Week 5 | Diabetic and Neuropathic Wounds (16181-SP)

Photo of two feet being examined.

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Topics

Introduction

  • Background: Prevalence
  • Impact on health/quality of life

Pathophysiology

  • Causal pathway
  • Neuropathy
    • Sensory
    • Motor
    • Autonomic

Neuropathic related conditions

  • Impaired Glucose Tolerance/Diabetes
  • Diseases of the nervous system (SCI)
  • Hansen’s disease
  • Pernicious anemia
  • Hypothyroidism
  • ETOH
  • Charcot Marie Tooth Disease
  • Exposure to heavy metals
  • Treatment agents for HIV/chemotherapy

Patient Assessment

  • Patient and wound history
    • Co-morbidities
    • Medications
    • Allergies/sensitivities
    • Laboratory data
    • Current and past treatments.
    • Pain
    • Mobility status
    • Nutritional status
  • Lower extremity exam
    • General appearance
    • Assess edema
    • Color changes (dependent rubor, elevational pallor)
    • Vascular assessment
      • capillary refill
      • venous refill time
      • assessment of pulses
      • ankle brachial index
    • Skin temperature
    • Sensory function: monofilament
    • Musculoskeletal assessment
    • Identify pre-ulcer cutaneous pathology
    • Evaluate footwear
  • Risk factors for ulceration
  • Ulcer characteristics
  • Wound sites and causative factors
  • Focused wound assessment

Management

  • Offload pressure or non-weight bearing: refer as indicated
    • Bedrest
    • Total contact cast
    • Removable cast walker/walking splint
    • Wedge sole shoe
    • Healing shoe with large toe box
    • Accommodative dressings (adhesive felt pad, crest pad etc.)
    • Assistive devices
    • Factors in selecting an offloading method
  • Debride callus and avascular tissue (after adequate perfusion has been established).
  • Glycemic control
  • Monitor and treat infection
    • Signs may be subtle
    • Rule out osteomyelitis
    • Signs of limb threatening infection
    • Signs of non-limb threatening infection
  • Pain management
  • Topical management
    • No evidence for one dressing over another
    • Role of topical antimicrobials
    • Cautious use of occlusive dressings
    • Moist wound healing
    • Indications for biopsy
  • Patient education
    • Basic foot care concepts
    • Smoking cessation
    • Weight control
    • Blood sugar monitoring
  • Summary

Objectives for Learning Outcomes

After completing this session, you will be able to:

  1. Identify the pathophysiology of neuropathic/diabetic ulcers. 
  2. Describe the risk factors for ulcer formation. 
  3. Identify the assessment parameters for an individual with a neuropathic ulcer. 
  4. Describe the elements of an effective management plan for an individual with a neuropathic ulcer.
Course summary
Available: 
10/01/2016
Expires: 
12/02/2017

Renee Anderson, MSN, RN, CWON
Certified Wound Ostomy Nurse; Co-Director, Wound Management Education Program (WMEP) and Wound Management Fundamentals Course (WMFC), Continuing Nursing Education, University of Washington School of Nursing, Seattle; President, Rainier Clinical Consultants, Inc, Seattle, WA

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