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Med Surg > Test 5- Lymphedema, Prosthetics, Wound Care, Pressure ulcers > Flashcards

Test 5- Lymphedema, Prosthetics, Wound Care, Pressure ulcers Flashcards

1
Q

Is primary or secondary lymphedema more common?

A

Secondary

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2
Q

Most common cause of secondary lymphedema?

A

Comprehensive cancer management

*also, Surgical dissection of lymph nodes, infection and inflammation, obstruction or fibrosis, or combined venous lymphatic dysfunction

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3
Q

Clinical manifestations of lymphatic disorders:

A 
Lymphedema 
Increased size of limb
Sensory disturbances 
Stiffness and limited ROM
Decreased resistance to infection
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4
Q

Primary cause of amputation in US

A

Peripheral vascular disease

*Second leading cause is trauma

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5
Q

2/3 of all lower extremity amputations in the US related to:

A

Diabetes mellitus

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6
Q

Name some factors that can affect blood flow in the deep veins and increase the risk for developing blood clots:

A

Increasing age, personal or family history of DVT or pulmonary embolism, certain types of malignant cancers, varicose veins, smoking, birth control pills, pregnancy, obesity, a broken hip or leg or major surgery on hip, knee, or lower leg

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7
Q

In some cases a pulmonary embolism may be the first sign of DVT. Symptoms of pulmonary embolism include:

A

Shortness of breath, sudden onset of chest pain, coughing, spitting up or vomiting blood

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8
Q

Wells Clinical Assessment for DVT:
If score is equal to or greater than 3 there is a 75% probability that the patient does have a DVT and should have _____ _____ performed.

A

Venous US

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9
Q 
Levels of amputation:
Partial toe
Toe disarticulation
Ankle disarticulation (Syme’s)
Transtibial
Transfemoral
Etc.
What does it mean if it’s a disarticulation?
A

They don’t cut through bone they cut at the joint space

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10
Q

Foot amputation levels (proximal to distal) :

A

Symes (ankle disarticulation)
Chopart
LisFranc
Transmetatarsal

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11
Q

Surgical approaches (amputations)
Myoplasty- ____ to _____
Myofascial- muscle to _____
My odes is- muscle to _______

A

Muscle to muscle

Muscle to fascia

Muscle to periosteum/bone

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12
Q

What is the most important factor in determining a good prosthetic candidate?

A

Patient’s prior level of activity

*Unilateral transtibial usually makes for a good candidate, bilateral transfemoral if person is in good health

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13
Q

Studies have shown that from 9% to 20% of people with diabetes who had already experienced an amputation underwent a second amputation within ___ months of first surgery.

A

12 months

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14
Q

An elastic wrap or shrinker application is for _____ control and ______ of limb.

A

Volume control and shaping

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15
Q

A monofilament exam, also known as a Semmes-Weinstein monofilament can be used to identify a high risk of _____ _____.

A

Foot ulceration

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16
Q

-
-

A

Rigid
IPOP (Immediate post op prosthesis)
Soft (elastic wraps, shrinkers)

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17
Q

3 post op dressings for volume control:

A

Soft gauze w/ ACE

Rigid Plaster to keep knee in extension and control edema

IPOP, plaster cast with pylon and foot

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18
Q

Have patient start putting pressure and sensations through limb to prepare for prothesis.
This is called:

A

Desensitization

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19
Q

What is important to remember about positioning for contracture prevention when it comes to amputees?

A

You want to keep the knee extension.

If elevating to prevent Edema make sure knee is kept in extension

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20
Q

Ther Ex for amputees:
- ROM/ stretching to prevent/correct ______ of LE’s

  • Strengthening of ___’s and contralateral LE
  • Strengthening of residual limb
A

Contracture

UE’s

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21
Q

Goals of Pre-Prosthetic phase:

Healing of residual limb
Independent transfers and mobility 
Positioning 
Pain mgt
Strengthening 
ROM
Shaping Limb
Pt Ed
Psychological adjustment
A

Boop

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22
Q

Def: Feeling that absent body part is still present

A

Phantom Limb Sensation

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23
Q

Phantom limb pain- sensations of cramping, ______, shooting, ______ pain

A

Burning, stabbing

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24
Q

Treatment options for phantom pain/sensations:

A 
Pharmacology (opioids, Botox, E Stim (TENS), anti-convulsives)
US
Dry needling
Compression 
Surgery-neuroma removal
VR
Mirror therapy
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25
Q

Def: A rare congenital deformity in which the hands or feet are attached close to the trunk, the listing grossly under developed or absence. This condition was a side effect of the drug Thalidomide taken during early pregnancy

A

Phocomelia

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26
Q

Def: Birth defect where part or all of the fibular bone is missing, as well as Associated limb length discrepancy, for deformities, and knee deformity’s. It is a very rare disorder occurring in only 1 in 40,000 births

A

Fibular Hemimelia

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27
Q

UE prosthetic devices:

A

Myoelectric
Body-powered
Terminal devices

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28
Q

Def: Amount of fluid transported

A

Lymphatic load

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29
Q

Def: The amount of fluid the lymphatic system can transport

A

Transport capacity

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30
Q

The main components of lymphatic fluid are ___ and ____ found in the extracellular spaces. In a normal state the lymphatic system transports this fluid back to the _____ circulation.

A

Water and protein

Venous

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31
Q

Primary Lymphedema is less common and is due to _______ _______.

A

Structural malformation

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32
Q

Stages of lymphedema:
Stage 0- _____ Stage
-No outward swelling noted
Stage 1- _____ Stage
-Elevation reduces swelling, no tissue fibrosis, swelling is soft or pitting
Stage 2- _____ Stage
- Fibrosis of tissue; brawny, hard swelling/no longer pitting, positive Stemmer sign, frequent infections
Stage 3- ______ Stage
-Positive Stemmer sign, Significant increase in limb volume, typical skin changes noted, bacterial and fungal infections of skin and nails more common

A

0–Latency stage
1–Reversible stage
2–Spontaneously irreversible
3-Lymphostatic elephantiasis

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33
Q

_____ Edema: Pressure on the edematous tissues With the fingertips causes an indentation of the skin that persists for several seconds after the pressure is removed. This reflects significant but short duration edema with little or no fibrotic changes in skin.

A

Pitting Edema

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34
Q

_____ edema: Pressure on the edematous areas feels hard with palpation. This reflects a more severe form of interstitial swelling with progressive, fibrotic changes in subcutaneous tissues.

A

Brawny Edema

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35
Q

_____ edema: This represents the most severe and long-duration form of lymphedema. Fluids leak from cuts or sores; wound healing is significantly impaired. Lymphedema of this severity occurs almost exclusively in the lower extremities.

A

Weeping edema

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36
Q

What are some comprehensive regimens and components for management of lymphedema? (4)

A

Manual lymphatic drainage
Exercise
Compression therapy
Skin care and hygiene

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37
Q

Reducing risk of lymphedema:

  • Keep _____. Sitting or standing for long periods of time can cause pooling of fluid in legs. Don’t sit with legs crossed
  • ______ involved limb and perform pumping ex. frequently
  • Be cautious about performing vigorous, _______ activities
  • Wear compressive garments while exercising
  • Monitor diet to maintain an ideal weight and minimize _____ intake
  • If possible have BP, needle sticks and blood draws performed on uninvolved extremity
A

Moving
Elevate
Repetitive
Sodium

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38
Q

Skin care with lymphedema:

  • Keep skin clean and supple; use moisturizer and sunscreen, but avoid ______ lotions
  • Immediately attend to skin abrasions or cuts, insect bites, burns
  • Protect hands and feet with socks, shoes, gloves, etc
  • Use an electric razor when shaving
  • Avoid ____ baths, whirlpools, and saunas that ______ the body’s core temperature
A

Perfumed lotion

Avoid hot baths that elevate core temp

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39
Q

Manual Lymphatic Drainage (MLD) components:

  • Very light, slow, _____ strokes/massage
  • Proximal congestion of trunk, _____, buttock, or _____ cleared first to make room for ____ fluid
  • Direction: ______ to _____
  • After proximal congestion, clear involved limb ____ portion first then working _____
A

Circular
Groin, axilla; distal fluid
Distal to proximal direction
(After prox congestion) Proximal portion first then working distally

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40
Q

Exercises for lymphatic drainage: principles and rationale

  • Contraction of muscles pumps fluids by direct _______ of the collecting lymphatic vessels
  • Exercise strengthens and prevents _____ of muscles of the limbs, which improves the efficiency of the lymphatic pump
  • Exercise should be sequenced to clear the _____ lymphatic reservoirs before the ______ areas
  • Ex. with compression bandaging enhances lymph flow and ____ resorption more efficiently than without
A

Compression
Atrophy
Central, peripheral
Protein

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41
Q 
Start an upper or lower extremity regimen for lymphedema with these exercises (Clearing centrally) :
-
-
-
-
A

Deep breathing exercises
Posterior pelvic tilts and partial curl ups
Cervical ROM
Bilateral scapular movements

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42
Q

-
-

A

Lymphovenous bypass
Lymph node transplant
Liposuction

43
Q

Components of exercise regimens for management of lymphedema:

  • Deep breathing exercises
  • ______ exercises
  • _______ and muscular _____ exercises
  • ______ conditioning exercises
  • Lymphatic _____ exercises
A

Flexibility
Strengthening and muscular endurance
Cardiovascular conditioning
Lymphatic drainage

44
Q

UE ex for Lymphedema (in sequence):

  • Active circumduction with involved arm elevated while supine
  • Bilateral active movements of arms while supine
  • Bilateral hand press while supine to sitting
  • Shoulder stretches while standing
  • Seated active exercises of elbow,forearm, wrist and fingers while UE elevated
  • Bilateral horizontal AB/ADD of sho
  • Overhead wall press
  • Finger ex.
  • Partial curl ups
  • Rest with involved UE elevated for 30 min
A

Have fun remembering that

45
Q

LE Ex. for Lymphedema (in sequence)

  • Alternate knee to chest
  • Bilateral knees to chest
  • Glute sets and posterior pelvic tilt
  • SKTC w/ involved LE
  • ER of hips while supine w/ both legs elevated resting on wall
  • Active knee flexion of involved LE
  • Active PF/DF/Circum of ankles while supine and LEs elevated
  • Active hip/knee flexion with ER and elevated
  • Active cycling and scissoring while elevated
  • Bilateral KTC ex, then partial curl ups
  • Rest w/ LEs elevated
A

Fun stuff

46
Q

During a wound assessment you look at what 4 things:

A

1) Location
2) Size, depth, shape
3) Tunneling, undermining
4) Exudate/drainage

47
Q

Attributes preventing healing of wounds:

  • ______ tissue
  • _____
  • Periwound erythema and _____
  • Edges _____ (not connected)
A

Necrotic
Hemorrhage
Edema
Undermined

48
Q

Attributes characteristic of a wound healing:

  • _______ tissue
  • New ______
  • _______ wound edges
A

Granulation
Epithelium
Attached

49
Q

Types of Exudates:
______: Thin, bright red
_____: Thin, watery, pale red to pink
_____: Thin, watery, clear
_____: Thin or thick, opaque tan to yellow
_____: Thick, opaque yellow to green with offensive odor

A 
Bloody
Serosanguineous
Serous 
Purulent
Foul Purulent
50
Q

Rating scale maybe used to quantify the amount of exudates:
1- None, dry
2- Scant, tissue moist, no exudates
3- Small, drainage <25%
4- Moderate, Tissue saturated, Drainage may or may not be evenly distributed, drainage >25% to <75% of wound dressing
5- Large, Tissues bathed in fluid, drainage >75% of wound dressing

A

Might need to know? Who knows.

51
Q

Indications for wound culture:

Signs of local infection-

A
  • Edema
  • Erythema or skin discoloration
  • Purulent or foul smelling drainage
  • Increased pain
  • Induration (harden)
  • Heat around wound
52
Q

Indications for wound culture:

Signs of systemic infection-

A
  • Elevated temperature (fever)
  • Elevated white blood cell count (leukocytosis)
  • Confusion or agitation in older adults
  • Red streaks from wound
53
Q

Other indications for wound culture are:

  • _____ involvement: Full thickness wound at increased risk for osteomyelitis
  • ____-healing wounds
A

Bone

Non-healing

54
Q

The function of a ________ is to:

  • Prevent additional wound contamination
  • Keep micro organisms in the wound from infecting other sites
  • Prevent further injury to the wound
  • Apply pressure to control hemorrhage
  • Absorb wound drainage
  • Assist wound healing
A

Dressing

55
Q

The function of a ________ is to:

  • Keep the dressing in place
  • Maintain a barrier between dressing and environment
  • Provide external pressure to control swelling
  • Provide support or stability to an area
  • Hold splints in place
A

Bandage

56
Q

General principles for dressing and bandaging:

  • Don’t touch open wound
  • Possibly limit skin of toes from touching
  • Dressings should always be applied securely to prevent ______ or _____ over wound
  • Always ____ and ____ wound before applying bandage
  • Place the part in a _____ position
  • When applying pressure bandage, do not _____ blood flow
A

Slippage or friction
Clean and dry
Functional
Constrict

57
Q

More Dressing principles:

  • Pressure bandage must have even _____
  • ______ part frequently, leave finger tips and toes exposed
  • Clips, clamps, pins, should be applied ____ from wound
A

Overlaps
Observe
Away

58
Q

____-______ Dressings: Permeable to gas, bacteria, fluid; good for wounds with significant drainage, infected wound
Ex. Dry dressing- Enough drainage where it won’t adhere to the wound, gauze, ABD pad
Impregnated Gauze/Petroleum Gauze

A

Non-Occlusive

59
Q

______ Dressings: different types chosen to keep wound bed at optimal environment; barrier to germs, limit scab formation, can be left on for 3 to 10 days.
-Promotes autolytic debridement

A

Occlusive Dressings

60
Q

Of the occlusive dressings, only ____ and _____ are used with infection.

A

Alginates and hydrofibers

61
Q

Non-occlusive dressing that is used as a primary dressing, is minimally absorptive, provides minimal protection, does not enhance a moist environment, and may create a greasy wound bed.
One of its more appropriate uses is as a primary dressing over new sutures to prevent them from catching or sticking in a gauze secondary dressing

A

Impregnated gauze/Petroleum gauze

62
Q

_______ Dressings: Semi permeable; keep wound bed at optimal environment; barrier to germs, limit scab formation. Promotes autolytic debridement.

A

Occlusive dressings

63
Q

Occlusive dressings:
Op site, _____: transparent, non-absorbent
____: very absorbent, hydrogel sheet, nonadherent
____: hydrocolloid, self adherent, minimal absorption
___-___: absorbent, foam adds cushion
Calcium _____: made from seaweed, very absorbent

A 
Tegaderm 
Vigilon 
Duoderm 
Epi-lock
Calcium alginate
64
Q

Which 2 occlusive dressings are good for infection and absorption?

A

Alginates and hydrofibers

65
Q

[occlusive dressings]
Semi-permeable films: most are adherent, allows some _______ but no _____.

Semi-permeable foams: insulation, good _____ for fibroblasts and epithelial cells, good _____

A

Evaporation, NO absorption

Absorption

66
Q

Between hydrogels and hydrocolloids, which is good for hydrating dry wounds?

A

Hydrogels

*hydrocolloids- very occlusive, good absorption

67
Q

Materials used for bandaging and dressing:
____: Light, cool, allows air to circulate, it does not stretch or conform well to body parts.
____: It is sterile and does not adhere to the wound. It does not come in a variety of sizes.
____ ____: Sterile and will not adhere to wound if changed frequently. It will adhere to wound if left in place for a long period of time.
_____: Gauze-like material, but has elasticity, it will cling to itself, and contours well to body parts and may adhere to wound.

A

Gauze
Adaptic
Telfa pad
Kling

68
Q

Materials used for bandaging & dressing continued:
- ______: Comes in a large roll container and may be cut to the desired length. Used between cast and patient. Secures dressings and keeps them clean.

  • Ace bandages
  • Compressogrip
A

Stockinette

69
Q 
Cavity Management (wounds):
\_\_\_\_\_: to delay wound closure
\_\_\_\_\_: to allow wound to fill in from inside out

*depends on moisture of the wound

A

Packing

Filling

70
Q

4 types of debridement:

A

1) Sharp
2) Mechanical
3) Chemical
4) Autolytic

71
Q

_____ debridement: Uses chemical ointment that has enzymes to break down necrosis. Only for necrotic wounds

_____ debridement: Uses the body’s own enzymes to break down necrotic tissue; optimized by occlusive dressings

A

Chemical/enzymatic

Autolytic

72
Q

_____ debridement: scissors, forceps, scalpel, very selective, effective in speeding healing process

A

Sharps

73
Q

Selective vs. Non-Selective Debridement
_______ : Removes only nonviable tissues

_____: Removes viable and nonviable tissues

A

Selective

Non-Selective

74
Q

______: A condition in which the epithelial edge of a wound rolls under itself, the cells contact each other, causing contact inhibition and re-epithelialization ceases

A

Epiboly

75
Q

_____: Result of excessive moisture on epithelial surfaces. The tissue will appear swollen and bleached out. An example is the result of staying in a pool too long or in the bath

A

Maceration

76
Q

______: The drying out of a wound. May occur due to a non-occlusive dressing allowing fluid to evaporate or excessive dressing changes with loss of fluid

A

Dessication

77
Q

______: Growth of granulation tissue in excess of the surface of the wound. Allows the wound to develop a mound exceeding the height of the surrounding skin and producing a scar

A

Hypergranulation

78
Q

2 types of wound over-repair:

  • ______ scars: don’t extend injury site
  • _______: extend past injury site and can regrow after excision
A

Hypertrophic scars

Keloids

79
Q

Which type of skin graft takes better, full thickness graft or cultured epithelial autografts (CEA)?

A

Full thickness graft

80
Q

Skin graft vs. Flap

Which can be thicker?

A

Flap

  • blood supply and tissue still connected

Skin graft-Tissue and Blood supply completely removed, revascularization is vital, can’t be too thick

81
Q

-
-

A

Local
Distant
Free

*Stretching and strengthening avoided for 2 to 3 weeks if it tenses area, avoid shesring

82
Q

Elastic wraps are applied in a ____-____ pattern to LEs.

______ wraps are used on the UEs and trunk.

A

Figure-eight

Spiral

83
Q

The application of pressure with pressure garments helps to prevent _______ scarring and assists the ______ fibers to lay down in an orderly fashion.

A

Hypertrophic

Collagen

84
Q

Indications for use of pressure garments (compression):

7

A

1) Edema
2) Varicose veins
3) Radical mastectomy
4) Anti-embolism therapy
5) Lymphedema
6) Burns
7) PVD

85
Q

Contraindications of pressure garments (compression):

5

A

1) Unhealed burns
2) Active phlebitis
3) Infection
4) Inflammation
5) When increased venous pressure is not desired

86
Q

Three factors besides pressure commonly contribute to pressure ulcer formation. These include: _____, ____, and ______.

A

Shear, friction, moisture (maceration)

87
Q

Stages of Pressure Ulcers (4):
Which stage?
Full thickness skin loss with extensive distruction, tissue necrosis or damage to muscle, bone, or supporting structures, tendon, joint capsule, etc.

A

Stage IV

88
Q

Stages of Pressure Ulcers (4):
Which stage?
Full thickness skin loss involving damage on a crisis of subcutaneous tissues which may extend down to, but not through underlying fascia. The ulcer presents as a deep crater with or without undermining.

A

Stage III

89
Q

Stages of Pressure Ulcers (4):
Which stage?
Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

A

Stage II

90
Q

Stages of Pressure Ulcers (4):
Which stage?

Non-blanchable erythema of intact skin

A

Stage I

91
Q

Def: Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal separation revealing a dark wound bed or blood filled blister.

A

Deep tissue pressure injury (DTPI)

92
Q

Ulcers of the lower leg:
_____ ulcer- The veins of the leg are ill-equipped for the task of moving blood back to the heart against gravity. These are usually located over the medial malleolus and have irregular borders, are usually shallow, and the fascia and deep structures are just generally not exposed. Pain RELIEVED with elevation.

A

Venous

93
Q

Ulcers of the lower leg:
_____ ulcers: They are known as Ischemic ulcers or infarcts and are caused by arterial insufficiency. These ulcers frequently involve the pretibial area or dorsum of the toes or feet. Tend to be more painful and leg elevation AGGRAVATES the pain because gravity assists ______ flow. These ulcers are usually deep and tendons are visible.

A

*Arterial ulcers

Arterial flow

94
Q

Ulcers of the lower leg:
______ ulcers- most are based on a combination of ischemia and neuropathy. The typical neuropathic foot ulcer occurs on the plantar surface of the foot, such as the heel, toes, and metatarsal heads. They are usually deep and infected and the ischemic limb is cool, skin appears shiny. The ulcer itself is painless but patients may complain of burning and paresthesia in extremities. In neuropathic ulcers touch, pressure, and proprioception are lost.

A

Diabetic Ulcers

95
Q

Gait deviation: Abduction or lateral trunk bending toward prosthesis (TF)

Intrinsic and Extrinsic causes-

A

Intrinsic: Weak hip ABductors, painful residual limb, lack of proper gait training

Extrinsic: Prosthesis too long, abducted socket

96
Q

Gait dev: Pistoning

Intrinsic and Extrinsic causes-

A

Intrinsic: Normal volume loss
Extrinsic: Socket too loose (add socks)

97
Q

Gait dev: Vaulting

Intrinsic and Extrinsic causes-

A

Intrinsic: Weak hip flexors or knee flexors ; Improper training

Extrinsic: Prosthesis too long or locked/stiff prosthetic knee
Poor suspension, medial wall too high

98
Q

Gait dev: Circumduction

Causes-

A

Intrinsic: Weak hip flexors or knee flexors, Lacks confidence/ability to flex knee, Abduction contracture, lack of proper gait training

Extrinsic: Prosthesis too long or locked knee, Inadequate suspension, medial wall too high

99
Q

Gait dev: Foot slap

Causes-

A

Extrinsic: Heel bumper too soft

100
Q

Gait dev: Excessive knee flexion in early stance

Causes:

A

Intrinsic: Flexion contracture, weak quads

Extrinsic: Heel cushion too firm, anterior socket placement

101
Q

3 Types of LE prostheses:

A

Exoskeletal (conventional)
Endoskeletal (Modular)
Cosmetic (Non-functional

102
Q

______ knees: stable, promotes normal gait (must load toe to unlock)

A

Polycentric knees

103
Q

__________ knee units: “C-leg”, has stumble recovery and stance stability; variable cadence

A

Micro-Processor

Med Surg (6 decks)

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