lymphedema and integumentary

Question 1

2 main functions of lymphatic system?

Answer 1

1. immune system (lymphocytes, WBCs)
2. drainage

Question 2

what duct drains R face and R UE?

Answer 2

lymphatic duct

Question 3

what’s the flow of lymph?

Answer 3

CV NoTeD
1. capillaries
2. vessels
3. nodes
4. trunks
5. ducts
6. subclavian veins/vascular system

Question 4

what duct drains both legs, L UE and L face?

Answer 4

thoracic duct

Question 5

name some causes of lymphedema

Answer 5

venous insufficiency
lymph node removal
increased lymphatic load
decreased transport capacity

Question 6

what does the venous system do?

Answer 6

carries blood back to the heart

if impacted it can cause fluid collection/lymphedema

Question 7

3 primary causes of lymphedema? and when do they occur?

Answer 7

Milroy’s disease (0-2 years)
Meige disease (adolescence to 35 yrs, hereditary)
Lymphedema Tarda (after 35 yrs)

Question 8

name some causes of secondary lymphedema

Answer 8

infection
tumor
lymph node removal
trauma
chronic venous insufficiency
fibrosis (decreased transport capacity)
filariasis (infected leg, elephantiasis)

Question 9

stemmers sign is an indication of what stages of lymphedema?

Answer 9

ii and iii

+ is the skin cannot be pinched on dorsal surface of fingers or toes

Question 10

4 stages of lymph0edema?

Answer 10

0: no clinical edema, just HEAVINESS
1: soft and pitting, reversible with ELEVATION
2: hard swelling, progressing to non pitting brawny. +stemmer’s, irreversible
3: + stemmer’s, severe brawny non pitting, skin changes (fibrosis, hyperkeratosis, warty protrusions), repeated infections common, can progress to weeping

Question 11

how do you grade pitting edema?

Answer 11

1+ mild, <1/4 inch pitting
2+ moderate, 1/4-1/2 inch pitting, returns to normal in 15 sec
3+ severe, takes 15-30s, 1/2 to 1 inch pitting
4+ very severe, takes over 30s, >1 inch pitting

Question 12

what’s lipidema?

Answer 12

b/l condition that affects BLE mostly, fat accumulation
not in feet
bruises easily and painful
hereditary or hormonal otherwise idk why it happens

Question 13

will lymphedema be painful with pressure?

Answer 13

no but lipedema will

Question 14

if lymphedema is distal, how do you measure?

Answer 14

volumetric

Question 15

how would you measure lymphedema of limbs/more proximal areas?

Answer 15

girth measurements every 10 cm then compare to uninvolved limb

Question 16

when would you used bio impedence?

Answer 16

pre and post surgery

Question 17

when do you use doppler US?

Answer 17

to d/d from venous insufficiency

Question 18

how do you measure lymphatic insufficiency?

Answer 18

lymphoscintipraphy

Question 19

describe a normal lymph node

Answer 19

soft, non-tender, mobile, non-palpable

Question 20

describe an abnormal lymph node

Answer 20

tender, hard, immobile, inflamed, REFER TO DR

Question 21

combining compression from a garment with what can be more effective in movement of fluid?

Answer 21

muscle contraction

Question 22

when doing manual lymphatic drainage, what direction do you stroke? what kind of stroking?

Answer 22

distal to proximal

light stroking and circular movements

Question 23

when doing manual lymphatic drainage, what areas of the body do you work on first?

Answer 23

proximal then distal (clear the traffic jam/clear the close closet)

Question 24

how is maintenance phase different than intensive phase?

Answer 24

self-MLD by patient and compression garment is worn during the day (not a long stretch) and short stretch at night

Question 25

what type of bandages do you use for compression therapy?

Answer 25

short/low stretch bands, they have a low resting pressure and a high working pressure, wrapped with more pressure distally than proximally

Question 26

when do you wear short stretch bandages for compression therapy in the intensive phase?

Answer 26

ALL THE TIME

Question 27

when do you progress to the maintenance phase?

Answer 27

once lymphedema has reached a plateau

Question 28

what kind of exercise should someone with lymphedema do, and what muscle groups should be worked first?

Answer 28

low intensity exercise while wearing compression garment proximal to distal swimming, elliptical, biking, etc.

Question 29

what structures are responsible for transmission of pressure and vibration?

Answer 29

Pacinian corpuscles

Question 30

Ruffini endings sense what?

Answer 30

hot and stretch (think of hot yoga teacher named Ruffini)

Question 31

Meissner corpuscles sense what?

Answer 31

light touch and texture

Question 32

Krause end bulbs sense what?

Answer 32

cold (Kold)

Question 33

merkel discs sense what?

Answer 33

light touch, texture and pressure

Question 34

free nerve endings detect what?

Answer 34

pain, temp, touch, pressure, tickle, and pain

Question 35

describe herpes zoster

Answer 35

present as a painful rash with clusters of fluid filled vesicles mostly unilateral raised to palpation pink with silvery white appearance

Question 36

what cranial nerves can be affected with herpes zoster?

Answer 36

3 and 5 (oculomotor and trigeminal)

Question 37

what is herpes zoster also called?

Answer 37

shingles

Question 38

initial sx of herpes zoster?

Answer 38

pain and paresthesia localized to affected dermatome

Question 39

precautions to be taken with herpes zoster?

Answer 39

gloves and n95 (airborne and contact if handling pts items)

Question 40

will you see herpes simplex virus type 1 above or below waistline?

Answer 40

above herpes simplex virus type 2 is below waistline (genitals)

Question 41

what are wheals?

Answer 41

itchy, raised hives

Question 42

what are pustules?

Answer 42

similar to blisters but filled with pus

Question 43

what are vesicles?

Answer 43

small liquid filled sacs, <.5 cm

Question 44

what are bullae

Answer 44

large fluid filled sacs, >.5cm

Question 45

describe the clinical presentation of venous insufficiency?

Answer 45

VenMo -medial malleolus wound -shallow -Hemosiderin staining (brown) -mild to moderate pain -elevate to decrease p!

Question 46

describe clinical presentation of arterial insufficiency?

Answer 46

AL -lateral malleolus, dorsum of foot -smooth edges -thin and shiny, hair loss, yellow nails -severe pain (no blood to muscles) -elevation makes it worse -intermittent claudication

Question 47

describe PT management for intermittent claudication

Answer 47

intermittent walking program have pt walk til grade III (pt's attention cannot be diverted d/t pain) then rest, walk again goal is to get 40-60 min of walking

Question 48

pressure ulcer stages

Answer 48

1: intact skin with non-blanchable redness 2: partial thickness wound, pink/red wound bed, epidermis and upper dermis 3: full thickness, FAT (3 letters) 4: full thickness, BONE/tendon, undermining and slough/eschar present Unstageable: wound bed covered in slough/eschar (can't ID depth) Deep tissue injury: intact skin but purple appearance

Question 49

can pressure ulcers be backstaged?

Answer 49

no

Question 50

where are diabetic ulcers usually?

Answer 50

WB surface of foot, 2nd toe usually

Question 51

granulation tissue is viable or non-viable?

Answer 51

viable, necrotic tissue is non-viable

Question 52

what's maceration?

Answer 52

when the wound is too moist and the edges and periwound are macerated white, wrinkled skin caused by inappropraite wound care

Question 53

what causes dessication?

Answer 53

would lacking moisture

Question 54

what can you use to clean a wound INITIALLY? (stage 2 pressure injury for example)

Answer 54

sterile normal saline

Question 55

3 types of selective debridement?

Answer 55

sharp enzymatic autolytic SEA think of this as taking out weeds in the garden. used when there's less than 50% of necrotic tissue

Question 56

when do you use nonselective debridement?

Answer 56

when theres greater than 50% necrotic tissue, everything comes out

Question 57

name three nonselective debridement methods

Answer 57

wet to dry dressings wound irrigation hydrotherapy

Question 58

how can you remember what dressing to use based on level of exudate?

Answer 58

amazing fan had heart failure A: calcium Alginates and hydrofiber (heavy exudate) F: foam (mod exudate) H: hydrocolloids (min exudate) H: hydrogel F: films (no to scant exudate)

Question 59

what dressing should I use for infected wounds?

Answer 59

HGAG Hydrofiber, hydroGels , calcium Alignates, Gauze

Question 60

list the types of burns from least severe to most severe

Answer 60

superficial superficial partial thickness deep partial thickness full thickness subdermal

Question 61

which type of burn is most painful and has quick capillary refill?

Answer 61

superficial partial thickness being an SPT is painful

Question 62

which burn type has pain with pressure and has slow capillary refill and decreased pinprick sensation?

Answer 62

deep partial thickness pressure is on you when you are a DPT

Question 63

what type of burn has no blanching, no pain, pressure, or temp sensation?

Answer 63

full thickness will have dry, rigid, leathery eschar, may have contractures

Question 64

what type of burn has charred, dry, and exposed deep tissue and may require amputation?

Answer 64

subdermal epidermis, dermis, subcutaneous tissue are all affected

Question 65

what's the rule of 9's for adults

Answer 65

arm ant/post: 4.5, 9 total for one arm leg ant/post: 9 each, 18 total for one leg trunk ant/post: 18 each, 36 total head ant/post: 4.5 each 9 total

Question 66

rule of 9's for kids?

Answer 66

same as adults but head is 8.5 each side and legs are 6.5 each side

Question 67

what type of scar is described by a healed wound with thick fibrous tissue that remains within the wound border?

Answer 67

hypertrophic

Question 68

what type of scar is described by excessive tissue growing outside the original margins of the wound?

Answer 68

keloid

Question 69

which type of ulcer has bone and tendon visible

Answer 69

stage 4 key word BONE (4 letters)

Question 70

is the epidermis vascularized or avascularized?

Answer 70

avascularized

Question 71

where are nerve endings in the skin?

Answer 71

hypodermis

Question 72

what layer of the skin has sebaceous glands and arrector pili muscles?

Answer 72

dermis

Question 73

what layer of the skin mostly has adipose tissue?

Answer 73

hypodermis

Question 74

what drainage is bloody, bright red fluid?

Answer 74

sanguineous, indicates an inflamed wound

Question 75

serous drainage is what color?

Answer 75

clear, amber, thin and watery

Question 76

transudate drainage looks

Answer 76

clear, thin, watery

Question 77

serosanguineous drainage looks

Answer 77

clear or tinge of red/brown , normal and indicates the wound is healing

Question 78

if you have loose debris, exudate and tunneling, what method should I use to clean it?

Answer 78

pulsative lavage with suction