Term
Explain the relationship between peripheral neuropathies and development of LE ulcers.
(sensory, motor and autonomic) |
|
Definition
| When a patient loses sensation to part of the ir LE, as in peripheral neuropathy, they cannot feel when something is irritating their foot or leg (ie: a pebble in their shoe). As a result, what begins as a minor irritation that a normal person would rectify, becomes a wound-causing agent in the patient who can't feel the annoyance. Motor loss can also accompany peripheral neuropathy, which can lead to muscle imabalances and deformities. These deformities can cause pressure points that aren't present in the 'normal' pt. And finally, autonomic loss can accompany neuropathy, which can lead to dry foot. This decreases elasticity of the skin, making it easier for skin to crack, bacteria to enter, and a wound to form. |
|
|
Term
| Why is the person with diabetes at higher risk for LE ulcer development than some other patients w/ peripheral neuropathy? |
|
Definition
| 1. Lack of insulin can lead to decreased uptake of amino acids which are required for protein synthesis, and proper wound healing. This leads to increased healing time, thus increases the risk of infection in a wound. 2. They are more prone to infection because of high blood glucose. 3. Obesity is commonplace in those with diabetes, and increases the amount of pressure on the LE during gait. |
|
|
Term
| What factors may contribute to the development of a pressure ulcer in a patient with a complete spinal cord injury? (7) |
|
Definition
| 1.Impaired sensory function, and inability to make postural adjustments create increased pressure points. 2.Loss of vasomotor control results in decreased tissue resistance to pressure. 3.Maceration as a result of prolonged exposure to moisture. 4.Trauma. 5.Poor nutrition. 6.Secondary infection. 7.Immobility. |
|
|
Term
| In what areas would you most commonly find a pressure sore on the diabetic patient? (5) |
|
Definition
| 1st 3rd and 5th met heads, great toe, sites of previous ulcers. |
|
|
Term
| In what areas would you commonly find pressure ulceration in the spinal cord/immobile patient? |
|
Definition
| 1. Sacrum/Coccyx, 2. Gr. Trochanter, 3. Ischial Tuberosity, 4. Heel |
|
|
Term
| What are Semmes-Weinstein filaments, and what are they used for? |
|
Definition
| Nylon filaments of different thickenesses, used to test sensation. |
|
|
Term
| Your patient can feel a Semmes-Weinstein filament that produces a force of 10g. What does this mean, and what is the implication for your treatment? |
|
Definition
| Loss of protective sensation. They don't have enough sensation to feel that they need to take protective measures. |
|
|
Term
| How much pressure does the thinnest Semmes-Weinstein filament exert? |
|
Definition
|
|
Term
| What are some signs and symptoms associated w/ peripheral neuropathy? |
|
Definition
| 1. Motor loss 2. foot deformities 3. sensory loss 4. autonomic loss |
|
|
Term
| How does joint mobility impact ulcer development? |
|
Definition
| If a joint has restricted or excessive motion, there is increased stress on surrounding structures during gait. |
|
|
Term
| What are the appropriate shoe measurements to avoid pressure sores caused by footwear? |
|
Definition
| 1. Shoe length should exceed foot length by approx. 1/5inch. 2. Toe box must be deep enough to avoid pressure on dorsum of toes and wide enough to avoid medal and lateral pressure on met heads. 3. Heel height greater than 2inches should be avoided as it shifts body weight forward. |
|
|
Term
| What are the stages of pressure ulcers? |
|
Definition
| 1. Non-blanchable erythema of intact skin. 2. Partial thickness skin loss involving epidermis, dermis or both. Presents as an abrasion, blister or shallow crater. 3. Full thickness skin loss. Damage or necrosis of subcutaneous tissue, which may extend to but not through underlying fascia. Oresents as deep crater, possible undermining. 4. Full-thickness skin loss w/ extensive destruction, tissue necrosis or damage to muscle or bone or support structures ie: tendon, joint, capsule. |
|
|
Term
| Where is there a pressure increase in the patient w/ claw toes? |
|
Definition
| Met heads, dorsal aspect of proximal IP joints. |
|
|
Term
| Where is there a pressure increase in the patient w/ Hammer/ Mallet toes |
|
Definition
|
|
Term
| Where is there a pressure increase in the patient w/ PF first ray |
|
Definition
| There will be more pressure on 1st methead |
|
|
Term
| Where is there a pressure increase in the patient w/ collapsed midfoot |
|
Definition
| bony prominences of midfoot |
|
|
Term
| Where is there a pressure increase in the patient w/ Hallux Limitus |
|
Definition
| Plantar surface of 1st toe |
|
|
Term
| Where is there a pressure increase in the patient w/ Equinus |
|
Definition
| Forefoot (b/c of decreased ankle DF) |
|
|
Term
| Where is there a pressure increase in the patient w/ Charcot's foot |
|
Definition
|
|
Term
| Where is there a pressure increase in the patient w/ prominant calcaneus |
|
Definition
|
|
Term
| How much force will a size 6.10 Semmes Weinstein Filament exert? |
|
Definition
|
|
Term
| Your patient's wound is secreting a pale yellow exudate. Do suspect infection? |
|
Definition
| No. This is normal. Green exudate would indicate infection |
|
|
Term
| What color is sanguineous exudate? |
|
Definition
|
|
Term
| What indicates need for sharp debridement? |
|
Definition
|
|
Term
| Contraindications for sharp debridement |
|
Definition
| 1. ischemic wounds, unless circulation is adequate. |
|
|
Term
| Explain the importance of appropriate wound moisture for healing. |
|
Definition
| Moderate moisture is needed for the cells to migrate and pull the wound tegether. Dry wounds do not heal well, and can crack and become infected. Excessively moist wounds can become macerated and more prone to trauma. |
|
|
