*6.PTA 200-Compression Flashcards
increased fluid in the interstitial spaces
-Normal fluid balance is controlled by the balance of osmotic & hydrostatic pressures.
(Hydrostatic pressure is determined by BP & gravity)
(Osmotic pressure is determined by concentration of Protein)
-Higher hydrostatic pressure inside the vessels pushes fluid out; higher protein concentration/ osmotic pressure inside the vessels acts to keep fluid inside the vessel.
Edema
- Pain
- Heavy limbs, poor body image
- decreased ROM resulting in ↓ function
- In the case of lymphedema,chronic edema can result in collagen formation resulting in tissue fibrosis
- Disfigurement and contracture
- Cellulitis due to ↓ circulation
- Stasis dermatitis
- wounds
Adverse consequences of edema
Heat increases acute edema but the following interventions DECREASE edema:
- elevation of the body part above the heart
- Heat for chronic edema
- cold
- EMS
- massage is used to decrease venous (distal to proximal) and lymphatic edema (proximal to distal)
- exercise is used to manage/control edema
- external compression
Interventions for edema
Quick Review of
Peripheral Vascular System
Arterial System:
Arteries are the elastic, muscular (smooth mm), tubular extensions of the heart that carry O2 rich blood at HIGH pressures to all parts of the body.
Pressures are greater within the major arteries near the heart compared with the smaller more distal arteries.
Vessels near the heart are more elastic; distal vessels tend to be more muscular to propel the blood to the outermost regions of the body.
Arterioles are smaller and branch from arteries.
Capillaries are the smallest of vessels. Exchange of gases, nutrients, and waste occur between the cells and the capillary complex to maintain cellular survival.
Artery wall: inside -> out -Basement membrane -Tunica intima -Tunica media -Tunica externa (review picture on pp slide) know anatomy of artery - fibroblast -smooth muscle cells -elastica interna -endothelial cels -Lumen, etc.
Arterial System
arteriole (endothelium, smooth muscle)
review pic on slide 17 on pp
Arterioles and Capillaries
review pic on slide 18 on pp
- Veins are structured similar to arteries except the tunica media is poorly developed and has insignificant supply of elastic or smooth mm fibers.
- Veins rely on a system of valves that assist the return of blood to the heart.
- Valves of the venous system are more common in the lower limbs where the forces of gravity are the greatest. At this point blood flow is dependent upon valvular competency and skeletal mm contraction = CALF PUMP - Venous division unique to the LE’s: Superficial veins are subcutaneous veins sometimes visible through the skin. Deep veins are larger in size and usually follow their corresponding arteries. Perforating veins provide a connection between the superficial and deep veins.
Venous System
Vein vs. Artery Anatomy
review pic on slide 21
Venous system
review pic on slide 22
The lymphatics of the human body include extensive networks of capillaries, collecting vessels, lymph nodes and lymph organs such as the tonsils, spleen and thymus. The lymph nodes are positioned like pearls on a long string necklace. There are ~600 lymph nodes in the body (160 in the head and neck. The lymph nodes are located in the axillae, groin, at the medial elbow, in the popliteal fossae, and on the back at ~L4-5.
-Review pic on slide 25 as well
Lymphatic System
The supply of blood is less than the mm demand which produces pain and cramping in the involved mm’s. (usually the calf mm’s) Intermittent claudication is associated with 50% occlusion of the affected vessel.
Intermittent claudication
blueness or pallor of the extremities usually associated with pain and numbness and caused by vasomotor disturbances (as in Raynaud’s disease); specifically : a disorder of the arterioles of the exposed parts of the hands and feet involving abnormal contraction of the arteriolar walls intensified by exposure to cold and resulting in bluish mottled skin, chilling, and sweating of the affected parts
Acrocyanosis
a bluish or purplish discoloration (as of skin) due to deficient oxygenation of the blood
Cyanosis
bilateral vasodilation affecting the extremities by redness, burning, and throbbing sensations and increased skin temperature
Erythromelalgia
- characterized by micro and macrocirculatory dysfunction of the venous system causing distention.
- Valves fail and do not close properly leading to venous reflux (backward flow of blood through a distended vein. Extreme edema, erythema, dermatitis, and stasis pigmentation (hemosiderin)
Chronic Venous Insufficiency (CVI)
- Height and weight (fluid retention)
- Volumetric Measure (page 593/Physical Rehab)
- Girth Measurement. (page 594/Physical Rehab)
- edema resulting from CVI will resolve in several hours of elevation
- but edema resulting from lymphedema will take several days.
Anthropometric Measurement
auscultation: listen for bruit. http://abclocal.go.com/kabc/story?section=news/health&id=6138187
ARTERIAL PERFUSION
assessment of tissue perfusion. Pg. 596 Physical Rehab, 6th edition. Sometimes referred to as ABPI Ankle-Brachial Pressure Index (LE systolic pressure/UE systolic pressure) Normal values are .95 to 1.19, ABI’s greater than 1.2 are falsly elevated, indicate arterial disease or diabetes. ABI’s of greater than 8 compression of 30-40 mm Hg can be used. Do not use compression with ABI’s less than .8 (Cameron has conflicting information)
http://www.youtube.com/watch?v=o72WAbC5rY8
120 mmhg LE/ 140mmhg UE = .86 ABI
ABI Ankle-Brachial Index
Test for DVT. Squeeze the gastroc while forcefully DF the ankle. + Acute pain + Homan’s sign.
NO LONGER CONSIDERED VALID- A DOPPLER US should access for DVT. -Doppler Ultrasound will be performed on all patients with Lymphedema to R/O DVT.
- Fibrosis
- Observation and Palpation –
- Trophic changes (See previous slide for arterial trophic changes related to circulation.)
- Coloration (for example: brown/dark red indicates a venous problem)
- Wounds – ANOTHER LECTURE!
Integumentary Integrity
Edema in patients with kidney dysfunction should not be treated because the kidney may not be able to excrete the additional fluid.
ABI of less than .8
Use List in Cameron Page 398:
-Heart failure or pulmonary edema
-Recent or acute DVT, thrombophlebitis, or pulmonary embolism
-Obstructed lymphatic or venous return
-Sever peripheral arterial disease or ulcers resulting from arterial insufficiency
-Acute local skin infection
-significant hypoproteinemia (protein levels
Contraindications for external compression
