EDEMA

Question 1

How does Edema develop?

Answer 1

-following a trauma to any part of the body
- impairment of the lymph system
- impairment of heart and lung function

Question 2

Signs and Symptoms of Edema

Answer 2

• heat
• puffiness
• redness
• stiffness
• swelling
• fever
• indentation (pitting)
• tenderness or comfort

Question 3

What are the precautions related to edema?

Answer 3

• closely monitor edema to prevent impairment of blood flow
• monitor for infection
• no edema management activities in the presence of infection
• protect affected extremities in the presence of edema because it may also contribute to a loss of sensation that will put the extremity at risk for mechanical injury
• observe for sensory changes in the affected edematous extremity because of possible nerve compression
• others (come back to this to refer to individual technique precautions)

Question 4

Methods of evaluating edema

Answer 4

1) Water displacement method
2) Circumferential Measurement Method

Question 5

Water Displace Method

Answer 5

Fill the volumeter to full, once the water stops dripping, slowly place the hand in the volumeter. Catch the displaced water with a beaker to measure volume.

Question 6

Circumferential Measurement method

Answer 6

with the use of tape measure and finger gauge, measure and test both hands, note the time of day and date, and be consistent in how the measurement is performed

Question 7

Water Displacement method Limitation

Answer 7

• cannot be used when there are open wounds or sutures following surgery
• does not measure all parts of the body
• may not be available easily in a clinical setting
• requires a water source within the clinic

Question 8

Circumferential Measurement Method Limitation

Answer 8

• time consuming
• the OTA must be precise in order to obtain accurate measurements
• the time of day should be consistent in terms of measurement whenever possible

Question 9

What happens when edema is left untreated?

Answer 9

-painful conditions that will take a very long time to resolve
- RSD - reflex sympathetic dystrophy (now: Complex Regional Pain Syndrome
- Frozen Shoulders
- Shoulder Hand Syndrome
- minor or major causalgia

Question 10

Edema Management Techniques

Answer 10

1) Positioning (in Elevation)
2) AROM
3) Contrast Baths
4) Compression Wraps
5) Retrograde Massage
6) Air splint
7) Electric Pumps
8) Kinesio taping

Question 11

Position in elevation

Answer 11

elevate UE above the heart, preferred when resting or during passive activities, can use devices like pillows, tables, and poles

Question 12

AROM Technique

Answer 12

actively moving the involved UE to do daily tasks, can be paired with other edema management, should be used as frequently as possible throughout the day

Precaution: do not use in the presence of Fx or infection or joint problems like instability

Question 13

Contrast Baths

Answer 13

Alternating placement of the edematous hand in baths of cool (66F) and warm water (96F) for 20 minutes total. Begin and and with cold bath - alternating cool and warm for one minute at a time. place tubs in higher position to promote vasodilation and vasoconstriction. Encourage the patient to engage the hand in activity while soaking.

Precautions: Do not use when patient has sutures, sensitivities to cooler temp (Reynaud’s disease), use of infection control procedures for the warm water baths with patient use. ``

Question 14

Compression Wraps

Answer 14

wrapping from distal to proximal and not too tight. Keep in place for 5 to 15 mins throughout the day as per THx or Physician’s order

Precaution: Do not wrap too tight, figure 8 technique in bandaging, no wrinkles in the wrap. For isotoner glove, the glove should be turned inside out to protect the skin from cuts from the seams. Observe for infection and monitor for decrease sensation. Consider other psychological reaction from feeling of tightness

Question 15

Retrograde Massage

Answer 15

an effective method because it directs fluid back toward the body, in a distal to proximal direction for 5 to 20 mins several times and should be taught to patient to perform throughout the day. Massage should be followed by an activity or functional task

Precautions: use of lotion to reduce friction that could break or bruise the skin, respect allergies and negative effects of people around scents, Massage should not be forceful, and produce no pain. should not be performed in the presence of infection. be aware of any kind tactile sensitivity.

Question 16

Air Splint

Answer 16

use of plastic, inflatable arm sleeve over edematous UE and inflate it to compress UE for 20 mins, should be used when there is severe edema, can also be used for LE, performed under the direction of a knowledgable OT practitioner in a clinical settings accompanied by therapeutic activity

Precautions: Monitor sensation limitations, monitor for impingement of nerves if left on too long, monitor for skin sensitivities with the use of plastic materials, and monitor for infection, *use activity and positioning with an air splint is required to be an effective intervention

Question 17

Electric pumps

Answer 17

placing a sleeve over the arm and turning on the machine that offers a compression and release action to reduce the edema, use pump 15 to 20 mins several times a day. use with severe edema (Lymphedema), physicians orders and an activity must follow

Precautions: pump cannot be use without training prior to using this device, monitor for sensation limitations and impingement of nerves, monitor for skin sensitivities with the use of pump sleeve and monitor for infection. A physician’s order is needed to use the pump and this device is only used with extreme lymphedema.

Question 18

Kinesio Taping

Answer 18

cut strips of elastic tape, the goal is to lift the skin, creating a space between the skin and the underlying tissue. The muscle group under the inflamed area should be held in a stretch position as the tape is applied.

Precaution: requires continuing education and supervision by certified OTR.