Lecture 5a - Lymphedema & Misc Wounds Flashcards

(74 cards)

1
Q

in the US and Europe, lymphedema occurs most often due to what?

A

treatment, surgery, radiation

breast, ovarian, cervical, endometrial, prostate cancers

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2
Q

2 functions of the lymphatic system

A

regulation of fluid balance
assistance with infection control

manages 10-20% of fluid removed from interstitial space

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3
Q

what system does the lymphatic system mirror?

A

venous system

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4
Q

once interstitial fluid goes into the lymph system it becomes

A

lymph

composed of water, protein, dead/dying cells, cellular components, foreign material, debris

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5
Q

exist as clusters; filter stations with lymphocytes that identify and destroy foreign material and provide immune support

A

lymph nodes

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6
Q

the area of the body that drains to a single lymph node, seperated by watersheds

A

lymphatic territories

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7
Q

2 things that help us keep lymph moving

A
  • lymph vessels dont have valves so fluid can move both ways
  • anastomoses
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8
Q

what are anastomoses?

A

peripheral collectors allowing regional lymph nodes from one area to use regional lymph nodes from another area as supplemental or alternative drainage

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9
Q

lymph movement is governed by what pressures?

A

hydrostatic and osmotic pressure

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10
Q

dynamic insufficiency

A

lymphatics unable to accomodate and remove fluid due to increased load

(aka system is not damaged, fluid is too much - edema, infection, CHF, DVT)

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11
Q

mechanical insufficiency

A

lymphatic system unable to manage normal load (system damage)

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12
Q

what leads to sclerosis and fibrosis of lymphatic vessels?

A
  • fibrogen in interstitium accumulates (fluid stagnation usually due to insufficiency)
  • macrophages migrate and activate fibroblasts (inflammation response triggered bc high protien content)
  • collagen and connective tissue develop in the area
  • fibrosis occurs
  • hardening of the area
  • sclerosis and induration
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13
Q

how does limb size affect diffusion?

A

increased limb size = increase diffusion distance for O2 and nutrients to reach cells = increased tissue pressure required for diffusion to occur = swelling = collapse lymphatic capillaries

edema or obesity can put pressure on the interstitial contents (think like compartment syndrome)

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14
Q

occurs without obvious cause, result of congenital malformation or impairment (10% of cases)

A

primary lymphedema

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15
Q

acquired lymphedema, caused by disruption in system by outside force

A

secondary lymphedema

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16
Q

you’re treating a patient with lymphedema, with no open wounds. could you see this patient in a wound clinic?

A

yes- because they need specialized treatment for compression

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17
Q

weeping, no actual open area but fluid drains through and beads on skin surface because the skin is stretched too far to act as a barrier

A

lymphorrhea

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18
Q

ulceractions may occur because of the stress to skin or with trauma in these pts. what can you expect to see with these wounds?

A

drainage to be a large issue, may have slough

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19
Q

what may present in an lymphedema periwound?

A

skin is often dry, flakey, scaly, and fibrotic (bc skin is stretched)

may have edema, papillomas, or papillomatosis

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20
Q

cauliflower like projections of epithelium causes by distended and dilated superficial lymphatics

A

papillomas

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21
Q

cobblestone-like appearance to skin seen in stage 3

A

papillomatosis

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22
Q

lymphedema risk factors:
- __________ of lymph nodes
radiation therapy
surgical complications
____________ time since surgery (removal of lymph nodes or radiation)
_________ BMI
air travel without __________

A

removal of lymph nodes
radiation therapy
surgical complications
increased time since surgery
increased BMI
air travel without compression

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23
Q

how to take lymphedema circumferential testing

A

measure every 3,4,8, 12 cm
try to use landmarks for documentation
measure both limbs! even if only 1 affected

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24
Q

lymphedema risk factors continued:
_____________ lymphatic load
________ lymphatic return
prone to scarring

A

increased lymphatic load
decreased lymphatic return
prone to scarring

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25
if your pt is at risk of lymphedema what should you not use to avoid restriction of lymph return?
BP cuff or torniquets on THAT limb
26
lymphedema testing methods which is the gold standard?
BMI sensory integration circulation - make sure safe to compress circumferential measures stemmer sign volumetric displacement (circumferential measure) is gold standard but not practical in clinic
27
to measure circulation, edema may limit ability to find pulse. what do you use? what about if skin folds are making it difficult to use ABI?
doppler TBI
28
normal BMI overweight obese class 1 class class 2
normal: 18.5-24.9 overweight: 25-29.9 class : 30-34.9 class 2: 35-39.9 class 3 > 40 probably dont need to know
29
what is a positive stemmers sign
inability to pinch a skin fold on dorsal aspect of edematous digit can determine lymphedema vs venous insufficient (venous flow doesn't have proteins and skin can still be lifted)
30
stage 1 latent
lymphedema staging: no edema reduced transport capacity usually from surgery or radiation
31
stage 2 reversible
lymphedema staging: pitting edema greatly/completely reduces with elevation no secondary skin changes
32
stage 3 spontaneously irreversible
lymphedema staging: no pitting edema no edema reduction with elevation skin is fibrotic or brawny
33
stage 4 lymphostatic elephantasis
lymphedema staging: extreme increase in limb volume deep skin folds and papillomas present frequent skin infections
34
mild unilateral lymphedema is a __ cm difference in circumference
<3 cm or < 20% inc limb volume
35
moderate unilatearal lymphedema is a __ cm difference in circumference
3-5 cm 20-40% inc limb vol
36
severe unilateral lymphedema is a __ cm difference
>5 cm > 40% inc limb vol
37
should you use hot tubs/saunas/ long hot showers if you have lymphedema? what about heating pads?
Naur
38
_______ is a good lotion for lymphedema
lanolin
39
T or F: you should wash and dry the limb each time you remove dressing/compression with soap and water
T
40
infiltration of the tumor into the skin, can appear as deep necrosis with hypertrophic granular tissue
fungating wounds
41
what settings are fungating wounds typically seen
palliative care
42
how should you treat fungating wounds?
protecting periwound use charcoal dressing to help with smell
43
what exercises should you do with someone with lymphedema
AROM - muscle pump aerobic exercise - muscle pump and BMI breathing exercise - respiratory pump strength training (no overload)
44
what exercises should you not do with someone with lymphedema?
high heat, constriction, bands/ankle weights strength training- avoid muscle overload (inflammation)
45
lymphatic drainage techniques gentle __ technique to stretch skin __ technique to work on fibrosis _______ to ________
J for stretch U for fibrosis proximal to distal!!
46
contraindications for lymph massage
DVT, infection, open wound, cancer, uncontrolled asthma, arterial disease, AAA, pregnancy has to be in the area*
47
T or F: compression is key to lymphedema treatment
T
48
what compression to use during exacerbation or air travel?
multilayer compression bandaging (4 layers) must use short stretch bandages
49
what compression to use for maintenance?
compression garments
50
contraindications to compression treatment
CHF, DVT (untreated), infection, arterial insufficiency (reduced BF even more)
51
compression level: 10-21 mmHg
light compression mild lymphedema
52
compression 15-32 mm Hg
medium compression mod-severe lymphedema in UE mild lymphedema LE
53
30-40 mmHg compression
strong compression mod to severe lymphedema in LE
54
> 40 mmHg compression
very strong compression stage 3 lymphedema
55
gold standard care of lymphedema in PT includes
"complete decongestive therapy (CDT) or complex decongestive therapy or complex PT" education skin care compression exercise MLD
56
T or F medicare/insurance does cover lymphedema products
FALSE why a lot of ppl fail to et treatment
57
T or F: surgery is a goof option for lymphedema treatment
FALSE doesn't work well and has risk of returning or worsening last resort for no responsive cases
58
should you use whirlpool on a patient with lymphedema?
NO
59
diuretics can ______ edema through increased protein concentration into institium
can worsen edema
60
prognosis (how many clinic vists for mild, moderate and severe)
mild 5-10 moderate 8-16 severe 14-24
61
B symmetrical adipose build up in abdomen, buttock and LE usually due to imbalance in pituitary, thyroid, and hormones
lipedema not super well understood but primarily in females
62
T or F: lipedema can be affected by diet and responds well to lymphedema treatments
FALSE
63
wound caused by friction and results in superficial or partial thickness wound
abrasion
64
wound caused my cutting or tearing into skins surface deep with smooth edges
laceration
65
caused my shear or friction and results in separation of epidermis from dermis (partial thickness) or dermis from subQ (full thickness)
skin tear
66
happens most often in older adults, 80% on arms or hands
skin tear
67
how to dress a skin tear
if you can see edges : skin sealant if you cant see edges: remove non viable tissue, cover w moisture retentive dressing
68
frequency (highest to lowest) of bite wounds
dog, cat, human
69
infection (largest to smallest) of bite wounds
human, cat, dog
70
which spider bite requires wound care
brown recluse
71
how do radiation burns present?
* inflammation, redness, local edema, dry skin and itchiness, sensitivity to touch * ulcers can form from trauma
72
what is the main treatment of radiation burns?
prevent trauma and moisturize, treat wounds w dressings that will not damage periwound
73
noninfectious progressive necrotizing skin condition, unclear cause
pyoderma gangrenosum
74
wound that begins as small, very painful papule that quickly expands, necrotic with undermining
pyoderma gangrenosum