Lymphedema/Other Wounds

Question 1

Lymphatic System

Answer 1

-regulates fluid balance and removal (10-20%)
-mirror venous sys
-Lymphnodes: fliter lymph
-moves by muscle pumps, smooth muscle
-osmotic pressure

Question 2

Lymphedema

Answer 2

-lymph accumulates

Prognosis:
Mild: 5-10 visits
Moderate: 8-16 visits
Severe: 14-26 visits

RK:
-radiation/chemo
trauma
-high BMI
-air travel w/o compression
-surgery complications
-decreased lymph return
-Removal of nodes

Etiology:
-stagnant edema
-Dynamic: increase load
-Mechanical: unable to manage load (lymphatic insufficiency from sclerosis)
-Combination
-Primary: no cause
-Secondary: aquirred from dysruption of system from outside forces

S/s:
-limb heaviness
-paresthesia
-achiness
-skin tightness
-decreased ROM
-Skin changes: Lymphorrhea (skin weaping or ulcers with slough)

Precautions:
-no whirlpool
-check DVT
-dieuretics

Question 3

Lymphedema Periwound

Answer 3

-cellulitis
-edema
-skin dry and flakey
-Papillomas: cauliflower like projections
-Papillomatosis: cobblestone like in stage 3

Question 4

Lymphedema Testing

Answer 4

-BMI
-Sensory
-Circulation
-Stemmer Sign: inability to pinch base of digit (venous vs lymphedema)
-Circumferential Measurements: volunmetric gold standard

Question 5

Lymphedema Staging

Answer 5

1: latent; no edema, reduced transport capacity

2: Reversible; pitting edema, reduces with elevation

3: Spontaneously Irreversable; no pitting edema, no edema reduction with elevation, skin is fibrotic

4: Lymphostatic Elephantiasis; extreme limb volume, deep fold and paplliomas, skin infections

Mild: <3cm diff, <20% volume
Moderate: 3-5cm, 20-40%
Severs: >5cm, >40%

Question 6

Lymphedema Treatment

Answer 6

-skin care: checks, moisturizer (lanolin) bathing, treat open areas, drink fluids, exercise, compression

-local wound care

-Exercise: avoid muscle overload or excessive exercise

-Compression

-Manual Therapy: proximal to distal

-Meds and surgery

Question 7

Lymphedema Compression

Answer 7

-enhances venous return, reduced ultrafiltration, muscle pump

Multilayer: short stretch, during exacerbation or air travel

Compression Garments: maintenance, sleep in

Precautions:
-radiation
-hx of DVT
-open wound
-immobile pt

Contraindications:
-arterial infufficiency
-CHF
-untreated DVT
-infection

Light: 10-21mmhg; mild, UE
Medium: 15-32mmhg, mod to severe UE and mod LE
Strong: 30-40mmhg, mod-severe LE
Very Strong: >40mmhg, stage 3 LE

Question 8

Lipedema

Answer 8

-adipose bildup bilaterally
-hormnal imbalance
-females in puberty

Question 9

Abrasion

Answer 9

-friction
-rarely chronic
-Stinging
-superficial or PT

Question 10

Laceration

Answer 10

-cutting or tearing
-partial thickness
-may need closure

Question 11

Skin Tear

Answer 11

-shear or friction
-usually arms or hands

Tx:
-sealant, film, mosture retentive dressing

Question 12

Surgical Wounds w/ Primary Closure

Answer 12

-look for infection/dehiscence
-avoid soaking
-suture removed in 7-10 days

Question 13

Bite Wounds

Answer 13

Frequency: dog, cat, human
Infection risk: human, cat, dog

Question 14

Spider Bites

Answer 14

Brown Recluse:
-local edema, blisters
-necrosis

Black Widdow: systemic illness, no wound care

Question 15

Radiation Burns

Answer 15

-delays healing by inhibiting inflammatory, proliferation, deposition

Question 16

Pyoderma Gangrenosum

Answer 16

-noninfectious necrotizing skin condition
-avoid inflammation
-no sharp debridement