Exam 1- Lymph and Diabetic foot

Question 1

Lymph structure

Answer 1

~Nodes
~The two sides are not connected/ two systems (2 separate- r arm- 1/4/// l arm and body- 3/4)
~Just returns (like venous)
~Filters out bad stuff (can get bigger things if it gets in there) from the skin to other organs to get rid of it

Question 2

Who is the typically lymph pt?

Answer 2

Breast cancer pt

~damage the lymph system (from the radiation and surgery) bc the lymph has nowhere to dump any more

Question 3

What is an example of an acute lymph?

Answer 3

when you get a bug bite and get swelling

Question 4

Is it important to educate?

Answer 4

YES!
~Sooner we educate, sooner we can stop it
~Once its swollen once, it is easier to swell faster and more
*stop this early!

Question 5

How does lymph swelling feel?

Answer 5

~This is hard and fibrotic

~scar tissue will start building in the interstitial tissue

Question 6

How to you get rid of the lymph swelling?

Answer 6

~Lymph massage

~rub away from the area/ compression (very specific way to wrap)

Question 7

Details on a lymph message

Answer 7

~Uncork the bottle- have to unblock the first area (proximal) and get the fluid moving before you can move more distally
~Superficial (the lymph are tiny vessels) so you are not pushing hard; barely touching them

Question 8

Lymph causes a high risk of

Answer 8

infection

*infection/ irritation can lead to edema

Question 9

What do you not do if you have had lymph?

Answer 9

~Prolong tissue in water (macerated tissue)- wear gloves if you are washing dishes 
~Gardening- wear gloves
~Nail salon 
~infection/ blood drawn
~Take blood pressure on the other side

Question 10

How does lymph feel? (first signs)

Answer 10

~Heavy, warm, achie
~clothing/ jewelry/ etc will feel heavier
~Ring can’t come off
~ROM is decreasing

Question 11

To prevent lymph event:

Answer 11

~Garments- compression sleeve (at night, all the time, etc) (one arm may be bigger)
~Protect skin and moisture
~Diuretics- water pill

Question 12

Be careful of _____ when you are moving all the fluid toward the heart

Answer 12

CHF! can be dangerous for these pts

Question 13

What do you need to be careful about and rule out?

Answer 13

DVTs!!

Question 14

What are some ways to rule out DVTs? (8)

Answer 14

~Ultrasound
~ABIs (could dislodges it) 
~Homan’s Test/ Wells DVT predication rules  
~Pain
~comorbidies
~recent surgeries
~immobility
~walking one day then you don’t want to walk the next day

Question 15

Where can DVTs go?

Answer 15

~Lungs (pulmonary embolism)

~Brain (stroke)

Question 16

When can you dislodge a DVT and s/s?

Answer 16

~when you start walking, it can dislodge a DVT

~shortness of breath, O2 stat drops, BP drops

Question 17

If you have a pt who has diabetes, talk to them about…

Answer 17

~Do you talk your blood sugar regularly? If yes, what are your sugars? Why or why not?
~When was the last time you went to your doc who manages your diabetes?
~Do you take care of your feet? Tell me about your foot care
~Look at their feet!

Question 18

Looking at toenails details

Answer 18

~Thicker, fungus (flacky, yellow)
~Questions:
*Cut them self, podiatrist, nail salon, etc 
*Pedicures?
*Do you soak your feet? (shouldn’t)

Question 19

What are things you look at on the feet?

Answer 19

~toe nails
~blood flow
~Callouses
~Skin
~Sensation decreased
~Deformities
~Between toes 
~Edema 
~Strengthen 
~ROM
~Shoes/ Socks

Question 20

Looking at blood flow details

Answer 20

~Cap refill
~Pulses: Dorsalis, post tib, popliteal
~can use an ABI

Question 21

Looking at Callouses details

Answer 21

Educate on:
~Don’t cut them off
~Don’t soak- can macerate them
~Don’t let them get to dry or they may flake off- moisture to keep safe

Question 22

Looking at skin details

Answer 22

~Dry
~colder (a little)
~hairless

Question 23

Deformities in the feet with diabetics

Answer 23

~arch decreased/ flat foot

~hammer toes

Question 24

Details on shoes

Answer 24

~Good for protection and support
~Diabetic shoes- no seams, great support, more doom (hammer hoes), wider
~Don’t wear sandals- no protection and rubs between toes and having to grip the sandal with toes (blister on toes)
~Have them check their shoes- make sure there is nothing in there (peddle/ toe, etc); creates pressure
~No laces- laces can create different pressures
~When to buy shoes- mid day (mod amount of swelling) morning- no swelling and you will but a shoe that is a 1/2 size too small; afternoon- a lot of swelling and buy a shoe that is a 1/2 size too big

Question 25

Details for socks in diabetics

Answer 25

~No seams
~Cotton- good for moisture control, but can take in a lot of moisture
~Not too tight at the top
~White- so you can see the blood

Question 26

Care for feet

Answer 26

~Toe nails: Make sure they are cut straight across (curves make ingrown toe nails)
~Wash them; moisture would be good; dry them with a cotton towel (in between toes- will macerate the tissue)
~don’t put lotion in between the toes
~Make sure they go to the podiatrist at least one a year

Question 27

Pressure sensation is measured with

Answer 27

Semmes Weinstein monofilament

Question 28

Details on Semmes Weinstein monofilament

Answer 28

~5.07 is the diameter or 10g of pressure means that you have protective sensation
~there are 10 places on the feet to measure
~it it takes 20g, then you have worse sensation
~You can have it missing in one place, but have it in all the others (the pt does not have protective sensation in that certain place)
~You have to test them 5 times- need to feel it 4 times out of 5
~If there are thick callouses, may cause lack of protective sensation