Lymph & Integ Flashcards
what are two different main causes of lymphedema? what’s an example of each?
(1) when lymphatic load exceeds transport capacity of the lymphatic system (ex. venous insufficiency)
(2) decreased transport capacity without increased lymphatic load (ex. lymph node removal)
what is the difference between primary and secondary lymphedema?
(1) primary: congenital or hereditary causes
(2) secondary: injury to one or more components of the lymphatic system
what is the difference between pitting, brawny, and weeping edema?
(1) pitting: soft feeling; leaves pits
(2) brawny: hard feeling; no indentation
(3) weeping: fluid leaks from cuts and sores
what is a stemmer sign? what does it indicate?
(1) on the dorsal side of the 2nd or 3rd digit, the skin is unable to be lifted or is difficult to do so
(2) indicates stage 2 or 3 lymphedema
what are the hallmarks of each stage of lymphedema?
- Stage 0: ocassional reports of heaviness; no edema and skin appears normal
- Stage 1: pitting edema; edema increases in standing and reduces with elevation
- Stage 2: hard swelling (brawny); fibrosclerotic tissues, possible (+) stemmer sign in later stage 2
- Stage 3: (+) stemmer sign, severe brawny edema, infections are common
which stage of lymphedema is the only reversible stage?
stage 1 (stage 0 is basically pre-lymphedema)
what is the pitting edema scale for both depth and time?
1+ - 0 seconds; <0.25 inches (mild)
2+ - <15 seconds; 0.25-0.5 inches (mod)
3+ - 15-30 seconds; 0.5-1 inches (severe)
4+ - >30 seconds; >1 inch (very severe)
what is the difference between lymphangitis, lymphadenitis, and lymphadenopathy?
(1) lymphaNGITIS: inflammation of lymph vessels
(2) lymphaDENITIS: inflammation of lymph nodes
(3) lymphaDENOPATHY: enlargement of lymph nodes
what is lipedema? what areas of the body does it typically affect?
(1) lipid accumulation within certain areas of the body
2) PROXIMAL areas, such as buttocks and thighs (but won’t affect feet
what is a huge difference between lipedema and lymphedema?
lipedema has NO swelling in feet, no stemmer sign, and is BILATERAL
how large would a lymph node need to be to refer a patient out?
> 1cm
what type of bandages are recommended for treatment of lymphedema?
low, short stretch bandages (NOT HIGH STRETCH)
what is the order in which manual lymphatic drainage is performed?
(1) decongest trunk FIRST
(2) decongest from PROXIMAL extremity to distal
(3) direction of flow is always towards the trunk
when performing exercises for lymphedema, what order should the exercises be performed?
proximal to distal (ex: cervical before shoulder and shoulder before elbow)
what sensation are krause end bulbs responsible for transmitting in the skin?
cold sensation (Krause = KOLD)
what sensation are meissner corpuscles responsible for transmitting in the skin?
light touch (Meissner’s LIGHT Beer)
what sensation are pacinian corpuscles responsible for transmitting in the skin?
pressure and vibration (P for pressure)
what sensation are ruffini endings responsible for transmitting in the skin?
hot sensation
what sensation are free nerve endings responsible for transmitting in the skin?
pain
what is the location, appearance, and symptoms of venous insufficiency wounds?
(1) location: proximal to medial malleolus
(2) appearance: irregular, shallow, hemosiderin staining
(3) sx: mild to moderate pain (relieved by elevation)
what is the location, appearance, and symptoms of arterial insufficiency wounds?
(1) location: lower 1/3 of leg, toe, lateral malleolus
(2) appearance: smooth, well defined, deep, hair loss, yellow nails
(3) sx: severe pain (made worse with elevation)
what are the stages for pressure ulcers?
Stage 1 - non-blanchable erythema
Stage 2 - superficial (first 2 layers gone)
Stage 3 - subcutaneous fat may be visible
Stage 4 - full-thickness; bone, tendon, etc exposed
Unstageable - excessive necrotic tissue
where are diabetic ulcers typically located?
weight bearing surfaces of the feet
what is the difference between vesicles and bullae?
vesicles are small blisters and bullae are large blisters
what is the difference between normal, hypertrophic, and keloid scars?
(1) normal: pink and flat; similar to skin color
(2) hypertrophic: thick fibrous, WITHIN original wound margins
(3) keloid: grows OUTSIDE of original wound margins
how do superficial burns present? how long does it take to heal?
(1) only involves epidermis; area may be red with slight edema (think sunburn)
(2) healing: 2-5 days
how do superficial partial thickness burns present? how long does it take to heal?
(1) involves epidermis and top layer of dermis; extremely painful and exhibit blisters (minimal to no scarring)
(2) healing: 5-21 days
how do deep partial thickness burns present? how long does it take to heal?
(1) complete loss of epidermis and most of dermis; hypertrophic / keloid scarring
(2) healing 21-35 days (if no infection)
how do full thickness burns present? how long does it take to heal?
(1) destruction of epidermis, dermis, and part of subcutaneous fat layer
(2) healing: weeks to months with or without graft
how do subdermal burns present? how long does it take to heal?
(1) complete destruction of epidermis, dermis, and subcutaneous tissue (may involve muscle and bone)
(2) healing: extensive; often require surgery
what is the rule of 9s for burns?
determine how much of the body was burned FRONT ONLY: head: 4.5% arms: 4.5 each torso: 18% leg: 9% each dick and balls: 1% (Back is the same)
what can generally be said about the inside and outside of wounds?
keep the inside of wounds WET
keep the outside of wounds DRY
what type of dressing should be used for very mild and minimal exudate wounds?
(1) very mild: transparent films
(2) minimal: hydrogel and hydrocolloid
what type of dressing should be used for moderate and heavy exudate wounds?
(1) moderate: foams
(2) heavy: alginates
what types of dressing should be used for infected wounds? (3)
(1) hydrogel
(2) alginates
(3) gauze
what is wet to dry gauze used for?
to remove necrotic tissue
what is the difference between selective and non-selective debridement?
(1) selective: removal of only necrotic tissue
(2) removal of both viable and necrotic tissue
what is the purpose of zinc oxide for wounds?
it increases wound healing
when is silver sulfate used for wounds?
for infected wounds
when is iodine used for wounds?
to clean a surgical sites
when is nitrofurazone used in wounds?
used for burns or skin infections due to grafts
what are the stage of lipedema?
Stage 1: skin surface smooth, subcutaneous fat thickened, fine knots
Stage 2: skin surface uneven, coarse knots
Stage 3: tissue coarse and hard, large deforming fat lobes
Stage 4: additional severe lipolymphedema
what are the 4 classes of garment compression? what are the pressure for each? when are they indicated?
Class 1: 20-30 mmHg pressure -mild lymphedema; frail skin Class 2: 30-40 mmHg -Stage II UE lymphedema Class 3: 40-50 mmHg -Stage II LE lymphedema Class 4: 50-60 mmHg (rarely used) -ONLY used for LE lymphedema
