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MY NPTE > Lymphatics/Wound Care > Flashcards

Lymphatics/Wound Care Flashcards

1
Q

Primary lymphedema

A

abnormal development of lymphatic system - from birth

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2
Q

Secondary lymphedema

A

Trauma
Surgery
Breast cancer
Radiation
Filariasis

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3
Q

Mechanical debridement

A

nonselective removal of necrotic or infected tissue (along with good viable tissue) with irrigation, wet to dry dressing or debridement pads

nonselective

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4
Q

Autolytic debridement

A

Auto = self

moisture retaining dressing - uses body natural fluids and enzymes
best for noninfected wounds

selective

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5
Q

Enzymatic debridement

A

using chemicals or enzymes such as an ointment or gel to soften bad tissue

selective

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6
Q

Biological debridement

A

maggots

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7
Q

Serous fluid

A

clear to yellow thin fluid,
no blood

this is a normal exudate for a healing wound - seen in inflammatory and proliferative stages

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8
Q

Serosanguinous

A

thin and watery, pink in color

this is a normal exudate for a healing wound - seen in inflammatory and proliferative stages

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9
Q

Sanguineous

A

fresh blood that is typically produced from deep wounds during the inflammatory stage of wound healing - may be brown if dried

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10
Q

Purulent

A

yellow, thick pus, odor
indicates infection

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11
Q

Sarcoidosis

A

african americans>caucasion

skin or eye lesions present
upon XRAY - diffuse pulmonary infiltration along with bilateral hilar adenopathy

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12
Q

Rule of nines adult

A

ANTERIOR ONLY
Head 4.5%
Trunk 18%
- 9% for upper half
- 9% for lower
UE 4.5% each
LE 9% each
Genitals 1% total

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13
Q

Rule of nines pediatric

A

ANTERIOR ONLY
Head 9%
Trunk 18%
UE 4.5% each
Legs 7% each

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14
Q

Wagner Ulcer Classification scale

A

Specific to diabetic foot ulcers

Grade 0 - no open lesion or healed ulcer
Grade 1 - superficial ulcer
Grade 2 - deep ulcer involving subcutaneous tissue and may expose bone or tendon
Grade 3 - deep ulcer with osteomyelitis
Grade 4 - gangrene of digit
Grade 5 - gangrene of entire foot

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15
Q

How is Wagner ulcer system different than pressure ulcer staging?

A

Wagner is specific for diabetic foot ulcers

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16
Q

Pressure ulcer staging

A

Stage 1 - intact skin but nonblanchable erythema
pain and sensation intact
Stage 2 - partial thickness affecting epidermis and dermis
presents with blistering
Stage 3- full thickness with loss of subcutaneous tissue
Stage 4 - full thickness with exposed tendon, bone, muscle

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17
Q

Pre albumin vs albumin

A

pre albumin = short term nutrition (2 days)
albumin = long term (20 days)

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18
Q

Normal pre albumin levels

A

20-40

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19
Q

What pre-albumin level would indicate malnutrition

A

less than 15

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20
Q

Normal albumin level

A

3.5-5.5

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21
Q

What Albumin level would indicate malnutrition

A

less than 3.5

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22
Q

Primary intention

A

Surgical closure via sutures, staples, glue, etc

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23
Q

Secondary intention

A

secondary = self

would closure through natural healing

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24
Q

Tertiary intention

A

delayed primary union

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25
Q

Indolent ulcer

A

ulcer that is slow to heal, non painful

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26
Q

How do first degree wounds heal?

A

through regeneration/epithelialization

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27
Q

What is the purpose of providing a moist wound environment?

A

a moist wound bed is healthier and epithelizes better than a dry wound

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28
Q

Factors that delay wound healing

A

increased age - decreased metabolism and needed growth factors for healing

impaired oxygenation/circulation

poor nutrition

comorbidities

infection

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29
Q

SInus tracts

A

tunneling wounds that communicate to deeper structures such as fat or muscle

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30
Q

Dermatitis is also known as

A

ezcema

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31
Q

Dermatitis

A

inflammation of the skin (can be caused by allergic reaction to chemicals/soaps, poison ivy, adhesives, etc)

causes itching, redness, scaling

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32
Q

Advice for dermatiits

A

apply lotions within 5 minutes of showering
know triggers

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33
Q

impetigo

A

superficial skin infection producing small pus filled vesicles
MRSA, staph

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34
Q

Cellulitis

A

inflammation of the skin and underlying tissue
skin is warm, red, signs of infection

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35
Q

Treatment for cellulitis

A

antibiotics
elevation
cool and wet dressings

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36
Q

Herpes simplex (1)

A

itching and soreness
vesicular eruption on face or mouth
ex. cold sore

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37
Q

Herpes 2

A

genital herpes
sexual contact

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38
Q

Tinea corporis

A

ringworm
fungal infection of hair skin nails
spread by direct contact

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39
Q

Tinea pedis

A

atheletes foot
treated with antifungal meds/creams
can progress to bacterial infection or cellulitis if untreated

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40
Q

Psoriasis most commonly affects which joints

A

small distal joints

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41
Q

Psoriasis

A

chronic autoimmune disorder where scaly silver plaques cover the skin

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42
Q

Most common area for psoriasis

A

ears, elbows, scalps, knees, genitals

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43
Q

Precipitating factors of psoriasis

A

trauma
infection
pregnancy
smoking
cold weather

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44
Q

Discoid lupus

A

affects only the skin
flare-ups with sun exposure

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45
Q

Systemic lupus

A

affects multiple body systems
skin heart kidneys nervous system

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46
Q

Long term side effects/conditions of corticosteroids

A

weight gain, acne, HTN, bruising, osteoporosis, diabetes, myopathy

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47
Q

Scleroderma

A

autoimmune disease of connective tissues causing fibrosis of skin, joints, blood vessels, internal organs (lungs heart)

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48
Q

Scleroderma is usually associated with what symptoms

A

arthralgias (joint pain)
malaise/fatigue
raynauds phenomenon
HA
weight loss
anemia
photosensitivity

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49
Q

Population: lupus

A

15-40 year old women

50
Q

Most common cause of death with lupus

A

kidney failure

51
Q

Stages of scar healing

A

bright pink (6-12 weeks)
lavender (12-15 months)
white, flat, soft (2 years)

52
Q

What should a scar look like at 6-12 weeks

A

bright pink

53
Q

What should a scar look like at 12-15 months

A

lavender

54
Q

What should a scar look like at 2 years

A

white, soft, flat

55
Q

What should PTs ensure to assess with patients with scleroderma

A

regularly assess vital signs and blood pressure

at risk for acute HTN

56
Q

Scleroderma - CREST

A

Calcification
Raynauds
Espohageal dysfunction
Sclerodactyl (skin damage of fingers)
Telangiectasia (Spider veins)

57
Q

Zone of coagulation

A

most cell damage, irreverible damage

58
Q

Zone of stasis

A

cells injured but can be “revived” with specialized tx
CSH
coag
Stasis
Hypermedia

59
Q

Zone of hyperemia

A

minimal cell injury, recovery

60
Q

1st degree burn

A

redness and tenderness, painful
only epidermis is damaged
heals in 3-7 days

61
Q

1st degree burn healing times

A

heals in 3-7 days

62
Q

2nd degree burn (superficial partial thickness) healing times

A

7-21 days

63
Q

2nd degree burns (superficial partial thickness)

A

all of epidermis, partial dermis
painful - light touch intact

bright red or pink

blanching with brisk refill

fluid loss and blistering

minimal scarring

64
Q

2nd degree burns (deep partial thickness)

A

red or white waxy

mod pain

severe damage to dermis and epidermis

blanching with slow refill

sensitive to pressure but lacks light touch or pin prick

21-28 days

65
Q

2nd degree (deep partial thickness) burns healing times

A

21-28 days

66
Q

3rd degree burns

A

damaged all the way to subcutaneous tissue, muscle and tendons - risk for contracture
no blanching

painless, dry, leathery

severe fluid loss and infection risk

grey, white or eschar appearance

will heal with a keloid scar

67
Q

Hypertrophic scar vs keloid scar

A

Hypertrophic Scar: raised scar that stays within boundaries of burn wound

Keloid Scar: raised scar that extends beyond boundaries of original burn wound

68
Q

blanching with slow refill =

A

2nd degree (deep partial thickness)

69
Q

blanching with quick refill =

A

2nd degree (superficial partial thickness)

70
Q

sensitive to pressure but lacks light touch or pin prick =

A

2nd degree (deep partial thickness)

71
Q

Location of arterial ulcers

A

lateral malleolus
lower 1/3 of leg
dorsal foot and toes

72
Q

Appearance/symptoms arterial ulcers

A

smooth, deep, with punched-out edges
minimal exudate
absent pulses
no edema
thin and shiny skin with hair loss

73
Q

Leg elevation increases pain

A

arterial ulcer

74
Q

Venous ulcers location

A

proximal to medial malleolus

75
Q

Appearance/symptoms venous ulcers

A

irregular, shallow wound
normal pulses
moderate to heavy exudate
mild pain
edema
hemosiderin staining

76
Q

Pulse scale

A

0- absent
1+ thready, weak
2+ normal
3+ increased
4+ full, bounding

77
Q

Braden scale

A

used for determining pressure sore risk
15-18 mild
13-15 mod
10-12 high
9 or less severe

78
Q

High risk Braden Scale

A

Rated out of 23

12 or less is serious risk

79
Q

Hydrogel

A

increases moisture in dry wound bed

80
Q

Most occlusive moisture retention dressing

A

hydrocolloid

81
Q

Best used for infected wounds with exudate

A

alginates

82
Q

Indications for autolytic debridement

A

natural debridement under semi-occlusive or occlusive dressing

use for all necrotic wounds in medically stable individuals

83
Q

Contraindications for autolytic debridement

A

infected wounds - do not want to trap in infection
dry gangrenous wounds

84
Q

Enzymatic debridement indications

A

Topical application of enzymes to promote liquefication of necrotic tissue

Moist necrotic wounds
people who are homebound

85
Q

Enzymatic debridement contraindications

A

clean granulated wounds
ischemic wounds

86
Q

Indications for mechanical debridement

A

ex. wet to dry, pulsed lavage, wound vac

wounds with foreign material

87
Q

Contraindications for mechanical debridement

A

clean granulated wounds

88
Q

Indications for sharps debridement

A

scoring or excision of necrotic tissue

89
Q

Contraindications for sharps debridement

A

clean wounds
people on anticoagulant therapy

90
Q

Surgical debridement indications

A

when life is threatened with infection or sepsis

91
Q

Minimally absorbent dressings

A

hydrogels
transparent films
gauze

92
Q

Maximally absorbent dressings

A

alginates
foams
hydrocolloids (mod to max)

93
Q

Minimally occlusive dressings

A

Gauze
Alginates
Hydrogels

94
Q

Maximally occlusive dressings

A

hydrocolloids
transparent films
foams

95
Q

Wound care options for arterial ulcers

A

hydrogel

96
Q

Wound care options for arterial ulcers

A

hydrogel transparent fild

97
Q

Advantages of transparent films

A

clear to visualize wounds
promote autolytic debridement
impermeable to water and bacteria

98
Q

Disadvantages of transparent films

A

nonabsorptive
wrinkling, hard to apply
not for infected wounds
can rip fragile skin

99
Q

Indications for transparent films

A

autolytic debridement
secondary dressing
stage 1-2 pressure ulcers w/ no infection

100
Q

Advantages of hydrocolloid

A

maintain moist wound environment
supports autolytic debridement
mod absorption
waterproof/occlusive

101
Q

Disadvantages of hydrocolloid

A

nontransparent
not good for infections
not good for lots of drainage

102
Q

Indications hydrocolloids

A

protection of partial thickness wounds
moderate exudating wound
autolytic debridement

103
Q

Advantages of hydrogel

A

Rehydrate dry wounds
promote autolytic debridement
nonadherent
can be used on infected wounds

104
Q

Disadvantages of hydrogel

A

require secondary dressing
not for exudating wounds
if dry out, could adhere to wound bed

105
Q

Indications for foams

A

partial to full thickness wounds
min to mod exudate
protection/insualtion

106
Q

Disadvantages foams

A

not used for dry eschar or no exudate wounds
require secondary dressing and tape

107
Q

Anteiror neck burn contracture

A

into flexion

position in hyperextension with cervical collar

108
Q

Shoulder burn contracture

A

adduction and IR

position into abduction and ER (airplane splint)

109
Q

Elbow burn contracture

A

flexion and pronation

position into extension and supination

110
Q

Hand burn contracture

A

flexion and adduction

position into wrist extension, MCP flexion, IP extension (resting pan splint)

111
Q

Knee burn contracture

A

flexion

position into extension with posterior knee brace

112
Q

Foot burn contracture

A

plantar flexion

position into DF

113
Q

Treatment compression for CVI

A

20-55 mmHg

114
Q

CDT Phase 1

A

intensive, MLD + skin care + bandaging (23 hours)

bandaging basically gets the limb as small as possible to prepare for compression garment at end of phase (20-40 mmHg) - worn 24 hours/day

115
Q

Bandaging for lymph

A

short stretch bandage (Comprilan, rosidal)

high working pressure

low resting pressure

116
Q

Exercise in phase 1 CDT

A

low impact, waling/cycling/swimming, Tai Chi

117
Q

Phase 2 CDT

A

self management phase
skin care + compression garment day, bandage at night

118
Q

Phase 2 CDT you wear what during the day

A

compression garment

119
Q

Phase 2 CDT you wear what during the night

A

bandage

120
Q

Pressures more than … are CONTRAINDICATED for lymphedema

A

45

121
Q

Describe phases of CDT

A

Phase 1 - intensive
Phase 2 - self management

122
Q

Centrifugal vs centripetal

A

fugal = toward feet
petal - toward heart

MY NPTE (22 decks)

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