Edema

Question 1

What are extrinsic factors for lymph transport?

Answer 1

• Musculoskeletal pump
• Changes in respiratory pressure
• Intrinsic pulsations
• Gravity

Question 2

When is it Edema?

Answer 2

> 30% above interstitial fluid

Question 3

What is the difference between Acute vs. Chronic edema?

Answer 3

Acute Edema: response to injury
- localized
- redness & warmth
- short span (wks-month)
- lymphatic & circulatory systems are healthier
- low protein content

Chronic Edema: lymph edemas; challenging
- slow, progressive
- lymphatic & venous system are compromised
- HIGH protein content ⇨ lymphatic can’t clear
- diffuse in nature
- warm, shiny & aching quality skin
- brawny

Question 4

What is a partial thickness wound? Ex?

Answer 4

shallow, moist & often painful & heal by regeneration (epithelization)

Ex: Cut thru epidermal layer; papercut

Question 5

What is full thickness wound?

Answer 5

heal via secondary intention healing

Question 6

What are the 3 phases of wound healing?

Answer 6

Inflammatory: initial phase
- begins when normal tissue is disrupted

Proliferative: tissue repair, revascularization & rebuilding of tissue
- epithelialization/granulation: migration of epithelial cells from the periphery to center
to cover the wound; tissue fills wound site
- Wound contraction: myofibroblasts accumulate in connective tissue to approx edges of wound, creating smaller area to be covered; contraction process may restrict movement
- Collage Production: laid down by fibroblasts first randomly oriented

Remodeling: disorganized collagen begins to reorient & scar tissue (scar maturation)
- collagen lysis: formation of new collagen ideally balanced with breakdown of old collagen
- Final outcome: pale, flat, mobile scar

Question 7

What are the vascular, hemostatic & cellular components of inflammatory stage?

Answer 7

Vascular (vessels)
- coagulation
- sealing of severed lymph channels
- arteriole constriction
- vasodilation
- increase micro vessel permeability
- edema formation

Hemostatic (blood)
- small blood vessels retract
- platelets aggregate
- fibrin deposited

Cellular
- Phagocytes performed by leukocytes
- Macrophages appear to debride wound & recruit fibroblasts for scar formation
- Growth factor is released to stimulate collagen production

Question 8

What are the cardinal signs of inflammation?

Answer 8

• redness
• warmth
• swelling
• pain
• LOF

Question 9

What is endothelial budding?

Answer 9

brand new baby blood vessels give the redness to
granulation, which are creating new blood pathways to old pathways of the wound

Question 10

What are the physical attributes of a scar?

Answer 10

Color
Size
Flat/Raised
Adhesions

Question 11

What would the diagnosis be if joint relief is found during distraction?

Answer 11

Arthritis

Question 12

What do colors mean in scarring?

Answer 12

White→ pallor; potential arterial issue
Blue→ cyanosis; potential venous blockage; congestion
Red→ erythema; potentially normal inflammatory phase; potential lack of outflow of blood from hand

Question 13

What are the vascular status assessments for observation?

Answer 13

• Color
• Trophic changes (texture)→ indicate sympathetic nerve dysfunction
  
  • dryness/moisture
• Temperature
• Peripheral pulse palpation
• Capillary refill
• Modified Allen’s Test

Question 14

What is the meaning of the observation & palpation of edema?

Answer 14

1+ = pitting 2mm; barely detectable, not very much indentation
2+ = pitting 4mm; visible indentiation
3+ = pitting 6mm; finger will go deeper & take longer to resolve to puff back up (~5-30s)
4+ = pitting 8mm; not as common, may be lymphedema situation, limb is huge & heavy
4+