Lecture 5a - Lymphedema & Misc Wounds

Question 1

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

Answer 1

treatment, surgery, radiation

breast, ovarian, cervical, endometrial, prostate cancers

Question 2

2 functions of the lymphatic system

Answer 2

regulation of fluid balance
assistance with infection control

manages 10-20% of fluid removed from interstitial space

Question 3

what system does the lymphatic system mirror?

Answer 3

venous system

Question 4

once interstitial fluid goes into the lymph system it becomes

Answer 4

lymph

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

Question 5

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

Answer 5

lymph nodes

Question 6

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

Answer 6

lymphatic territories

Question 7

2 things that help us keep lymph moving

Answer 7

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

Question 8

what are anastomoses?

Answer 8

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

Question 9

lymph movement is governed by what pressures?

Answer 9

hydrostatic and osmotic pressure

Question 10

dynamic insufficiency

Answer 10

lymphatics unable to accomodate and remove fluid due to increased load

Question 11

mechanical insufficiency

Answer 11

lymphatic system unable to manage normal load

Question 12

what leads to sclerosis and fibrosis of lymphatic vessels?

Answer 12

• 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

Question 13

how does limb size affect diffusion?

Answer 13

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

Question 14

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

Answer 14

primary lymphedema

Question 15

acquired lymphedema, caused by disruption in system by outside force

Answer 15

secondary lymphedema

Question 16

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

Answer 16

yes- because they need specialized treatment for compression

Question 17

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

Answer 17

lymphorrhea

Question 18

what may present in an lymphedema periwound?

Answer 18

skin is often dry, flakey, scaly, and fibrotic

may have edema, papillomas, or papillomatosis

Question 19

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

Answer 19

papillomas

Question 20

cobblestone-like appearance to skin seen in stage 3

Answer 20

papillomatosis

Question 21

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

Answer 21

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

Question 22

how to take lymphedema circumferential testing

Answer 22

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

Question 23

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

Answer 23

increased lymphatic load
decreased lymphatic return
prone to scarring

Question 24

what is a positive stemmers sign

Answer 24

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

Question 25

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

Answer 25

latent stage 1

Question 26

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

Answer 26

reversible stage 2

Question 27

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

Answer 27

spontaneously irreversible stage 3

Question 28

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

Answer 28

lymphostatic elephantiasis stage 4

Question 29

mild unilateral lymphedema is a __ cm difference in circumference

Answer 29

<3 cm

Question 30

moderate unilatearal lymphedema is a __ cm difference in circumference

Answer 30

3-5 cm

Question 31

severe unilateral lymphedema is a __ cm difference

Answer 31

>5 cm

Question 32

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

Answer 32

Naur

Question 33

_______ is a good lotion for lymphedema

Answer 33

lanolin

Question 34

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

Answer 34

T

Question 35

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

Answer 35

fungating wounds

Question 36

what settings are fungating wounds typically seen

Answer 36

palliative care

Question 37

how should you treat fungating wounds?

Answer 37

protecting periwound use charcoal dressing to help with smell

Question 38

what exercises should you do with someone with lymphedema

Answer 38

AROM aerobic exercise breathing exercise

Question 39

what exercises should you not do with someone with lymphedema?

Answer 39

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

Question 40

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

Answer 40

J for stretch U for fibrosis proximal to distal

Question 41

T or F: compression is key to lymphedema treatment

Answer 41

T

Question 42

what compression to use during exacerbation or air travel?

Answer 42

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

Question 43

what compression to use for maintenance?

Answer 43

compression garments

Question 44

compression level: 10-21 mmHg

Answer 44

light compression

Question 45

compression 15-32 mm Hg

Answer 45

medium compression

Question 46

30-40 mmHg compression

Answer 46

strong compression

Question 47

> 40 mmHg compression

Answer 47

very strong compression

Question 48

should you use whirlpool on a patient with lymphedema?

Answer 48

NO

Question 49

diuretics can ______ edema through increased protein concentration

Answer 49

can worsen edema

Question 50

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

Answer 50

lipedema

Question 51

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

Answer 51

abrasion

Question 52

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

Answer 52

laceration

Question 53

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

Answer 53

skin tear

Question 54

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

Answer 54

skin tear

Question 55

how to dress a skin tear

Answer 55

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

Question 56

frequency (highest to lowest) of bite wounds

Answer 56

dog, cat, human

Question 57

infection (largest to smallest) of bite wounds

Answer 57

human, cat, dog

Question 58

which spider bite requires wound care

Answer 58

brown recluse

Question 59

how do radiation burns present?

Answer 59

* inflammation, redness, local edema, dry skin and itchiness, sensitivity to touch * ulcers can form from trauma

Question 60

what is the main treatment of radiation burns?

Answer 60

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

Question 61

noninfectious progressive necrotizing skin condition, unclear cause

Answer 61

pyoderma gangrenosum

Question 62

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

Answer 62

pyoderma gangrenosum