Edema Management and Compression Flashcards by Michele Glowacki

Define Venous Edema

Excess protein poor interstitial fluid resulting from increased capillary permeability that cannot be accommodated by the normal lymphatic system

How well did you know this?

Not at all

Perfectly

This is also known as tissue swelling, It is formed by the accumulation of inter-cellular fluid present in the tissues as a result of filtration of fluid from within the vascular system into the surrounding intersitial space

Edema

How well did you know this?

Not at all

Perfectly

Your patient has heart failure. What could be a secondary complication?

Venous Edema

Other conditions: Chronic venous insufficiency, hepatic cirrhosis, nephritic syndrome, inflammatory wound healing response

How well did you know this?

Not at all

Perfectly

Define Lymphedema

Low output failure of the lymphatic system

- May be congenital or due to anatomical disruption such as surgical dissection or recurrent infection

How well did you know this?

Not at all

Perfectly

Can your dx of your patient be edema?

No, it is a symptom of something else. Excess fluid in the tissues is a sx of an underlying condition

How well did you know this?

Not at all

Perfectly

Name 5 of the 9 bilateral causes of edema

) Cardiac Disease
) Renal Disease
) Hepatic Disease
) GI Disease
) Immune disease and allergy
) Nutritional Disease
) Pregnancy
) Circulatory Problems (Vena Cava obstruction)
) Drugs and Medications

How well did you know this?

Not at all

Perfectly

Name 3 of the 5 unilateral causes of edema

) Venous Disease
) Arterial Disease (AV fistula)
) Lymphatic Disease
) Operations
) Trauma

How well did you know this?

Not at all

Perfectly

Your patient comes in with what looks like bilateral swollen legs. You are able to pinch the skin on the top of the foot. What is your hypothesis?

Lipedema: Abnormal accumulation of adipose tissue in the LE, can be mistaken for lymphedema, dorsum of the feet are spared

How well did you know this?

Not at all

Perfectly

During the subjective interview and your screen what are some things you should be asking/looking for in a patient with edema?

Adequate hx providing info regarding medical conditions that could cause edema
Occupation
Duration of edema
BMI
Edema Distribution
Pitting
Varicosities
Skin Changes
Color (Red may not mean infection)
Measurement of the limb

How well did you know this?

Not at all

Perfectly

What are some ways to treat edema?

Leg elevation (should be at least around waist level)
Exercise: Calf muscle pump
Compression Therapy

How well did you know this?

Not at all

Perfectly

What should you do before putting on bandages?

Evaluation of arterial circulation = Pulse exam (femoral, popliteal, dorsalis pedis, posterior tib)
-Also do doppler assessment (ABI)

How well did you know this?

Not at all

Perfectly

What amount of compression is ideal for treatment of edema and venous stasis ulcers?

35-45 mmHg

How well did you know this?

Not at all

Perfectly

Your patient is able to walk around in their bandage…what type of compression bandage would you use?

Inelastic (short stretch) bandage b/c pressure increases when the patient moves. This bandage doesn’t apply compression, doesn’t expand when the muscle contracts and is able to conform to the extremity. At rest pressure is 28 mmHg ( medium compression)

How well did you know this?

Not at all

Perfectly

What type of compression is >60 mm Hg

Very strong Compression

How well did you know this?

Not at all

Perfectly

What type of compression is 20-<40 mmHg

Medium Compresion

How well did you know this?

Not at all

Perfectly

What type of compression is 40-<60 mmHg

Strong Compression

This type of compression provides grades compression from the ankle to below the knee.

Compression Stocking

Define the classes of compression stockings

Class 1: 14-19 mmHg
Class 2: 19-24 mmHg
Class 3: 25-35 mmHg
Class 4: 40-50 mmHg

Provide examples of single layer elastic compression bandages

-Ace Wrap
-Coban
(Provide mild compression)

These bandages are 2-4 layers and provide moderate to high compression

Multilateral elastic compression bandages

With this type of bandage pressure will decrease with movement, and example is the Unna Boot. Certain amount of pressure is applied to the extremity (ideal is 35-45 mmHg)

Long Stretch Compression Bandages

What is the purpose of using compression devices for edema reduction?

-Improves healing environment
-Reduces neuromuscular inhibition
-Improves ROM
-Decreases pain
Also, helps prevents DVT by increasing venous flow which prevents clots

This type of compression device inflates as a unit

Circumferntial Unit

If you want to inflate the compression unit and have it remain inflated…what would you call this

Constant Unit

Name at least 8 contraindications for use of a compression device

1. ) Acute or unhealed fracture 2. ) Uncontrolled Hypertension 3. ) Compartment Syndrome 4. ) Current PVD 5. ) Arteriosclerosis 6. ) Edema secondary to CHF 7. ) Ischemic vascular disease 8. ) Pulmonary edema 9. ) Gangrene 10. ) Dermatitis 11. ) DVT 12. Thrombophlebitits

When the unit milks from distal to proximal, chambers inflate individually

Sequential Unit

Air (pneumatic) or chilled water (hydraulic) are what type of unit?

Media Unit

Name the physiological effects of compression devices

- Mechanical pressure reduces edema - Forces venous fluids proximally - Decrease capillary filtration pressure, limiting formation of edema - Increased lymphatic uptake - Improved absorption and removal of solid wastes - Increase ROM - Decrease Pain

What are some things that can be done with compression therapy?

- Elevation of limb (gravity assists in venous and lymphatic return - Electrical Stimulation: Motor level stimulation provides muscle pump

What step is out of order for Termination of the Treatment? 1. ) Reduce the ON time or select the DRAIN mode to remove the air or fluid from the appliance 2. ) Allow the appliance to deflate 3. ) Remove body part 4. ) Apply a compression wrap and any appropriate supportive device 5. ) Re-measure circumference of extremity and determine amount of edema reduction 6. ) Encourage patient to keep the limb elevated whenever possible between treatments

Step #5 is wrong, it should be step #4 1. ) Reduce the ON time or select the DRAIN mode to remove the air or fluid from the appliance 2. ) Allow the appliance to deflate 3. ) Remove body part 4. ) Re-measure circumference of extremity and determine amount of edema reduction 5. ) Apply a compression wrap and any appropriate supportive device 6. ) Encourage patient to keep the limb elevated whenever possible between treatments

What are the steps for initiation of compression therapy?

1. ) Set TEMP between 50-55 F 2. ) Select the MAX PRESSURE for tx. - 30-60 mm Hg for UE and 60-80 for LE 3. ) Select the ON-OFF times - 3:1 duty cycle is often used 4. ) Select TREATMENT TIME - Post-traumatic edema: 20-30 minutes - Lymphedema: Several hours

What things should you be instructing the patient on during/before the compression device starts?

- Inform pt about sensations to be expected - Instruct pt to perform ROM exercises during the off cycle - If sessions are longer then 60 minutes you must stop session and inspect extremity for proper capillary refill and sensation or the presence of unusual marking or unexpected pitting edema

Maintenance of the machine after each treatment includes what....

- Check for leaks/tears, if found repair with an approved patch kit or return to manufacture - Clean the appliance using an approved cleaner - If machine washable, turn them inside out and close them

Quarterly maintenance includes...

-Check air/water hoses, clean external unit, check plugs, cables and cords for frays etc

Annually or as required maintenance includles

A qualified technician should perform an inspection and calibration and perform any needed maintenance

Application of compression therapy includes

- Distal to Proximal - Wrap medial to lateral with an initial figure 8 - Decrease tension moving proximally - Avoid circumferential and spiral wrapping - Assess capillary refill post application