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ACOLS > Edema of Other Genesis > Flashcards

Edema of Other Genesis Flashcards

1
Q

Inflammation is characterized in the acute form by the classical signs.

A

Redness
Heat
Pain
Swelling
Functional Disorder

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2
Q

Why does edema usually accompany trauma?

A

Inflammatory process is high protein resulting in edema.

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3
Q

Negative Effects of Swelling in Trauma (5)

A
  1. Lack of oxygen and nutrients to traumatized area
  2. Decreased transport of macrophages to traumatized area
  3. Decreased transport of basic substances needed for tissue healing
  4. Irritation of nociceptors (pain receptors)
  5. Increased scar formation (Keloiding)
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4
Q

What is the primary cause of the negative effects of swelling in trauma?

A

Increased Diffusion Distance

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5
Q

What is the goal of therapy in traumatic edema?

A

Reduce swelling to normalize diffusion distance via manual lymph drainage both direct and proximal to the injury.
This improves absorption of edema fluid and accelerates wound healing.

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6
Q

Describe the treatment plan for Blunt Trauma <6-8 hours.

A

Lymph Load consists of Hematoma components (dead cells)
* Thumb circles to work directly over hematoma - from inside out
* All directions
* This should be the bulk of your treatment - 15- 20 min.
* Apply bandage after MLD for 2 hours
* Give second MLD treatment after 2-3 hours - beginning with ice
* Reapply a padded compression bandage

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7
Q

When is MLD contraindicated in Blunt Trauma?

A
  • severe injuries such as fractures or compartment sysndrome
  • severe pain or dizziness a physician must be consulted first
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8
Q

Treatment considerations for joint/limb surgery.

A
  • May begin 6-8 hours post-op
  • Twice a day for 2-3 days
  • May work around the border of the incision after 5-7 MLD sessions (gently avoid tension on wound edges)
  • stimulation of regional lymph nodes followed by basic MLD techniques proximal to the inicsion
  • wait until sutures/staples removed (1-2wks) prior to scar work.
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9
Q

Specific treatment consideration for knee surgery.

A
  • MLD - Iguinal Nodes
  • Pumps on anterior and lateral thigh
  • Dynamic Stationary Circles at Medial Thigh
  • Do basic techniques down to the knee
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10
Q

Consideration for Open Wounds and MLD.

A
  • Basic MLD techniques proximal to the wound in order to increase lymph flow
  • Special MLD techniques -thumb circles with working pressure directed into the wound bed.
  • Wound debris is removed with sterile gauze dressing.
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11
Q

Characteristics of Acute Inflammation (5)

A
  • Increase of Lymphatic Loads
  • Increase in permeability of proteins through blood capillary membrane
  • Increase in Lymph Time Volume (LTV)
  • If the lymphatic system is able to compensate - no swelling
  • If edema presents - high protein edema
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12
Q

Characteristics of Chronic Inflammation (6)

A
  • Increased Lymphatic Load
  • Increase in the permeability of BC’s to proteins
  • Increased LTV - sustained over a prolonged period of time damage LS
  • Pain - lymphangiospasm
  • Lymphangitis - inflammation of lymph vessels
  • Lymphadenitis - inflammation of the lymph nodes
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13
Q

When will Chronic Inflammation develop into combined insufficiency?

A

If the lymphatic system is mechanically insufficient and the lymphatic loads are increased.

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14
Q

Term for chronic, systemic inflammatory disease that mostly affects the synovial membranes and associated join capsule structures.

A

Rheumatoid Arthritis

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15
Q

Symptoms of Rheumatoid Arthritis.

A
  • fever
  • loss of energy
  • loss of appetite
  • anemia
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16
Q

What are the major components of the Joint Capsule?

A
  • synovial membrane (movement produces synovial fluid)
  • no blood vessels
  • living tissue
  • receives nutrients from synovial fluid
  • many proprioceptors and nociceptors
  • large number of lymph vessels
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17
Q

What is the main cause of pain in Rheumatoid Arthritis?

A

as per study by Dr. Brugger and Foldi pain is exclusively from intra-articular swelling.

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18
Q

What is the main cause of pain in Rheumatoid Arthritis?

A

as per study by Dr. Brugger and Foldi pain is exclusively from intra-articular swelling.

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19
Q

What are some key point of Rheumatoid Arthritis Pathophysiology?

A
  • Autoimmune response following an infection with streptococci (autoimmune response)
  • Can progress through stages
  • Can effect the lymphatic system with localized joint swelling
  • Lymphangiospasm
  • Lymphangitis
  • Prolonged dynamic insufficiency
  • Mural (wall) insufficiency of the lymph collectors (high intra-lymphatic pressure from high-protein fluid)
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20
Q

What phase of Rheumatoid Arthritis includes the inflammation of the synovial membrane with intra/extra-articular swelling (pain).

A

Inflammatory Phase

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21
Q

What phase of Rheumatoid Arthritis includes the destruction of the cartilage and bone tissue resulting in deformation of the joints.

A

Destructive Phase

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22
Q

What is the result of joint swelling in Rheumatoid Arthritis?

A

Increased diffusion distance b/w intra-articular blood capillaries and synovial membrane thus decreased supply of oxygen and nutrients to the cartilage.
- decreased ROM
-Pain

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23
Q

Treatment considerations for Rheumatoid Arthritis?

A

Goal - reduce intra/extra-articular swelling thus break pain cycle
MLD Daily- after acute (inflammatory phase)
Stroke Sequence - basic stroke sequence with regional lymph nodes and extremity including the affected joints.
Mild Compression - with physicians approval and only for short time (hours), must not cause pain or restrict movement.

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24
Q

Characteristics of Reflex Sympathetic Dystrophy - Complex Regional Pain Syndrome - Shoulder-Hand Syndrome - Sudeck’s Atrophy

A
  • Abnormal response of the autonomic nervous system (ANS)
  • Localized inflammation accompanied by morphological changes in soft tissue, nerves, bones, joints, and disturbances in the local blood supply
  • More commonly seen in upper extremities
  • Often caused by some trauma
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25
Q

What stage of Reflex Sympathetic Dystrophy is the following:
* Inflammation begins due to protein-rich swelling caused by the increased lymphatic loads in combination with lymphangiospasm
* Severe Pain
* Vasodilation

A

Stage 1 - Inflammatory Acute Stage

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26
Q

What are the characteristics of Reflex Sympathetic Dystrophy Stage 2?

A

Degenerative Stage - Dystrophic
* Atrophy of the skin and musculature * Soft tissue becomes fibrotic due to proliferation of connective tissue
* Skin becomes pale
* Brittle nails
* Swelling recedes
* Decrease in circulation
* Vasoconstriction

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27
Q

What are the characteristics of Reflex Sympathetic Dystrophy Stage 3?

A
  • Joint, skin, muscle contractures
  • blood circulation back to normal (no known reason as to why this happens)
28
Q

Treatments Objectives for Reflex Sympathetic Dystrophy.

A
  • Reduce angiospasm to control swelling
  • Pain reduction - break the pain cycle
  • MLD is more effective in Stage 1 and the transition between Stage 1 and 2, when swelling and pain are the dominant symptoms
  • MLD applied to the regional lymph nodes and PROXIMAL to the involved
    area
29
Q

Syndrome characterized by soft (pitting) symmetric edema-weight gain in menstruating females.

A

Cyclic Idiopathic Edema

30
Q

Characteristics of Cyclic Idiopathic Edema

A
  • Involves the entire body
  • unclear cause
  • associated with CVI, Lipedema, and Lymphedema
  • MLD can be used in edema phase
  • compression garments (panty)
31
Q

When does Lymphostatic Encephalopathy occur?

A

If the normal flow of lymph from the head and neck is disrupted resulting in lymphedema.

32
Q

Outermost of the 3 meninges - fibrous membrane that covers the brain and spinal cord, lining the inner surface of the skull.

A

Dura Mater

33
Q

Define Intra-Dural Dainage

A

everything beneath the dura mater
- 50% drains along the fibers of the olfactory nerve, through the cribiform plate and to the mucus membrane of the nasal cavity (lymph vessels)

34
Q

Define Extra-dural drainage.

A

Everything between the dura mater and the skull
- through the sutures of the skull to lymph vessels of scalp

35
Q

Are there lymphatic vessels present in the CNS?

A

NO

36
Q

Describe the route of Interstitial fluid from the brain tissue.

A

Interstitial Fluid from blood and brain
to
diffusion through extracellular spaces of the brain
to
build flow from the brain along basement membranes in the walls of capillaries and arteries
to
walls of carotid and ? vertebral arteries
to
cervical lymph nodes

37
Q

Describe the flow of CSF to the lymph system.

A

CSF from choroid plexus
to
Ventricles
to
Subarachnoid space
to
nasal lymphatics
to
cervical lymph nodes

38
Q

Characteristics of Primary Encephalopathy.

A
  • Cases are rare
  • If present, often combined with UE or trunk involvement
  • One side of the face
  • Deviated septum
  • Chronic mouth breathers
  • Dry mucus membrane
  • Can lead to repetitive infections of cervical lymph nodes
  • Lymph nodes become fibrotic/scarred
39
Q

Characteristics of Secondary Encephalopathy.

A
  • Seen with surgical neck dissections
  • Radiation of cervical lymph nodes
  • Chronic inflammatory process in the neck, nose, ears or teeth area
  • Results in a chronic lymphangitis or lymphadenitis
  • Inflammatory process can interfere with drainage from the brain
40
Q

Symptoms of Secondary Encephalopathy.

A
  • visual signs of swelling around head, neck, face
  • trouble swallowing
  • constant feeling of sore throat
  • difficulty breathing
  • dry mouth (salivary glad disfunction)
  • trismus (restricted mouth opening)
  • referred pain (scalp, behind eye, headaches)
  • tinnitus,
  • vertigo, imbalance
  • blurred vision, redness of the eye
41
Q

Primary Encephalopathy Treatment plan.

A
  • convert to mouth breather
  • SLP referral
  • MLD/CDT
  • Exercises: chewing, facial movements
42
Q

Secondary Encephalopathy Treatment plan.

A
  • MLD/CDT
  • teach self-MLD
  • good oral hygiene
  • Exercises - chewing, facial movements
43
Q

Consideration for Facial Swelling Treatment

A
  • wear at night (face and neck)
  • wear 2 hours 2-4 times a day
  • gravity assist drainage during the day
  • forehead and scalp are not generally involved
  • drainage areas for post neck-dissection conditions are the cranial portions of the upper quadrants and the axillary lymph node groups
44
Q

Why is an accurate and timely Lymphedema Evaluation important?

A
  • essential so the appropriate amount of treatment can be applied in a prompt, cost effective and minimally intensive fashion.
  • identify impairments in function, determine prognosis and develop comprehensive plan of care.
45
Q

What are some important considerations in reviewing previous medial history?

A
  • Patient interview, review medical record, medical history questionnaire
  • Previous and current oncological history and diagnosis (chemo, radio, lymphedema)
  • Surgical history
  • Past and present history of lymphedema, treatments and results
  • Current compliance
  • Medication - lab work
  • Review pertinent radiological studies and operative reports
46
Q

What components of oncological history are important to include?

A

Diagnosis
Grade and Stage of Tumor
Treatments - past, present, future
Results of Treatment
Complications

47
Q

What important factors regrading medications are important to review.

A
  • Current Medications
  • Will altered fluid balance effect potency or absorption
  • Analgesics, possible narcotics, chemotherapy agents, hormone treatments, neuromuscular meds
48
Q

What areas of the social history are needed in an assessment.

A
  • Prior functional level
  • Living situation
  • Help at home - family/caregiver support available
  • How long swelling has been present
  • Hobbies - leisure time activities
  • Work/Family Expectations
  • Transportation
  • Travel outside the US
  • Personal goals
  • Problems
49
Q

Objective Skin Observations include what 3 categories.

A
  • Skin: note appearance of skin: thin, taut, shiny, presence of fibrosis, color, presence of edema (pitting or non-pitting)
  • Scars: appearance, location, color
  • Wounds: size, location, color, drainage, dressing, sutures
50
Q

What components of scars are important to document?

A
  • Location and size
  • type of scar (hypertorophic, keloid, widespread)
  • texture (thick, rigid, raised, flat, soft)
  • presence of adhesions
  • mobility of scar (poor,fair,good,normal)
51
Q

What are the specific components of a skin review? (12)

A

Color -discoloration
Temperature/Texture
Fibrotic Tissue
Fistulas
Radiation Fibrosis
Nails
Scars
Skin folds - Pitting
Fungus - hyperkeratosis
Stemmer Sign
Cyst Wounds
Papillomas

52
Q

What are the objective measurements and assessment that should be part of the physical assessment?

A
  • Strength/coordination - ROM
  • Circumferential or volume measures
  • Pictures
  • Posture/alignment
  • Upper and lower quadrant screens
  • Balance
  • Coordination
  • Transfers - gait
  • Pain - sensation
  • Independence with ADLs
  • Joint mobility (impingement syndrome, rotator cuff tears, labral tears, acromio-clavicular osteoarthrititis)
  • Cognition
53
Q

What are the Differential Diagnosis that need to be considered in a Lymphedema Assessment. (7)

A
  • Acute trauma or surgery (6-8 weeks swelling normal)
  • Recurrent or metastatic disease
  • Thrombophlebitis or deep vein thrombosis (DVT). (warmth, redness, discoloration, pain upon palp.
  • Arterial insufficiency (cold, pallor, cold sensitivity)
  • CHF - be cleared by cardiologist prior to MLD
  • CVI - edema present in dependent positions only
  • Lipedema - bilateral, symmetrical fatty deposits

Consider additional possibilities for an edematous limb

54
Q

What is the determining factor in deciding the need to move forward with treatment in regards to measurement.

A

A difference of 2 cm or more at any measurement point between the affected and non-affected extremity.

55
Q

What are some short term goals in lymphedema treatment to consider?

A
  • Instruction with abdominal breathing
  • Min or Mod verbal cuing to perform exercises with bandages on
  • Recognize and verbalize signs of infection to prevent hospitalization
  • Girth measurements
  • Functional goals
56
Q

What are some LONG term goals in lymphedema treatment to consider?

A
  • Instruction with donning garment
  • Instruction with home exercise program (HEP)
  • Instruction with self-bandaging
  • Girth measurements
  • Functional goals
57
Q

What are some Plan of Care steps in lymphedema treatment to consider?

A
  • Select all appropriate interventions (CDT)
  • Develop a comprehensive discharge plan
  • Determine the need for skilled care
  • Confirm the patient will be able to continue at home upon discharged
  • Set short and long term goals
58
Q

What are some Prognosis considerations in lymphedema treatment to consider?

A
  • Expected improvement - rehab potential
  • Amount of time needed to obtain the improvement
  • Tentative discharge plans (when the patient will be ready for discharge)
  • Equipment needs
  • Advocate for patient to ensure proper care
  • Do not start Tx until the conditions have been met to have a successful outcome
59
Q

Measurement Techniques in Assessment of Lymphedema. (4)

A
  • Water Displacement
  • Limb girth via tape measurement
  • Infrared laser perometry
  • Bioelectrical Impedance (BIA
    No Gold Standard
60
Q

Water Displacement Measurement - Pros/Cons

A

Cons
- messy
- sanitation concerns
- limb may not fit into container
- time consuming
- does not provide data about localization of edema
Pros
- more accurate for isolated hand/foot measurements

61
Q

At what points are Circumferential Measurements taken for the legs.

A
  1. Largest circumference of dorsum
  2. Ankle - smallest ankle circumference
  3. Distal calf - where calf meets Achilles tendon 4. Mid calf-largest
    circumference
  4. Popliteal fossa - knee
    crease
  5. Distal thigh
  6. Proximal thigh - Standing use flexible paper in groin
    Measure height from the heel
62
Q

At what points are Circumferential Measurements taken for the arms.

A

7) Proximal upper arm- place paper around arm- mark top of paper
6) Mid-upper arm
5) Elbow crease
4) Proximal forearm - largest part of forearm
3) Mid-forearm
2) Wrist - smallest circumference
1) Web space meets thumb in abduction
Measure height from the proximal nail bed of the middle finger

63
Q

Explain how to complete Volumetric Measurements - using the 4cm Model.

A

4cm Model
1. Determine “0 point” and mark
2. Mark extremity in 4 cm increments from distal to proximal
3. Measure circumference at each point
4. Square each number
5. Take the sum of all square numbers
6. Divide sum by 3.14 = ml (Divide by 1000 for Liters) 7. Measure the uninvolved limb in the same fashion; repeat calculations
8. Subtract the final numbers for total difference between limbs in order to determine edema volume (in ml)

64
Q

What type of measurement tool uses infrared light transmitters and the truncated cone method?

A

Perometer -very expensive

65
Q

What type of measurement tool uses a single frequency low voltage electrical current to determine extra cellular fluid.

A

Bioelectrical Impedance (BIA)
- quick and painless
- portable
- no pacemakers or metal implants

ACOLS (7 decks)

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