Compression Therapy: General & Bandages Flashcards
abnormalities = interstitial edema
all could be due to what -
- unregulated BP
- plasma proteins imbalance
- lymphatic flow obstruction
- venous insufficiency
localized edema
associated with conditions such as venous insufficiency, lymphatic blockage, and prolonged dependency, localized inflammation
where does localized edema occur
discrete areas of body
systemic or general edema
associated with systemic conditions such as CHF, hypoalbuminemia, kidney dysfunction
systemic or general edema occurs where
more broad, non-discerning edmatous pattern
consequences of edema
decreased ROM
functional limitations
decreased somatosensory input (fall risk)
pain
increased collagen leading to fibrosis
ultimately may lead to contracture, increased risk of infx, amputation
when assessing edema, what does softer thickening tend to be associated with
new onset, acute symptoms
pitting edema
thick and slow moving
indentation remains following removal of pressure source
pitting edema scale 1+ 2+ 3+ 4+
1+: barely detectable depression when finger is depressed into the skin
2+ slight indentation, 15sec rebound
3+ deeper indentation, 30sec rebound
4+ >30sec rebound
volumetric measurement for assessing edema
measure water displaced in a marker volume container which will easily accomodate the extremity, partially filling the container with water and immersing the extremity to a known anatomical landmark
linear measurement for assessing edema
tape measure
- key is to keep them the same each time they are measured, and compare involved to uninvolved
what is edema reduction is effected by what
- improved venous and lymphatic circulation
- physical barried to limit the size and shape of the tissue
- increased tissue temp
compression uses
- improve fluid balance, increased venous & lymph return, reducng vascular or lymphatic edema
- DVT prevention
- shaping of limb
- proven to facilitate healing
- manual massage/drainage = mechanical compression
- sometimes daily use
goald and indications for compression therapy
- amputation - molding limb
- decrease chronic edema
- lymphedema management
- stasis ulcer
- venous insufficiency
- subacute injuries
contraindications
- trauma/fx
- acute DVT
- completely obstructed lymph or venous return
- arteria disease/insufficiency
- arterial revascularization
- acute pulmonary edema
- loss of sensation
- edema with cardiac or renal impairment
- impaired cognition
- infxn in treatment area
- hypoproteinemia
precautions
- decreased sensation
- malignancy
- uncontrolled HTN
- over area of superficial peripheral n.
static compression
exerting a continous or constant force
intermittent compression
exerting a varying force over time
milking mechanism from distal to proximal
what is applied when elastic properties of the bandage are stretched in application
resting pressure
it remains whether patient moves or remains still (ace bandages)
highly extensible bandages
provide high resting pressures when stretched with application, but typically provide very low working pressure
- apply daily
relatively inelastic bandages
provide low resting pressure but high working pressure
pros of highly elastic bandages
inexpensive
readily available
easily removed
patient/care giver can be trained to install
cons of highly elastic bandages
- corrent and incorrect application
- may slide down the extremity
- difficult to apply even tension
- quickly loose their elastic properties
- requires pt to be able to reach area to be wrapped/unwrapped if they do not have a caregiver to help
low stretch bandage pros
apply to extremity PRN to control edema
- higher working pressure generated, rather than resting pressure
- still relatively inexpensive
- easily removed
- pt/care giver can be trained to install
- more fool-proof for application of compressive forces
low stretch bandage cons
- not as effective at removing edema as highly elastic bandages
- less comfortable
- corrent/incorrect application
- requires pt to be able to reach area to be wrapped/unwrapped
- less readily available
semi-rigid bandages
apply every 4-7 days to extremity after edema has been removed by other means
semi-rigid bandages pros
useful for less compliant patients, remains in place
eliminates daily dressing changes
semi-rigid bandages cons
must be protected from environment
long term applications allows for pressure areas if not correctly applied
patient may be unable to remove easily if discomfort occurs
precautions for bandages
propensity to be discharging to facility, unfamiliar with use of multi-layer dressing
frail skin
bony prominences
contraindications for bandages
- pt with arterial disease
- pt inability to remove bandage
- allergy to component
- active wound infxn
- active cellulitis
