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CP2 > Compression Therapy (wk 4) > Flashcards

Compression Therapy (wk 4) Flashcards

1
Q

How is homeostasis of vessel fluid maintained?

A

maintained through hydrostatic and osmotic pressure inside and outside the vessels

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2
Q

In normal circumstances hydrostatic is (=/>) osmotic forcing movement of fluid ____

A

hydrostatic is > osmotic, forcing small amounts of fluid into interstitium

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3
Q

What is edema?

A

excess fluid in the extra-cellular tissue spaces of the body

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4
Q

What can lead to edema?

A
  1. Venous insufficiency
  2. lymphatic abnormalities
  3. plasma proteins imbalance
  4. unregulated BP
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5
Q

Localized edema tends to occur in discrete areas of the body in conditions such as:

A
  1. venous insufficiency
  2. lymphatic blockage
  3. prolonged dependency (pregnant women)
  4. localized inflammation (sprained ankle)
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6
Q

Systemic edema, typically a more broad, and non-discerning edematous pattern, is associated with what conditions?

A

systemic conditions such as

  1. CHF (back up of blood returning to hear)
  2. hypoalbuminemia (decreased osmotic pressure)
  3. kidney dysfunction
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7
Q

What are consequences of edema?

A
  1. Decreased ROM
  2. Functional limitations
  3. Decreased somatosensory input
  4. Pain
  5. Increased collagen leading to fibrosis
  6. Ultimately may lead to contracture, increased risk of infection, amputation
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8
Q

T/F Pitting edema tends to be associated with new onset, acute symptoms

A

False, Softer thickening tends to be associated with new onset, acute symptoms
- Pitting edema is thick and slow moving. An indentation remains following removal of pressure source

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9
Q 
What are the measurements of pitting edema:
1+
2+
3+
4+
A

1+ Barely detectable depression when finger is depressed into the skin
2+ Slight indentation. 15 seconds to rebound
3+ Deeper indentation. 30 seconds to rebound
4+ > 30 seconds to rebound

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10
Q

Two ways to measure volumetric change cause by edema?

A
  1. Volumetric water displacement
  2. Linear measurement
    - > compare to uninvolved side
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11
Q

Edema reduction affected by what 3 means?

A
  1. Improved venous and lymphatic circulation
  2. Physical barrier to limit the size and shape of tissue
  3. Increased tissue temperature
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12
Q

What are uses of compression to help with edema?

A
  1. increase venous and lymph return
  2. DVT prevention
  3. Shaping residual limb
  4. facilitate healing in venous insufficient wound areas
  5. daily to counteract effect of gravity on vascular and lymph systems
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13
Q

Contraindication or precaution of compression for edema: decreased sensation

A

precaution

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14
Q

Contraindication or precaution of compression for edema: Trauma/fractuere

A

Contraindication

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15
Q

Contraindication or precaution of compression for edema: acute dvt

A

Contraindication

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16
Q

Contraindication or precaution of compression for edema: completely obstructed lymph or venous return

A

Contraindication

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17
Q

Contraindication or precaution of compression for edema: malignancy

A

precaution

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18
Q

Contraindication or precaution of compression for edema: arterial disease/insufficiency

A

Contraindication

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19
Q

Contraindication or precaution of compression for edema: arterial revascularization

A

Contraindication

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20
Q

Contraindication or precaution of compression for edema: uncontrolled HTN

A

precaution

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21
Q

Contraindication or precaution of compression for edema: acute pulmonary edema

A

Contraindication

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22
Q

Contraindication or precaution of compression for edema: loss of sensation

A

Contraindication

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23
Q

Contraindication or precaution of compression for edema: edema with cardiac or renal impairment

A

Contraindication

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24
Q

Contraindication or precaution of compression for edema: impaired cognition

A

Contraindication

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25
Q

Contraindication or precaution of compression for edema: Over area of superficial peripheral nerve

A

precaution

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26
Q

Contraindication or precaution of compression for edema: infection in treatment area

A

Contraindication

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27
Q

Contraindication or precaution of compression for edema: Hypoproteinemia (<2g/dL)

A

Contraindication

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28
Q

Two types of compression?

A
  1. Static- Exerting a continuous or constant force
  2. Intermittent- Exerting a varying force over time
    - This type is thought to provide improved outcomes through a milking mechanism from distal to proximal
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29
Q

T/F Greater compression forces proximally and decrease moving distally.

A

False, greater compression forces in the distal extremity and gradually decreasing proximally, aiding in circulatory return

30
Q

What is resting pressure?

A

applied when elastic properties of the bandage are stretched in application.
This pressure remains whether patient moves or remains still

31
Q

What is working pressure?

A

produced by muscle activity of movement pushing against the restraining bandage.

32
Q

Highly extensible bandages offer what type of resting and working pressures?

A

high resting pressures when stretched with application, but typically provide very low working pressure
(ace bandage)

33
Q

relatively inelastic bandages offer what type of resting and working pressures?

A

low resting pressure, but high working pressure

34
Q

Pros of highly elastic bandages?

A

+ Inexpensive
+ Readily Available
+ Easily Removed
+ Patient/Caregiver can be trained to install

35
Q

Cons of highly elastic bandages?

A
  • Correct and Incorrect Application
  • May slide down the extremity
  • Difficult to apply even tension
  • Quickly lose their elastic properties
  • Requires patient to be able to reach area to be wrapped/unwrapped if they do not have a caregiver to help
36
Q

Pros of low stretch bandages?

A

+ Higher working pressure generated, rather than resting pressure (less likely to impede circulation)
+ Still relatively inexpensive
+ Easily Removed
+ Patient/Caregiver can be trained to install
+ More fool-proof for application of compressive forces (not as much give)

37
Q

Cons of low stretch bandages?

A
  • Not as effective at removing edema as highly elastic bandages
  • Less comfortable to wear than highly elastic bandages
  • Correct and Incorrect Application
  • Requires patient to be able to reach area to be wrapped/unwrapped
  • Less readily available than highly elastic
38
Q

How often do you apply semi-rigid bandages?

A

Apply every 4-7 days to extremity after edema has been removed by other means

39
Q

Pros of semi-rigid bandages?

A

+ Useful for less compliant patients, in place for several days
+ Eliminates daily dressing changes

40
Q

Cons of semi-rigid bandages?

A
  • Must be protected from environment (shower)
  • Long term applications allows for pressure areas if not correctly applied
  • Patient may be unable to remove easily if discomfort occurs
41
Q

2 Precautions when using bandages for edema?

A
  1. Propensity to be discharging to facility unfamiliar with use of multi-layer dressing
  2. Frail skin / Bony prominences
42
Q

Contraindications of using bandages for edema?

A
  1. Patients with arterial disease (ABI < 0.8)
    - ABI = compare BP at ankle to BP at brachium
    - Low = blockage in leg (strength in body is not equal)
    - Should be .9
  2. Patient inability to remove bandage (physical or mental)
  3. Allergy to component
  4. Active wound infection at bandage site
  5. Active cellulitis (infection of skin) at bandage site
43
Q

Pros of custom compressive garments:

A

+ OTC and Custom-fit Available
+ Last 4-9 months with proper care
+ Provide Graded Compression
+ Cosmetically Acceptable

44
Q

Cons of custom compressive garments:

A
  • Can be difficult to don, especially with arthritic hands

- Costly and not universally covered item by 3rd party payers

45
Q

2 Precautions of using compressive garments:

A
  1. May be difficult to don, may require an assistant or assistive aids
  2. Not recommended for over open wounds
46
Q

2 contraindications of using compressive garments:

A
  1. Patients with arterial disease

2. Allergy to component

47
Q

Mechanical compression pumps decreased interstitial fluids by:

A
  1. Increase pressure -> forcing the fluid to move into the lymphatic and venous systems
  2. Increase local tissue temp -> allowing improved activity of temperature dependent enzymes (e.g. collagenase – wound healing)
48
Q

Two types of intermittent pneumatic pumps:

A
  1. Non-dynamic (static)

2. Dynamic

49
Q

Non-dynamic (static) intermittent pneumatic pumps -

A

Same pressure throughout surface being compressed, force applied and released cyclically

50
Q

When are Non-dynamic (static) intermittent pneumatic pumps utilized?

A
  1. DVT prophylaxis in sedentary patients

2. Patient not ambulating

51
Q

T/F Can ambulate wearing a Non-dynamic (static) intermittent pneumatic pump

A

False, must be removed for ambulation

52
Q

Dynamic intermittent pneumatic pumps -

A
  1. Varying pressure throughout surface being compressed, force applied and released cyclically
  2. peak pressure distally -> moves proximally in wave action
53
Q

Pumps general guidelines:

Why do you need to check the patient’s BP before using?

A

need BP > so can overcome pressure

54
Q

Pumps general guidelines:
Inflation/deflation ratio for edema =
Inflation/deflation ratio for residual limb shaping =

A

Inflation/deflation ratio for edema = 3:1

Inflation/deflation ratio for residual limb shaping = 4:1

55
Q

T/F Numbness, tingling, pulsating, or pain will be felt during treatment of pumps.

A

False SHOULD NOT BE FELT

56
Q

Precautions or contraindication of pumps:

CHF patient must be monitored closely for signs of intravascular fluid burden

A

Precautions

57
Q

Precautions or contraindication of pumps:

Impaired sensation or mentation

A

Precautions

58
Q

Precautions or contraindication of pumps:

DVT, thrombophlebitis

A

contraindication

59
Q

Precautions or contraindication of pumps:

Acute cardiac failure

A

contraindication

60
Q

Precautions or contraindication of pumps:

Uncontrolled HTN

A

Precautions

61
Q

Precautions or contraindication of pumps:

Obstructed lymphatic of venous flow

A

contraindication

62
Q

Precautions or contraindication of pumps:

CA

A

Precautions

63
Q

Precautions or contraindication of pumps:

CVA

A

Precautions

64
Q

Precautions or contraindication of pumps:

Arterial disease

A

contraindication

65
Q

Precautions or contraindication of pumps:

Fracture

A

contraindication

66
Q

Precautions or contraindication of pumps:

Valve insufficiency

A

Precautions

67
Q

Precautions or contraindication of pumps:

Superficial peripheral nerves

A

Precautions

68
Q

Precautions or contraindication of pumps:

Local infection

A

contraindication

69
Q

Precautions or contraindication of pumps:

Requires barrier for patients with Contact Isolation Precautions

A

Precautions

70
Q

Precautions or contraindication of pumps:

Significant hypoproteinemia- protein levels < 2 g/dl

A

contraindication

71
Q

Precautions or contraindication of pumps:

Never adjust pressure to greater than diastolic blood pressure

A

Precautions

72
Q

Precautions or contraindication of pumps:

Suspected underlying syndrome which may be affected by compression (compartment syndrome)

A

contraindication

CP2 (20 decks)

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