Edema

Question 1

reduction techniques for acute edema (9)

Answer 1

1. bulky dressing
2. high voltage pulsed current
3. elevation
4. cold packs
5. retrograde massage
6. compression
7. elastic taping
8. manual edema mobilization (MEM)
9. exercise

Question 2

acute edema - bulky dressing

Answer 2

applied at the time of surgery gives counterforce to the outflow (filtration) by changing the tissue pressure; composed of appropriate wound care dressing, fluffy gauze sponges, and rolled-on gauze

Question 3

acute edema - high voltage pulsed current

Answer 3

reported to retard the high capillary permeability in very acute edema and frequently used as a modality to reduce acute edema

Question 4

acute edema - elevation

Answer 4

hand above the heart (unless contraindicated) reduces outflow because it reduces the arterial hydrostatic pressure; ideally in a +45 degree “ski hill” position

Question 5

acute edema - cold packs

Answer 5

cause vasoconstriction and thus reduce the outflow of fluid in the acute stage (unless contraindicated)
used in first 24-48 hours only as directed by physician

Question 6

acute edema - retrograde massage

Answer 6

light retrograde massage with elevation facilitates diffusion of small molecules into the venous system

Question 7

acute edema - compression

Answer 7

light compression (elastic glove, Coban, or low-stretch finger bandage wraps) facilitates small molecule absorption by the venous system and absorption of large and small molecules by the lymphatic system

Question 8

acute edema - elastic taping

Answer 8

kinesio tape; when applied in a specific manner it is theorized that the edema reduces because patient movement pulls the skin in the opposite direction from where the tape was applied which puts a stretch on the initial lymphatic structures facilitating congested lymphatic absorption

Question 9

acute edema - manual edema mobilization

Answer 9

designed to activate lymphatic vessels; following the first week of surgery, acute edema is transudate that is changing to exudate edema as the plasma proteins invade and are contained and only the lymphatic vessels can remove excess proteins from the interstitium

Question 10

acute edema - exercise

Answer 10

proximal active motion of an extremity or gliding of the involved structures, or both, during the acute stage of wound healing decongests the lymphatic vessels and removes tissue waste products, resulting in better oxygenation to tissue and faster wound healing

Question 11

reduction techniques for subacute edema (9)

Answer 11

1. exercise
2. MEM
3. elastic taping
4. myofascial release (MFR)
5. thermal modalities
6. loose compression
7. pneumatic pump
8. low stretch bandages, gloves, massage, chip bags
9. contrast baths

Question 12

reduction techniques for chronic edema

Answer 12

1. all techniques for subacute edema

2. methods to soften indurated tissue

Question 13

subacute edema - contrast baths

Answer 13

Commonly is performed by having the client immerse the hand in warm water for 3 minutes and then in cold water for 1 minute. This sequence is repeated four times, ending on cold.
cold 71.6 deg warm 98.6 deg

Question 14

subacute edema - thermal modalities

Answer 14

heat will increase tissue elasticity and lymph flow and soften tissue due to decongestion of the lymph
fluidotherapy machine at 98 degrees

Question 15

subacute edema - pneumatic pump

Answer 15

system mimics MLD by first decongesting trunk edema and then proceeding to the extremity(ies) with the sequence, a rolling light chamber pressure, and the timing used with MLD

Question 16

subacute edema - elastic taping

Answer 16

kinesio tape; when applied in a specific manner it is theorized that the edema reduces because patient movement pulls the skin in the opposite direction from where the tape was applied which puts a stretch on the initial lymphatic structures facilitating congested lymphatic absorption

Question 17

subacute edema - exercise

Answer 17

start proximally with diaphragmatic breathing, trunk stretches, trunk exercises, easy (appropriate) yoga trunk stretches

Question 18

subacute edema - low-stretch bandages, gloves, massage, and chip bags

Answer 18

must be light to avoid collapsing the single-celled initial lymphatics in the dermal layer

Question 19

subacute edema - myofascial release

Answer 19

MFR
manual technique that entails sustaining a very light gentle pressure on soft tissue that in turn impacts the fascial system directly below the therapist’s hands resulting in elongation or softening of the fascia and its ground substances

Question 20

subacute edema - MEM

Answer 20

designed to activate lymphatic vessels; following the first week of surgery, acute edema is transudate that is changing to exudate edema as the plasma proteins invade and are contained and only the lymphatic vessels can remove excess proteins from the interstitium

Question 21

chronic edema - methods to soften indurated tissue

Answer 21

chip bags, convoluted foam in stockinette, elastomer and elastomer-type products, silicone gel sheets, foam-lined orthoses, low stretch bandages, cotton finger wraps, loose stockinette and/or gloves

Question 22

contraindications for MEM (8)

Answer 22

1. infection is present
2. over areas of inflammation
3. presence of hematoma or blood clot in area
4. presence of active cancer
5. client has CHF, severe cardiac problems, or pulmonary problems
6. during inflammatory (acute) stage of acute wound healing
7. client has renal failure or severe kidney disease
8. client has primary lymphedema or lymphedema arising from a mastectomy