Exam 1- Lymph and Diabetic foot Flashcards Preview

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Flashcards in Exam 1- Lymph and Diabetic foot Deck (28)
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Lymph structure

~The two sides are not connected/ two systems (2 separate- r arm- 1/4/// l arm and body- 3/4)
~Just returns (like venous)
~Filters out bad stuff (can get bigger things if it gets in there) from the skin to other organs to get rid of it


Who is the typically lymph pt?

Breast cancer pt
~damage the lymph system (from the radiation and surgery) bc the lymph has nowhere to dump any more


What is an example of an acute lymph?

when you get a bug bite and get swelling


Is it important to educate?

~Sooner we educate, sooner we can stop it
~Once its swollen once, it is easier to swell faster and more
*stop this early!


How does lymph swelling feel?

~This is hard and fibrotic
~scar tissue will start building in the interstitial tissue


How to you get rid of the lymph swelling?

~Lymph massage
~rub away from the area/ compression (very specific way to wrap)


Details on a lymph message

~Uncork the bottle- have to unblock the first area (proximal) and get the fluid moving before you can move more distally
~Superficial (the lymph are tiny vessels) so you are not pushing hard; barely touching them


Lymph causes a high risk of

*infection/ irritation can lead to edema


What do you not do if you have had lymph?

~Prolong tissue in water (macerated tissue)- wear gloves if you are washing dishes
~Gardening- wear gloves
~Nail salon
~infection/ blood drawn
~Take blood pressure on the other side


How does lymph feel? (first signs)

~Heavy, warm, achie
~clothing/ jewelry/ etc will feel heavier
~Ring can’t come off
~ROM is decreasing


To prevent lymph event:

~Garments- compression sleeve (at night, all the time, etc) (one arm may be bigger)
~Protect skin and moisture
~Diuretics- water pill


Be careful of _____ when you are moving all the fluid toward the heart

CHF! can be dangerous for these pts


What do you need to be careful about and rule out?



What are some ways to rule out DVTs? (8)

~ABIs (could dislodges it)
~Homan’s Test/ Wells DVT predication rules
~recent surgeries
~walking one day then you don’t want to walk the next day


Where can DVTs go?

~Lungs (pulmonary embolism)
~Brain (stroke)


When can you dislodge a DVT and s/s?

~when you start walking, it can dislodge a DVT
~shortness of breath, O2 stat drops, BP drops


If you have a pt who has diabetes, talk to them about...

~Do you talk your blood sugar regularly? If yes, what are your sugars? Why or why not?
~When was the last time you went to your doc who manages your diabetes?
~Do you take care of your feet? Tell me about your foot care
~Look at their feet!


Looking at toenails details

~Thicker, fungus (flacky, yellow)
*Cut them self, podiatrist, nail salon, etc
*Do you soak your feet? (shouldn’t)


What are things you look at on the feet?

~toe nails
~blood flow
~Sensation decreased
~Between toes
~Shoes/ Socks


Looking at blood flow details

~Cap refill
~Pulses: Dorsalis, post tib, popliteal
~can use an ABI


Looking at Callouses details

Educate on:
~Don’t cut them off
~Don’t soak- can macerate them
~Don’t let them get to dry or they may flake off- moisture to keep safe


Looking at skin details

~colder (a little)


Deformities in the feet with diabetics

~arch decreased/ flat foot
~hammer toes


Details on shoes

~Good for protection and support
~Diabetic shoes- no seams, great support, more doom (hammer hoes), wider
~Don’t wear sandals- no protection and rubs between toes and having to grip the sandal with toes (blister on toes)
~Have them check their shoes- make sure there is nothing in there (peddle/ toe, etc); creates pressure
~No laces- laces can create different pressures
~When to buy shoes- mid day (mod amount of swelling) morning- no swelling and you will but a shoe that is a 1/2 size too small; afternoon- a lot of swelling and buy a shoe that is a 1/2 size too big


Details for socks in diabetics

~No seams
~Cotton- good for moisture control, but can take in a lot of moisture
~Not too tight at the top
~White- so you can see the blood


Care for feet

~Toe nails: Make sure they are cut straight across (curves make ingrown toe nails)
~Wash them; moisture would be good; dry them with a cotton towel (in between toes- will macerate the tissue)
~don’t put lotion in between the toes
~Make sure they go to the podiatrist at least one a year


Pressure sensation is measured with

Semmes Weinstein monofilament


Details on Semmes Weinstein monofilament

~5.07 is the diameter or 10g of pressure means that you have protective sensation
~there are 10 places on the feet to measure
~it it takes 20g, then you have worse sensation
~You can have it missing in one place, but have it in all the others (the pt does not have protective sensation in that certain place)
~You have to test them 5 times- need to feel it 4 times out of 5
~If there are thick callouses, may cause lack of protective sensation