    • NPWT- negative pressure wound therapy
  7. Total contact casting
    • For grades 1 and 2 ulcers
    • Molded to lower leg and foot
    • Dispersed weight bearing ® decrease plantar pressures
    • Controls edema
    • Immobilizes foot ® decrease shear forces
    • Protects foot from trauma & microbes
  8. Diabetic Gait and mobility training
    • Unload affected tissue (heel WB with assistive device)
    • PWB with assistive device
    • Step-to pattern decreases plantar pressures by up to 53%
    • Walk heel step to walker
    • Slower steps (to take pressure off feet)
    • Decreased heel strike and push-off
    • Heel wb in some pts.
    • Modified footwear to reduce plantar pressures
  9. Diabetic Therapeutic exercise/ROM exercise
    • Ankle dorsiflexion, toe extension
    • Subtalar joint motion
  10. Diabetic Therapeutic exercise/Aerobic
    • Weight loss
    • Lower hyperglycemia
    • Improve glycemic control
  11. Diabetic Prescription, Application, and Fabrication of Devices & Equipment
    • Padded ankle-foot orthoses
    • Walking shoes
    • Relief pads under post-ulcerated areas
    • Protect foot and minimize plantar pressures
    • Appropriate size; extra depth
    • Especially if toes are clawed
    • Gradually-increased wearing time
    • Soft, moldable materials
    • Severe foot deformities should be custom-molded by an orthotist or pedorthist
  12. Diabetic ambulation
    • ¯ walking speed
    • use of an assistive device
    • limit ambulation (~1/3 of normal)
    • limb protection
    • “break in” new shoes gradually
    • appropriate footwear
    • ¯ risk factors
    • timely follow-up
    • foot care education*
    • careful foot inspection daily
  13. Osteomyelitis
    • Present in 1/3 to 2/3 of all diabetic foot infections
    • Inflammation of bone caused by infecting organism
    • Red flags:
    • 1. Any puncture injury
    • 2. History of chronically draining ulcer
    • 3. Exposed bone at base of ulcer
    • Treatment: combined antimicrobial and surgical approach
    • Can be oral and topical antibiotics (ex silver)
    • Presence of osteo increases risk of amp.
    • Bone scan is the gold standard for diagnosis of osteomyelitis.
  14. Partial Foot Amputations
    • Increased use & better outcomes due to:
    • ----Development of more refined vascular surgery procedures
    • ----Improved methods of reconstructive surgery
    • ----Improved broad-spectrum antibiotics
    • ----Ergonomic benefit (more foot that you have the better off you are

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