Lecture 5a - Lymphedema & Misc Wounds Flashcards
in the US and Europe, lymphedema occurs most often due to what?
treatment, surgery, radiation
breast, ovarian, cervical, endometrial, prostate cancers
2 functions of the lymphatic system
regulation of fluid balance
assistance with infection control
manages 10-20% of fluid removed from interstitial space
what system does the lymphatic system mirror?
venous system
once interstitial fluid goes into the lymph system it becomes
lymph
composed of water, protein, dead/dying cells, cellular components, foreign material, debris
exist as clusters; filter stations with lymphocytes that identify and destroy foreign material and provide immune support
lymph nodes
the area of the body that drains to a single lymph node, seperated by watersheds
lymphatic territories
2 things that help us keep lymph moving
- lymph vessels dont have valves so fluid can move both ways
- anastomoses
what are anastomoses?
peripheral collectors allowing regional lymph nodes from one area to use regional lymph nodes from another area as supplemental or alternative drainage
lymph movement is governed by what pressures?
hydrostatic and osmotic pressure
dynamic insufficiency
lymphatics unable to accomodate and remove fluid due to increased load
mechanical insufficiency
lymphatic system unable to manage normal load
what leads to sclerosis and fibrosis of lymphatic vessels?
- fibrogen in interstitium accumulates
- macrophages migrate and activate fibroblasts
- collagen and connective tissue develop in the area
- fibrosis occurs
- hardening of the area
- sclerosis and induration
how does limb size affect diffusion?
increased limb size = increase diffusion distance for O2 and nutrients to reach cells = increased tissue pressure = swelling = collapse lymphatic capillaries
occurs without obvious cause, result of congenital malformation or impairment (10% of cases)
primary lymphedema
acquired lymphedema, caused by disruption in system by outside force
secondary lymphedema
you’re treating a patient with lymphedema, with no open wounds. could you see this patient in a wound clinic?
yes- because they need specialized treatment for compression
weeping, no actual open area but fluid drains through and beads on skin surface because the skin is stretched too far to act as a barrier
lymphorrhea
what may present in an lymphedema periwound?
skin is often dry, flakey, scaly, and fibrotic
may have edema, papillomas, or papillomatosis
cauliflower like projections of epithelium causes by distended and dilated superficial lymphatics
papillomas
cobblestone-like appearance to skin seen in stage 3
papillomatosis
lymphedema risk factors:
- __________ of lymph nodes
radiation therapy
surgical complications
____________ time since surgery (removal of lymph nodes)
_________ BMI
air travel without __________
removal of lymph nodes
radiation therapy
surgical complications
increased time since surgery
increased BMI
air travel without compression
how to take lymphedema circumferential testing
measure every 3,4,8, 12 cm
try to use landmarks
measure both limbs
lymphedema risk factors continued:
_____________ lymphatic load
________ lymphatic return
prone to scarring
increased lymphatic load
decreased lymphatic return
prone to scarring
what is a positive stemmers sign
inability to pinch a skin fold on dorsal aspect of edematous digit
lymphedema staging:
no edema
reduced transport capacity
usually from surgery or radiation
latent stage 1
lymphedema staging:
pitting edema
greatly/completely reduces with elevation
no secondary skin changes
reversible stage 2
lymphedema staging:
no pitting edema
no edema reduction with elevation
skin is fibrotic or brawny
spontaneously irreversible stage 3
lymphedema staging:
extreme increase in limb volume
deep skin folds and papillomas present
frequent skin infections
lymphostatic elephantiasis stage 4
mild unilateral lymphedema is a __ cm difference in circumference
<3 cm
moderate unilatearal lymphedema is a __ cm difference in circumference
3-5 cm
severe unilateral lymphedema is a __ cm difference
> 5 cm
should you use hot tubs/saunas/ long hot showers if you have lymphedema? what about heating pads?
Naur
_______ is a good lotion for lymphedema
lanolin
T or F: you should wash and dry the limb each time you remove dressing/compression with soap and water
T
infiltration of the tumor into the skin, can appear as deep necrosis with hypertrophic granular tissue
fungating wounds
what settings are fungating wounds typically seen
palliative care
how should you treat fungating wounds?
protecting periwound
use charcoal dressing to help with smell
what exercises should you do with someone with lymphedema
AROM
aerobic exercise
breathing exercise
what exercises should you not do with someone with lymphedema?
high heat, constriction, bands/ankle weights
strength training- avoid muscle overload
lymphatic drainage techniques
gentle
__ technique to stretch skin
__ technique to work on fibrosis
_______ to ________
J for stretch
U for fibrosis
proximal to distal
T or F: compression is key to lymphedema treatment
T
what compression to use during exacerbation or air travel?
multilayer compression bandaging (4 layers)
must use short stretch bandages
what compression to use for maintenance?
compression garments
compression level: 10-21 mmHg
light compression
compression 15-32 mm Hg
medium compression
30-40 mmHg compression
strong compression
> 40 mmHg compression
very strong compression
should you use whirlpool on a patient with lymphedema?
NO
diuretics can ______ edema through increased protein concentration
can worsen edema
B symmetrical adipose build up in abdomen, buttock and LE
usually due to imbalance in pituitary, thyroid, and hormones
lipedema
wound caused by friction and results in superficial or partial thickness wound
abrasion
wound caused my cutting or tearing into skins surface
deep with smooth edges
laceration
caused my shear or friction and results in separation of epidermis from dermis (partial thickness) or dermis from subQ (full thickness)
skin tear
happens most often in older adults, 80% on arms or hands
skin tear
how to dress a skin tear
if you can see edges : skin sealant
if you cant see edges: remove non viable tissue, cover w moisture retentive dressing
frequency (highest to lowest) of bite wounds
dog, cat, human
infection (largest to smallest) of bite wounds
human, cat, dog
which spider bite requires wound care
brown recluse
how do radiation burns present?
- inflammation, redness, local edema, dry skin and itchiness, sensitivity to touch
- ulcers can form from trauma
what is the main treatment of radiation burns?
prevent trauma and moisturize, treat wounds w dressings that will not damage periwound
noninfectious progressive necrotizing skin condition, unclear cause
pyoderma gangrenosum
wound that begins as small, very painful papule that quickly expands, necrotic with undermining
pyoderma gangrenosum
