Exam 1- Lymph and Diabetic foot Flashcards
Lymph structure
~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
Who is the typically lymph pt?
Breast cancer pt
~damage the lymph system (from the radiation and surgery) bc the lymph has nowhere to dump any more
What is an example of an acute lymph?
when you get a bug bite and get swelling
Is it important to educate?
YES!
~Sooner we educate, sooner we can stop it
~Once its swollen once, it is easier to swell faster and more
*stop this early!
How does lymph swelling feel?
~This is hard and fibrotic
~scar tissue will start building in the interstitial tissue
How to you get rid of the lymph swelling?
~Lymph massage
~rub away from the area/ compression (very specific way to wrap)
Details on a lymph message
~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
Lymph causes a high risk of
infection
*infection/ irritation can lead to edema
What do you not do if you have had lymph?
~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
How does lymph feel? (first signs)
~Heavy, warm, achie
~clothing/ jewelry/ etc will feel heavier
~Ring can’t come off
~ROM is decreasing
To prevent lymph event:
~Garments- compression sleeve (at night, all the time, etc) (one arm may be bigger)
~Protect skin and moisture
~Diuretics- water pill
Be careful of _____ when you are moving all the fluid toward the heart
CHF! can be dangerous for these pts
What do you need to be careful about and rule out?
DVTs!!
What are some ways to rule out DVTs? (8)
~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
Where can DVTs go?
~Lungs (pulmonary embolism)
~Brain (stroke)
When can you dislodge a DVT and s/s?
~when you start walking, it can dislodge a DVT
~shortness of breath, O2 stat drops, BP drops
If you have a pt who has diabetes, talk to them about…
~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!
Looking at toenails details
~Thicker, fungus (flacky, yellow) ~Questions: *Cut them self, podiatrist, nail salon, etc *Pedicures? *Do you soak your feet? (shouldn’t)
What are things you look at on the feet?
~toe nails ~blood flow ~Callouses ~Skin ~Sensation decreased ~Deformities ~Between toes ~Edema ~Strengthen ~ROM ~Shoes/ Socks
Looking at blood flow details
~Cap refill
~Pulses: Dorsalis, post tib, popliteal
~can use an ABI
Looking at Callouses details
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
Looking at skin details
~Dry
~colder (a little)
~hairless
Deformities in the feet with diabetics
~arch decreased/ flat foot
~hammer toes
Details on shoes
~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
