lymphedema and integumentary Flashcards
2 main functions of lymphatic system?
- immune system (lymphocytes, WBCs)
- drainage
what duct drains R face and R UE?
lymphatic duct
what’s the flow of lymph?
CV NoTeD
1. capillaries
2. vessels
3. nodes
4. trunks
5. ducts
6. subclavian veins/vascular system
what duct drains both legs, L UE and L face?
thoracic duct
name some causes of lymphedema
venous insufficiency
lymph node removal
increased lymphatic load
decreased transport capacity
what does the venous system do?
carries blood back to the heart
if impacted it can cause fluid collection/lymphedema
3 primary causes of lymphedema? and when do they occur?
Milroy’s disease (0-2 years)
Meige disease (adolescence to 35 yrs, hereditary)
Lymphedema Tarda (after 35 yrs)
name some causes of secondary lymphedema
infection
tumor
lymph node removal
trauma
chronic venous insufficiency
fibrosis (decreased transport capacity)
filariasis (infected leg, elephantiasis)
stemmers sign is an indication of what stages of lymphedema?
ii and iii
+ is the skin cannot be pinched on dorsal surface of fingers or toes
4 stages of lymph0edema?
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
how do you grade pitting edema?
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
what’s lipidema?
b/l condition that affects BLE mostly, fat accumulation
not in feet
bruises easily and painful
hereditary or hormonal otherwise idk why it happens
will lymphedema be painful with pressure?
no but lipedema will
if lymphedema is distal, how do you measure?
volumetric
how would you measure lymphedema of limbs/more proximal areas?
girth measurements every 10 cm then compare to uninvolved limb
when would you used bio impedence?
pre and post surgery
when do you use doppler US?
to d/d from venous insufficiency
how do you measure lymphatic insufficiency?
lymphoscintipraphy
describe a normal lymph node
soft, non-tender, mobile, non-palpable
describe an abnormal lymph node
tender, hard, immobile, inflamed, REFER TO DR
combining compression from a garment with what can be more effective in movement of fluid?
muscle contraction
when doing manual lymphatic drainage, what direction do you stroke? what kind of stroking?
distal to proximal
light stroking and circular movements
when doing manual lymphatic drainage, what areas of the body do you work on first?
proximal then distal (clear the traffic jam/clear the close closet)
how is maintenance phase different than intensive phase?
self-MLD by patient and compression garment is worn during the day (not a long stretch) and short stretch at night
what type of bandages do you use for compression therapy?
short/low stretch bands, they have a low resting pressure and a high working pressure, wrapped with more pressure distally than proximally
when do you wear short stretch bandages for compression therapy in the intensive phase?
ALL THE TIME
when do you progress to the maintenance phase?
once lymphedema has reached a plateau
what kind of exercise should someone with lymphedema do, and what muscle groups should be worked first?
low intensity exercise while wearing compression garment
proximal to distal
swimming, elliptical, biking, etc.
what structures are responsible for transmission of pressure and vibration?
Pacinian corpuscles
Ruffini endings sense what?
hot and stretch (think of hot yoga teacher named Ruffini)
Meissner corpuscles sense what?
light touch and texture
Krause end bulbs sense what?
cold (Kold)
merkel discs sense what?
light touch, texture and pressure
free nerve endings detect what?
pain, temp, touch, pressure, tickle, and pain
describe herpes zoster
present as a painful rash with clusters of fluid filled vesicles
mostly unilateral
raised to palpation
pink with silvery white appearance
what cranial nerves can be affected with herpes zoster?
3 and 5 (oculomotor and trigeminal)
what is herpes zoster also called?
shingles
initial sx of herpes zoster?
pain and paresthesia localized to affected dermatome
precautions to be taken with herpes zoster?
gloves and n95 (airborne and contact if handling pts items)
will you see herpes simplex virus type 1 above or below waistline?
above
herpes simplex virus type 2 is below waistline (genitals)
what are wheals?
itchy, raised hives
what are pustules?
similar to blisters but filled with pus
what are vesicles?
small liquid filled sacs, <.5 cm
what are bullae
large fluid filled sacs, >.5cm
describe the clinical presentation of venous insufficiency?
VenMo
-medial malleolus wound
-shallow
-Hemosiderin staining (brown)
-mild to moderate pain
-elevate to decrease p!
describe clinical presentation of arterial insufficiency?
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
describe PT management for intermittent claudication
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
pressure ulcer stages
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
can pressure ulcers be backstaged?
no
where are diabetic ulcers usually?
WB surface of foot, 2nd toe usually
granulation tissue is viable or non-viable?
viable, necrotic tissue is non-viable
what’s maceration?
when the wound is too moist and the edges and periwound are macerated
white, wrinkled skin
caused by inappropraite wound care
what causes dessication?
would lacking moisture
what can you use to clean a wound INITIALLY? (stage 2 pressure injury for example)
sterile normal saline
3 types of selective debridement?
sharp
enzymatic
autolytic
SEA
think of this as taking out weeds in the garden. used when there’s less than 50% of necrotic tissue
when do you use nonselective debridement?
when theres greater than 50% necrotic tissue, everything comes out
name three nonselective debridement methods
wet to dry dressings
wound irrigation
hydrotherapy
how can you remember what dressing to use based on level of exudate?
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)
what dressing should I use for infected wounds?
HGAG
Hydrofiber, hydroGels , calcium Alignates, Gauze
list the types of burns from least severe to most severe
superficial
superficial partial thickness
deep partial thickness
full thickness
subdermal
which type of burn is most painful and has quick capillary refill?
superficial partial thickness
being an SPT is painful
which burn type has pain with pressure and has slow capillary refill and decreased pinprick sensation?
deep partial thickness
pressure is on you when you are a DPT
what type of burn has no blanching, no pain, pressure, or temp sensation?
full thickness
will have dry, rigid, leathery eschar, may have contractures
what type of burn has charred, dry, and exposed deep tissue and may require amputation?
subdermal
epidermis, dermis, subcutaneous tissue are all affected
what’s the rule of 9’s for adults
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
rule of 9’s for kids?
same as adults but head is 8.5 each side and legs are 6.5 each side
what type of scar is described by a healed wound with thick fibrous tissue that remains within the wound border?
hypertrophic
what type of scar is described by excessive tissue growing outside the original margins of the wound?
keloid
which type of ulcer has bone and tendon visible
stage 4
key word BONE (4 letters)
is the epidermis vascularized or avascularized?
avascularized
where are nerve endings in the skin?
hypodermis
what layer of the skin has sebaceous glands and arrector pili muscles?
dermis
what layer of the skin mostly has adipose tissue?
hypodermis
what drainage is bloody, bright red fluid?
sanguineous, indicates an inflamed wound
serous drainage is what color?
clear, amber, thin and watery
transudate drainage looks
clear, thin, watery
serosanguineous drainage looks
clear or tinge of red/brown , normal and indicates the wound is healing
if you have loose debris, exudate and tunneling, what method should I use to clean it?
pulsative lavage with suction
