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unit 11 > lymphedema > Flashcards

lymphedema Flashcards

1
Q

at the arterial end of the capillary, which is higher, capillary hydrostatic pressure or blood colloidal osmotic pressure?

A

capillary hydrostatic pressure

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2
Q

what happens at the arterial end of the capillary?

A

filtration, fluid exits the capillary

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3
Q

is the net filtration + or - at the arterial end of the capillary?

A

+

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4
Q

why does reabsorption occur at the venous end of the capillary?

A

fluid re-enters the capillary because chp is less than blood colloidal osmotic pressure

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5
Q

is net filtration pressure + or - at the venous end of the capillary?

A

-

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6
Q

what causes active hyperemia?

A 
heat 
friction
trauma 
infection
inflammation
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7
Q

what is the physiological process behind active hyperemia?

A

vasodilation increases blood capillary pressure via increased arterial flow

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8
Q

what is the physiological process behind passive hyperemia?

A

vasodilation increases bcp via decreased venous outflow due to venous obstruction

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9
Q

what causes passive hyperemia?

A

DVT
CHF
chronic venous insufficiency
tumor

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10
Q

what are the two forces that starling didn’t take into account when thinking about lymphedema? what is the effect of that?

A 
colloid osmotic pressure (assists ultrafiltration)
interstitial pressure (resists ultrafiltration)
no changes across capillary bed in normal situation
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11
Q

what happens to cop in lymphatic dysfunction? what is the net effect?

A

increases

net effect: increased ultrafiltration

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12
Q

what happens to interstitial pressure in lymphedema?

A

decreases w reduced atmospheric pressure
decreases w aging and decreased collagen
net effect: increased ultrafiltration

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13
Q

is lymphedema unilateral or bilateral?

A

both

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14
Q

what is a major concern in unilateral sweling?

A

acute dvt

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15
Q

what is homan’s sign and what can it indicate?

A

passively and abruptly dorsiflex the foot and squeeze the calf, pain =positive sign, indicate possible DVT

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16
Q

how many points on the wells rule does a patient need to have to be a high risk for DVT?

A

> 3,

17
Q

what are a few signs of chronic venous insufficiency?

A

fibrosis of skin
atrophy of skin: dry, no hair
pain above medial mallelous

18
Q

what does a low albumin level mean?

A

malnutrition
inflammation
liver disease

19
Q

what does a high albumin level mean?

A

dehydration

20
Q

what is the cause of primary lymphedema?

A

developmental anomalies of vessels/nodes

21
Q

what is the cause of secondary lymphedema?

A 
known trauma to lymphatics
surgery
radiation
filariasis (parasite)
infection
cancer (metastic)
iatrogenic
22
Q

what is lipedema?

A

pathological deposition of fatty tissue below the waist resistant to diet

23
Q

what is stemmers sign?

A

positive if fold of skin lifted at base of toe is thickened or impossible to lift
indicative of the reactive fibrosis of soft tissue tissue that is characteristic of lymphedema

24
Q

what are the 5 effects of manual lymphatic drainage?

A 
increase absorption of fluid/protein by capillaries
increase lymphangion activity/transport
diuresis
relaxation response
analgesic
25
Q

what are two benefits of compression?

A

increases interstitial pressure

reduces ultrafiltration

26
Q

what are three contraindications for compression?

A

acute infection
arterial disease
acute chf

27
Q

what are two precautions for compression?

A

decreased sensation

limb paralysis

28
Q

what are the indications for use of a high stretch ace bandage?

A

short term use, somewhat effective

not safe to wear full time due to hi resting pressure

29
Q

what are the indications for use of a low stretch ace bandage?

A

long term use, highly effective

safe for wear full time due to low resting pressure

30
Q 
Hi or Lo stretch bandage? 
Increase interstitial pressure and reduce ultrafiltration
Increase musculoskeletal pump
Reshape irregular limp profile
Reduce fibrotic changes
A

Lo stretch bandage

31
Q

do elastic garments reduce limb in size?

A

no

32
Q

what enhances the musculoskeletal pump more: elastic or low stretch bandages?

A

low stretch

33
Q

what are 5 contraindications for lymphedema garments?

A 
acute dvt
arterial disease
acute infection
uncontrolled chf
untreated ulcers
34
Q

what is a TED hose, 12-20 mmHg used for?

A

TEDS are for BED

mild edema, but are not medical grade-not medical grade

35
Q

what is compression class 1 (20-30 mmHg) used for in lymphedema treatment?

A 
mild lymphedema
prevention/recurrence of venous ulcers
mild venous insufficiency
burn scars
dvt prevention
36
Q

what is compression class II (30-40 mmHg) used for in lymphedema treatment?

A 
chronic venous insufficiency
moderate lymphedema
management of active venous ulcers
moderate and post-traumatic edema
varicosities during pregnancy
prevention of DVT/post thrombotic syndrome
37
Q

when should one wear an elastic compression garment?

A

daytime only

38
Q

what kind of pressure does a high stretch garment have?

A

hi resting pressure

39
Q

in lymphedema treatment, how would a patient balance hi stretch and low stretch garment use?

A

high stretch during day and low bandages/garments at night

unit 11 (12 decks)

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