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npte study decks > lymphedema and integumentary > Flashcards

lymphedema and integumentary Flashcards

1
Q

2 main functions of lymphatic system?

A
  1. immune system (lymphocytes, WBCs)
  2. drainage
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2
Q

what duct drains R face and R UE?

A

lymphatic duct

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3
Q

what’s the flow of lymph?

A

CV NoTeD
1. capillaries
2. vessels
3. nodes
4. trunks
5. ducts
6. subclavian veins/vascular system

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4
Q

what duct drains both legs, L UE and L face?

A

thoracic duct

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5
Q

name some causes of lymphedema

A

venous insufficiency
lymph node removal
increased lymphatic load
decreased transport capacity

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6
Q

what does the venous system do?

A

carries blood back to the heart

if impacted it can cause fluid collection/lymphedema

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7
Q

3 primary causes of lymphedema? and when do they occur?

A

Milroy’s disease (0-2 years)
Meige disease (adolescence to 35 yrs, hereditary)
Lymphedema Tarda (after 35 yrs)

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8
Q

name some causes of secondary lymphedema

A

infection
tumor
lymph node removal
trauma
chronic venous insufficiency
fibrosis (decreased transport capacity)
filariasis (infected leg, elephantiasis)

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9
Q

stemmers sign is an indication of what stages of lymphedema?

A

ii and iii

+ is the skin cannot be pinched on dorsal surface of fingers or toes

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10
Q

4 stages of lymph0edema?

A

0: no clinical edema, just HEAVINESS
1: soft and pitting, reversible with ELEVATION
2: hard swelling, progressing to non pitting brawny. +stemmer’s, irreversible
3: + stemmer’s, severe brawny non pitting, skin changes (fibrosis, hyperkeratosis, warty protrusions), repeated infections common, can progress to weeping

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11
Q

how do you grade pitting edema?

A

1+ mild, <1/4 inch pitting
2+ moderate, 1/4-1/2 inch pitting, returns to normal in 15 sec
3+ severe, takes 15-30s, 1/2 to 1 inch pitting
4+ very severe, takes over 30s, >1 inch pitting

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12
Q

what’s lipidema?

A

b/l condition that affects BLE mostly, fat accumulation
not in feet
bruises easily and painful
hereditary or hormonal otherwise idk why it happens

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13
Q

will lymphedema be painful with pressure?

A

no but lipedema will

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14
Q

if lymphedema is distal, how do you measure?

A

volumetric

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15
Q

how would you measure lymphedema of limbs/more proximal areas?

A

girth measurements every 10 cm then compare to uninvolved limb

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16
Q

when would you used bio impedence?

A

pre and post surgery

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17
Q

when do you use doppler US?

A

to d/d from venous insufficiency

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18
Q

how do you measure lymphatic insufficiency?

A

lymphoscintipraphy

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19
Q

describe a normal lymph node

A

soft, non-tender, mobile, non-palpable

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20
Q

describe an abnormal lymph node

A

tender, hard, immobile, inflamed, REFER TO DR

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21
Q

combining compression from a garment with what can be more effective in movement of fluid?

A

muscle contraction

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22
Q

when doing manual lymphatic drainage, what direction do you stroke? what kind of stroking?

A

distal to proximal

light stroking and circular movements

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23
Q

when doing manual lymphatic drainage, what areas of the body do you work on first?

A

proximal then distal (clear the traffic jam/clear the close closet)

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24
Q

how is maintenance phase different than intensive phase?

A

self-MLD by patient and compression garment is worn during the day (not a long stretch) and short stretch at night

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25
Q

what type of bandages do you use for compression therapy?

A

short/low stretch bands, they have a low resting pressure and a high working pressure, wrapped with more pressure distally than proximally

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26
Q

when do you wear short stretch bandages for compression therapy in the intensive phase?

A

ALL THE TIME

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27
Q

when do you progress to the maintenance phase?

A

once lymphedema has reached a plateau

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28
Q

what kind of exercise should someone with lymphedema do, and what muscle groups should be worked first?

A

low intensity exercise while wearing compression garment
proximal to distal

swimming, elliptical, biking, etc.

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29
Q

what structures are responsible for transmission of pressure and vibration?

A

Pacinian corpuscles

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30
Q

Ruffini endings sense what?

A

hot and stretch (think of hot yoga teacher named Ruffini)

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31
Q

Meissner corpuscles sense what?

A

light touch and texture

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32
Q

Krause end bulbs sense what?

A

cold (Kold)

33
Q

merkel discs sense what?

A

light touch, texture and pressure

34
Q

free nerve endings detect what?

A

pain, temp, touch, pressure, tickle, and pain

35
Q

describe herpes zoster

A

present as a painful rash with clusters of fluid filled vesicles
mostly unilateral
raised to palpation
pink with silvery white appearance

36
Q

what cranial nerves can be affected with herpes zoster?

A

3 and 5 (oculomotor and trigeminal)

37
Q

what is herpes zoster also called?

A

shingles

38
Q

initial sx of herpes zoster?

A

pain and paresthesia localized to affected dermatome

39
Q

precautions to be taken with herpes zoster?

A

gloves and n95 (airborne and contact if handling pts items)

40
Q

will you see herpes simplex virus type 1 above or below waistline?

A

above

herpes simplex virus type 2 is below waistline (genitals)

41
Q

what are wheals?

A

itchy, raised hives

42
Q

what are pustules?

A

similar to blisters but filled with pus

43
Q

what are vesicles?

A

small liquid filled sacs, <.5 cm

44
Q

what are bullae

A

large fluid filled sacs, >.5cm

45
Q

describe the clinical presentation of venous insufficiency?

A

VenMo
-medial malleolus wound
-shallow
-Hemosiderin staining (brown)
-mild to moderate pain
-elevate to decrease p!

46
Q

describe clinical presentation of arterial insufficiency?

A

AL
-lateral malleolus, dorsum of foot
-smooth edges
-thin and shiny, hair loss, yellow nails
-severe pain (no blood to muscles)
-elevation makes it worse
-intermittent claudication

47
Q

describe PT management for intermittent claudication

A

intermittent walking program

have pt walk til grade III (pt’s attention cannot be diverted d/t pain) then rest, walk again

goal is to get 40-60 min of walking

48
Q

pressure ulcer stages

A

1: intact skin with non-blanchable redness
2: partial thickness wound, pink/red wound bed, epidermis and upper dermis
3: full thickness, FAT (3 letters)
4: full thickness, BONE/tendon, undermining and slough/eschar present
Unstageable: wound bed covered in slough/eschar (can’t ID depth)
Deep tissue injury: intact skin but purple appearance

49
Q

can pressure ulcers be backstaged?

A

no

50
Q

where are diabetic ulcers usually?

A

WB surface of foot, 2nd toe usually

51
Q

granulation tissue is viable or non-viable?

A

viable, necrotic tissue is non-viable

52
Q

what’s maceration?

A

when the wound is too moist and the edges and periwound are macerated

white, wrinkled skin

caused by inappropraite wound care

53
Q

what causes dessication?

A

would lacking moisture

54
Q

what can you use to clean a wound INITIALLY? (stage 2 pressure injury for example)

A

sterile normal saline

55
Q

3 types of selective debridement?

A

sharp
enzymatic
autolytic

SEA

think of this as taking out weeds in the garden. used when there’s less than 50% of necrotic tissue

56
Q

when do you use nonselective debridement?

A

when theres greater than 50% necrotic tissue, everything comes out

57
Q

name three nonselective debridement methods

A

wet to dry dressings
wound irrigation
hydrotherapy

58
Q

how can you remember what dressing to use based on level of exudate?

A

amazing fan had heart failure

A: calcium Alginates and hydrofiber (heavy exudate)
F: foam (mod exudate)
H: hydrocolloids (min exudate)
H: hydrogel
F: films (no to scant exudate)

59
Q

what dressing should I use for infected wounds?

A

HGAG

Hydrofiber, hydroGels , calcium Alignates, Gauze

60
Q

list the types of burns from least severe to most severe

A

superficial
superficial partial thickness
deep partial thickness
full thickness
subdermal

61
Q

which type of burn is most painful and has quick capillary refill?

A

superficial partial thickness

being an SPT is painful

62
Q

which burn type has pain with pressure and has slow capillary refill and decreased pinprick sensation?

A

deep partial thickness

pressure is on you when you are a DPT

63
Q

what type of burn has no blanching, no pain, pressure, or temp sensation?

A

full thickness

will have dry, rigid, leathery eschar, may have contractures

64
Q

what type of burn has charred, dry, and exposed deep tissue and may require amputation?

A

subdermal

epidermis, dermis, subcutaneous tissue are all affected

65
Q

what’s the rule of 9’s for adults

A

arm ant/post: 4.5, 9 total for one arm
leg ant/post: 9 each, 18 total for one leg
trunk ant/post: 18 each, 36 total
head ant/post: 4.5 each 9 total

66
Q

rule of 9’s for kids?

A

same as adults but head is 8.5 each side and legs are 6.5 each side

67
Q

what type of scar is described by a healed wound with thick fibrous tissue that remains within the wound border?

A

hypertrophic

68
Q

what type of scar is described by excessive tissue growing outside the original margins of the wound?

A

keloid

69
Q

which type of ulcer has bone and tendon visible

A

stage 4

key word BONE (4 letters)

70
Q

is the epidermis vascularized or avascularized?

A

avascularized

71
Q

where are nerve endings in the skin?

A

hypodermis

72
Q

what layer of the skin has sebaceous glands and arrector pili muscles?

A

dermis

73
Q

what layer of the skin mostly has adipose tissue?

A

hypodermis

74
Q

what drainage is bloody, bright red fluid?

A

sanguineous, indicates an inflamed wound

75
Q

serous drainage is what color?

A

clear, amber, thin and watery

76
Q

transudate drainage looks

A

clear, thin, watery

77
Q

serosanguineous drainage looks

A

clear or tinge of red/brown , normal and indicates the wound is healing

78
Q

if you have loose debris, exudate and tunneling, what method should I use to clean it?

A

pulsative lavage with suction

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