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Integ > Lecture 5a - Lymphedema & Misc Wounds > Flashcards

Lecture 5a - Lymphedema & Misc Wounds Flashcards

1
Q

in the US and Europe, lymphedema occurs most often due to what?

A

treatment, surgery, radiation

breast, ovarian, cervical, endometrial, prostate cancers

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2
Q

2 functions of the lymphatic system

A

regulation of fluid balance
assistance with infection control

manages 10-20% of fluid removed from interstitial space

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3
Q

what system does the lymphatic system mirror?

A

venous system

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4
Q

once interstitial fluid goes into the lymph system it becomes

A

lymph

composed of water, protein, dead/dying cells, cellular components, foreign material, debris

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5
Q

exist as clusters; filter stations with lymphocytes that identify and destroy foreign material and provide immune support

A

lymph nodes

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6
Q

the area of the body that drains to a single lymph node, seperated by watersheds

A

lymphatic territories

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7
Q

2 things that help us keep lymph moving

A
  • lymph vessels dont have valves so fluid can move both ways
  • anastomoses
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8
Q

what are anastomoses?

A

peripheral collectors allowing regional lymph nodes from one area to use regional lymph nodes from another area as supplemental or alternative drainage

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9
Q

lymph movement is governed by what pressures?

A

hydrostatic and osmotic pressure

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10
Q

dynamic insufficiency

A

lymphatics unable to accomodate and remove fluid due to increased load

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11
Q

mechanical insufficiency

A

lymphatic system unable to manage normal load

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12
Q

what leads to sclerosis and fibrosis of lymphatic vessels?

A
  • 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
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13
Q

how does limb size affect diffusion?

A

increased limb size = increase diffusion distance for O2 and nutrients to reach cells = increased tissue pressure = swelling = collapse lymphatic capillaries

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14
Q

occurs without obvious cause, result of congenital malformation or impairment (10% of cases)

A

primary lymphedema

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15
Q

acquired lymphedema, caused by disruption in system by outside force

A

secondary lymphedema

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16
Q

you’re treating a patient with lymphedema, with no open wounds. could you see this patient in a wound clinic?

A

yes- because they need specialized treatment for compression

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17
Q

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

A

lymphorrhea

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18
Q

what may present in an lymphedema periwound?

A

skin is often dry, flakey, scaly, and fibrotic

may have edema, papillomas, or papillomatosis

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19
Q

cauliflower like projections of epithelium causes by distended and dilated superficial lymphatics

A

papillomas

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20
Q

cobblestone-like appearance to skin seen in stage 3

A

papillomatosis

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21
Q

lymphedema risk factors:
- __________ of lymph nodes
radiation therapy
surgical complications
____________ time since surgery (removal of lymph nodes)
_________ BMI
air travel without __________

A

removal of lymph nodes
radiation therapy
surgical complications
increased time since surgery
increased BMI
air travel without compression

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22
Q

how to take lymphedema circumferential testing

A

measure every 3,4,8, 12 cm
try to use landmarks
measure both limbs

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23
Q

lymphedema risk factors continued:
_____________ lymphatic load
________ lymphatic return
prone to scarring

A

increased lymphatic load
decreased lymphatic return
prone to scarring

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24
Q

what is a positive stemmers sign

A

inability to pinch a skin fold on dorsal aspect of edematous digit

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25
Q

lymphedema staging:
no edema
reduced transport capacity
usually from surgery or radiation

A

latent stage 1

26
Q

lymphedema staging:
pitting edema
greatly/completely reduces with elevation
no secondary skin changes

A

reversible stage 2

27
Q

lymphedema staging:
no pitting edema
no edema reduction with elevation
skin is fibrotic or brawny

A

spontaneously irreversible stage 3

28
Q

lymphedema staging:
extreme increase in limb volume
deep skin folds and papillomas present
frequent skin infections

A

lymphostatic elephantiasis stage 4

29
Q

mild unilateral lymphedema is a __ cm difference in circumference

A

<3 cm

30
Q

moderate unilatearal lymphedema is a __ cm difference in circumference

A

3-5 cm

31
Q

severe unilateral lymphedema is a __ cm difference

A

> 5 cm

32
Q

should you use hot tubs/saunas/ long hot showers if you have lymphedema? what about heating pads?

A

Naur

33
Q

_______ is a good lotion for lymphedema

A

lanolin

34
Q

T or F: you should wash and dry the limb each time you remove dressing/compression with soap and water

A

T

35
Q

infiltration of the tumor into the skin, can appear as deep necrosis with hypertrophic granular tissue

A

fungating wounds

36
Q

what settings are fungating wounds typically seen

A

palliative care

37
Q

how should you treat fungating wounds?

A

protecting periwound
use charcoal dressing to help with smell

38
Q

what exercises should you do with someone with lymphedema

A

AROM
aerobic exercise
breathing exercise

39
Q

what exercises should you not do with someone with lymphedema?

A

high heat, constriction, bands/ankle weights
strength training- avoid muscle overload

40
Q

lymphatic drainage techniques
gentle
__ technique to stretch skin
__ technique to work on fibrosis
_______ to ________

A

J for stretch
U for fibrosis
proximal to distal

41
Q

T or F: compression is key to lymphedema treatment

A

T

42
Q

what compression to use during exacerbation or air travel?

A

multilayer compression bandaging (4 layers)
must use short stretch bandages

43
Q

what compression to use for maintenance?

A

compression garments

44
Q

compression level: 10-21 mmHg

A

light compression

45
Q

compression 15-32 mm Hg

A

medium compression

46
Q

30-40 mmHg compression

A

strong compression

47
Q

> 40 mmHg compression

A

very strong compression

48
Q

should you use whirlpool on a patient with lymphedema?

A

NO

49
Q

diuretics can ______ edema through increased protein concentration

A

can worsen edema

50
Q

B symmetrical adipose build up in abdomen, buttock and LE
usually due to imbalance in pituitary, thyroid, and hormones

A

lipedema

51
Q

wound caused by friction and results in superficial or partial thickness wound

A

abrasion

52
Q

wound caused my cutting or tearing into skins surface
deep with smooth edges

A

laceration

53
Q

caused my shear or friction and results in separation of epidermis from dermis (partial thickness) or dermis from subQ (full thickness)

A

skin tear

54
Q

happens most often in older adults, 80% on arms or hands

A

skin tear

55
Q

how to dress a skin tear

A

if you can see edges : skin sealant
if you cant see edges: remove non viable tissue, cover w moisture retentive dressing

56
Q

frequency (highest to lowest) of bite wounds

A

dog, cat, human

57
Q

infection (largest to smallest) of bite wounds

A

human, cat, dog

58
Q

which spider bite requires wound care

A

brown recluse

59
Q

how do radiation burns present?

A
  • inflammation, redness, local edema, dry skin and itchiness, sensitivity to touch
  • ulcers can form from trauma
60
Q

what is the main treatment of radiation burns?

A

prevent trauma and moisturize, treat wounds w dressings that will not damage periwound

61
Q

noninfectious progressive necrotizing skin condition, unclear cause

A

pyoderma gangrenosum

62
Q

wound that begins as small, very painful papule that quickly expands, necrotic with undermining

A

pyoderma gangrenosum

Integ (14 decks)

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