Patient Care 1 – Exam 2 Review

Sensation and Reflexes

Terms Definitions

Primary Senses Determines if a particular pathway is functioning

Integration of sensory (cortical discrimination) Determines if patient can use information from sensory stimulation in meaningful
stimuli ways
Proprioception Awareness of position of limb/body in space

Stereognosis ability to perceive and recognize the form of an object in the absence of visual and auditory information,
by using tactile information
Graphesthesia ability to recognize writing on the skin purely by the sensation of touch

Point Location ability to recognize where on the body one has been touched

Two-Point discrimination ability to distinguish two distinct points of contact at various widths on the skin

Paresthesia perception of abnormal sensations such as tingling or burning

Pendular Reflexes muscle contraction followed by a pendulum like swing indicates cerebellar disease

Reasons why we should test sensation: Common patient populations with impaired
Localize a lesion (differential diagnosis) sensation:
 Dermatome  Diabetes Mellitus
 Peripheral nerve  Peripheral Vascular Disease
 Interruption of transmission along a Spinal pathway  Nerve entrapment disorders
 CNS and/or PNS  Spinal Cord Injury
 Hypersensitivity  CVA
 TBI
To guide proper treatment  Cerebral Palsy Burns
 Indications/Contraindications  Scar tissue/skin grafts
 Elderly
 Monitor progress/regress
 Patient Care 1 – Exam 2 Review

Primary Senses Carried by:

Light touch dorsal columns/anterior spinothalamic
tracts
Superficial pain (sharp/dull) Lateral spinothalamic tracts
Temperature Lateral spinothalamic tracts
Deep Pressure Lateral spinothalamic tracts
Vibration dorsal columns/medial lemniscus
pathway

Grading of Responses to Stimuli:

0 Absent

1 Impaired

2 Normal

Muscle Spindles: signal changes in the stretch, or length of the muscles

Golgi Tendon Organs: signal changes in the tension in the muscle

Reflex Grading Scale:

0 no response (indicative of lower motor neuron lesion)
(1+) minimal response
(2+) normal response
(3+) brisk response
(4+) hyperreactive response (indicative of upper motor neuron lesion)
 Patient Care 1 – Exam 2 Review

Therapeutic Heat

To INCREASE tissue temperature within 1-3 cm depth use: Key Points:

 Moist heat packs
 Paraffin wax bath  To provide a therapeutic effect, tissue temperature
 Fluidotherapy should be elevated to 104° F to 113° F (40° C to
 Warm whirlpool 45° C).
 Microwave gel packs  Metabolic reactions to heat include:
 Air-activated heat wraps o Increase cell activity and metabolic rate
 Electric heating pads o Increase oxygen uptake by tissues
o More nutrients will be available to promote
To INCREASE tissue temperature within 1-5 cm depth use: tissue healing
 Continuous ultrasound  The effects of heat on connective tissue include:
 Continuous shortwave diathermy o Increase elasticity
o Increase muscle flexibility
o Decrease viscosity
o Decrease joint stiffness
Conduction – physical  Moist heat packs
heat transfer through  Electric heating pads Research has shown that heating a muscle to 42º C
stationary contact  Hot water bottles (107ºF) results in muscle relaxation via the following
 Paraffin mechanisms:
 Warm water baths 1) decreased firing rate from Type II fibers, resulting in
decreased stimulus to tonic AMN
Convection – physical  Whirlpool 2) increased firing from GTO (Ib) receptors, which
heat transfer from a  Showers synapse with the AMN and are inhibitory
circulating medium  Fans 3) decreased gamma efferent firing, resulting in less
 Fluidotherapy stretch of the receptor of the spindle, causing
decreased afferent firing and decreased AMN
stimulation
 Patient Care 1 – Exam 2 Review

Modalities Indications Precautions Contraindications Notes Tx Dosage /

Duration
 Decrease muscle spasm  Infants/toddlers may  Patients with impaired  Should be Apply 6-8 layers of
 Decrease pain not be able to circulation, impaired appropriate size to toweling for 20
 Increase local blood flow to communicate sensation, or impaired totally cover the minutes
improve local nutrition; assist the appropriately how it ANS function may intervention area and
resolution of inflammatory feels experience negative should secured in Kept in water at
exudates/infiltrates  Elderly patients have reactions to heat place temperate between
 Increases general thinner skin and may application  Make sure the pack 160°-175° F
relaxation/sedation get burns more easily  Acute inflammation or is not too tightly
 Increase tissue extensibility / edema secured that the
Decreases stiffness  Regions such as the patient could not
Heat Pack developing fetus, remove it if it
gonads, malignancies, becomes too hot
and scar tissue (new or
old)

Advantages:
 Ease of preparation and application
 Variety of shapes and sizes available
 Moist, comfortable heat
 Relatively inexpensive to purchase and replace
Disadvantages:
 No method of temperature control once applied to patient
 Does not readily conform to all body parts
 Sometimes awkward to secure in place on a patient
 Does not retain heat for longer than about 20 minutes
 A passive intervention: patient exercise cannot be performed
simultaneously
 May leak and then must be discarded

 Chronic arthritis conditions of the  Open wounds Concept of Specific heat: 8-10 dips, then
distal extremities: Rheumatoid  Infected skin lesions The amount of energy wrapped and covered
Arthritis  Contagious skin required to raise the for 15-30 minutes
 Scleroderma conditions or warts temperature of water 1 °C;
 Contractures: post-traumatic,  Skin grafts (unless it has arbitrarily set at 1.0. Make sure fingers or
pathologic, or post immobilization been longer than 10 Amount of energy required toes are spread
Paraffin wax  Decrease pain days) to raise the temperature of apart, dip into wax
 Increase soft-tissue plasticity and paraffin mix 1 °C is .55. until the desired area
ROM Thus, less energy into the is completely
 Increase local metabolism conducting agent, and less covered, remove and
 Vasodilation thermal energy given off. hold above the bath
The lower specific heat of until the wax has
stopping dripping and
 Patient Care 1 – Exam 2 Review

paraffin allows for higher it becomes opaque,

therapeutic temperatures. then dip again

 Make sure to remove Kept at 126° - 128°F

all jewelry
 Wash hands/feet
before dipping
Advantages: Disadvantages:
 Low specific heat allows for application at a higher temperature than water  Paraffin wax is effective only for distal extremities in terms
without the risk of a burn of ease of application
 Low thermal conductivity allows for heating of tissues to occur more slowly,  The most effective method of application is the bath
thus reducing the risk of overheating the tissues method, which limits accessibility for other body parts to be
 Molten state allows for even distribution of heat to areas like fingers and toes treated effectively
 First dip traps air and moisture to create more even heat distribution  There is no method of temperature control once applied
 Oils used in the wax add moisture to the skin  The heating lasts only about 20 minutes
 Wax remains malleable after removal, allowing for use as an exercise tool  It is a passive intervention: patient exercise cannot be
 Paraffin provides comfortable, moist heat performed simultaneously
 Replacing the wax is relatively inexpensive

 Arthritis  Open wounds (can be  The patient can use 15-20 minutes
 Chronic tendonitis treated, but needs to therapeutic devices
 Raynaud’s syndrome be protected/covered) while receiving this Temperatures range
 Use for distal extremities such as: modality from 102°F to 118°F
wrist, hand, fingers, ankle, foot,  Multiple entry ports
toes allow the clinician to Lower ranges should
be able to provide be used for edema or
passive range of desensitization
motion while treatment
is administered
Fluidotherapy Advantages: Disadvantages:
 Fluidotherapy is convenient and easy to administer  Fluidotherapy is a relatively expensive modality to purchase
 Temperature of application can be controlled  Some patients are intolerant to the enclosed container
 Agitation of dry particles can be controlled for comfort (claustrophobic)
 Variety of unit sizes allows for most body areas to be treated  Some patients are intolerant to the dry materials used
 Fluidotherapy allows for some active exercise to be carried out during
intervention
 Fluidotherapy provides a dry, comfortable heat
 Fluidotherapy can be used for desensitization of hypersensitive hands/fingers
or feet/toes
 Patient Care 1 – Exam 2 Review

Thermal:  Small piece of metal in  Any metal within the  SWD does not reflect 15-30 minutes
 Vasodilation to increase blood flow the body electromagnetic field at bone, so there is no
 Increased rate of nerve conduction  Intrauterine  Any metals imbedded in risk of periosteal burns After 30 minutes,
 Increase tissue temp. contraceptive with the body  Capacitive: produce rebound effect where
 Relax the tissues and loosen joints copper  Metal loops imbedded in most heat in skin/fat digital temp may drop
 Increase tissue extensibility  Decreased sensation the body and less heat in because of reflex
 Elevation of pain threshold  Impaired circulation  Cancerous tissue deeper structures. vasoconstriction
 Alteration of muscle strength  Over growing  Hemorrhage  Inductive: most
 effective at heating Thermal:
 Acceleration of enzymatic activity epiphyses in children Cardiac Pacemaker
 Obese patients  Inflammation deeper structures Dose I (lowest): No
 (muscle) sensation of heat,
Athermal: Near other medical  Pregnancy
 Control edema electrical devices  Joints or organs with high  Can be pulsed or (acute)
sprains/strains,
 Decrease pain/ inflammation/  Over the low back or levels of fluid (eyes or continuous
 Clinicians should limit edema reduction, cell
swelling pelvis in women who testis)
their exposure to repair
 Quicken healing are menstruating  Contact lens Dose II (low): Mild
 Increased microvascular perfusion  Atrophic, infected, or  Circulatory impairments electromagnetic
Short Wave waves from diathermy heating sensation
Diathermy  Altered cell membrane function damaged skin
(subacute injuries
devices by maintaining
and cellular activity and inflammation)
a safe distance from
 Altered calcium ion binding Dose III (medium):
the device during Tx.
 Relieve trigger point pain Moderate (pleasant)
 Improve healing rate in damaged heating sensation,
tissues and ulcers pain, muscle spasm,
chronic inflammation
Dose IV (heavy):
Intense heating that
is tolerable below
pain threshold
(chronic): ↑ blood
flow, collagen
extensibility

Advantages:
 greater depth of heating than superficial thermal modalities
 it can heat a larger area than US
 Patient Care 1 – Exam 2 Review

 Skin conditions: psoriasis, acne,  Impaired sensation  Malignancy  Not proven to help Apply 10-20” away
eczema, jaundice, uremic pruitis,  Indirect eye exposure  Pregnancy with neuropathy from skin to avoid
ulcers  High sensitivity to light  Growth plates in children  Provides a superficial burns
 Kill some bacteria or fungi  Photophobia  Skin cancer heat
 Increases circulation and tissue  Pretreatment with  Lupus  Make sure jewelry is Can use towel over
temperature photosensitizing  Active TB removed area
 Psychological: seasonal affect medications  Within 6 months after
disorder and/or depression radiotherapy Tx: 15-20 mins
Infrared Lamp
and Light  Hemorrhage areas
Don’t repeat dose
Therapy  Severe cardiac, kidney,
until erythema has
or liver disease
faded
 Direct irradiation of eyes
 Endocrine glands

Important: Erythema is a normal effect from this treatment but should be monitored to avoid burns. Do NOT repeat the next does until all the erythema has
faded or it could result in a burn.
Note: Infrared Lamp and Laser Therapy share the same precautions and contraindications.

 Healing of wounds by increasing  Impaired sensation  Direct eye exposure  To elicit a warming 
Apply laser
circulation, increasing metabolism,  Indirect eye exposure  Pregnancy effect: high intensity directly over
and stimulating cell mediated  High sensitivity to light  Malignancy lasers for heat and lesion/wound
healing  Photophobia  Hemorrhage areas destroy tissue and/or site of
 Pain and inflammation associated  Pretreatment with  Growth plates o Used in surgery to pain, peripheral
with musculoskeletal conditions: photosensitizing  Endocrine glands cauterize nerve, trigger
TMJ dysfunction, Spine (low back), medications o Not used in Rehab points,
Shoulder pain/dysfunction acupuncture
 Trigger points  To elicit a cooling points
 Fibromyalgia effect: low level laser  Light contact with
Laser Therapy  Fractures therapy skin
 Lymphedema o Used in Rehab for  Directly
biostimulation and perpendicular to
facilitated healing target tissue
 Measure using
gridding
technique
Physiological effects: cell proliferation, increase collagen synthesis, increase pathogen binding, phagocytosis, angiogenesis, enhanced matrix remodeling,
immune system stimulation, modulation of serotonin and endorphin metabolism, decrease nociceptive activity
Note: Infrared Lamp and Laser Therapy share the same precautions and contraindications.
 Patient Care 1 – Exam 2 Review

 Contracture: joint capsule/  Vulnerable tissues  Pregnancy  Can be pulsed or Thermal or athermal
adhesive scars (new tissue, gonads)  Cardiac Pacemakers continuous settings (see US
 Chronic osteoarthritis pain relief  Poor  Active bone growth at  Treat 2-3 times the decision tree)
 Bursitis / tendonitis / capsulitis / circulation/sensation: epiphysis size of the sound head
ligament sprains greater risk of burns  Cancer (2,5,10 cm2 heads are Tx can be anywhere
 Neuroma pain relief  Standing wave (hot  Infections available) from 4-15 minutes
 Plantar warts spot) risk: can cause  Reproductive organs  Always use a barrier: depending upon the
 Open wounds cell  Eyes water, gel, lotion, condition, area, and
 Chronic peripheral arterial disease  damage and vessel  Anterior neck medication the effect you are
to increase blood flow endothelial lining  Fracture sites  Test sensation trying to solicit
damage  Sterilize head between
Thermal:  Prolonged patients Most Treatments are
 Don’t overdose/ 8 minutes to be billed
 Decrease viscosity inflammation
as 1 unit.
 Increase tissue extensibility overutilize (6-15x)
 Decrease stiffness
 Stimulate synovial fluid production
Ultrasound
 Increase blood flow
 Decrease pain
 Decrease muscle spasms
 Increase nerve conduction velocity
 Increase enzymatic activity

Athermal:
 Increase blood flow and
metabolism
 Increase ion exchange
 Increase fibroblast activity
 Increase calcium ion uptake
 Mast cell degranulation
 Increase cell membrane/vascular
wall permeability

Phonophoresis: ultrasonic energy to enhance percutaneous absorption of drugs (anti-inflammatory or local anesthetic)
 Increase cell membrane/vascular wall permeability
 Circulate medication to tissues
PRECAUTION: sensitivity or allergy to topical cream or medication
Dose: Use athermal settings
 Patient Care 1 – Exam 2 Review

Ultrasound Decision Tree:

Effects of Ultrasound Thermal Athermal

Duty Cycle 100% 10%,Athermal

20%, or 50%
Thermal

Depth of Problem 1-2 cm 100% Up to 5 cm 10%, 20%, or Up

1-2 cm 50%to 5 cm

Ultrasound Frequency 3 (or1-2

3.3)
cmMHz 3 (or1-2
3.3)cm
MHz Up1.0
to MHz
Up1.0
to MHz
5 cm 5 cm

1.0 MHz
Ultrasound Intensity 0.5
3 (orW/cm
2
3.3) MHz 1.5 – 2.0 W/cm2 3 (or 3.3) MHz0.5-1.0 W/cm
2

1.0 MHz

0.5 W/cm2 1.5 – 2.0 W/cm2

Duration of Treatment 5-15 mins/2 X ERA
0.5-1.0 W/cm2

5-15 mins/2 X ERA

 Patient Care 1 – Exam 2 Review

Terms Definitions

Conduction A method of heat transfer where the kinetic motion of atoms and molecules of one object is passed
on to another object
Convection The bulk movement of moving molecules, either in liquid or gaseous form, such that head is
transferred from one place to another
Radiation The conversion of heat energy to electromagnetic radiation

Specific Heat is the amount of energy required to raise temp of 1g of solution 1°C

Thermal Conductivity Rate at which substance conducts heat

Cohesion force of attraction between neighboring molecules of the same type of matter

Adhesion force of attraction between neighboring molecules of the different type of matter molecules adhere
to body and create some drag minimal effect in hydro
Surface Tension (force of attraction between surface molecules of a fluid) harder to break surface or exercise at
surface
Turbulence/Drag A state or quality of being violently disturbed or agitated

Indications
Hydrotherapy  Analgesia
 Muscle Relaxation
 Increase ease of joint
movement
 Facilitation of mechanical
debridement
 Facilitation of exercise
 Decrease muscle spasm
 affect BP
Decrease pain sensitivity
 Increase strength and
endurance
 Decrease gravitational forces
 Enhances peripheral
circulation
 Improves body awareness,
trunk stability, and balance
 Strengthen respiratory
muscles
Whirlpool:
 Sprains and strains
 Contractures
 Postsurgical repair of joints
and soft tissues
 Healing fractures of bones
 OA and RA
Contrast bath: repeated immersion of an extremity into a tub or tank of hot water and alternating with a tube or tank of cold water to increase blood flow
in the immersed body part without causing or increasing edema. The fixed ratio is 3 or 4 minutes in the hot bath to 1 minute in the cold bath, repeated 4 to
5 cycles. This alternating method will trigger vascular pumping action caused by vasodilation (hot water) and vasoconstriction (cold water).
Water Temperatures:
Cold: 56°F to 65°F
Neutral: 93°F to 96°F
Hot: 100°F to 104°F
Patient Care 1 – Exam 2 Review
Hydrotherapy
Precautions Contraindications Notes Tx Dosage / Duration
 Cardiac conditions  Bowel incontinence  Can be used for wound Duration varies based
 Large, open wounds  Bladder incontinence cleansing and/or on patient’s diagnosis,
 Respiratory  Acute inflammation debridement goals of the Tx, the
conditions  Danger of hemorrhage  Water can assist with patient’s physical and
 Thermal insensitivity  Fear/confusion/aquaphobia promoting circulation or mental condition, and
 Dermatological  Pregnancy alleviating peripheral patient tolerance
conditions including  Multiple sclerosis edema
dry skin or skin  Inability to dissipate water  Immersion in water may Whirlpool:
If the goal is to heat a
rashes  Communication disorders
 Severe peripheral or tracheostomy  Agitation can be used in body part, then typically
whirlpool or tanks 20 minutes.
arterial disease  Infectious disease
 Controlled seizure  Cardiovascular problems If the goal is to cool a
disorders  Uncontrolled seizure body part, then 10-15
 Aspiration risk disorders minutes depending on
 Cognitive  Skin conditions (eczema) patient tolerance.
impairments or skin infections
 Tetraplegia or high If the goal is to
paraplegia exercise, then 10-30
 Severe minutes depending on
arteriosclerosis patient’s medical
Be conscious that an
status.
obvious danger with a
patient immersed in water
is drowning and should be
monitored closely.
Expect Physiological Effects:
 33°F to 80°F = vasoconstriction, analgesia, possible anesthesia
 81°F to 96°F = likely no loss of body heat or change in core temperature or limb size
o this is the best temp range for pool exercise
 97°F to 104°F = vasodilation, analgesia, relaxation
 105°F to 110°F = this may cause rapid fatigue and overheating
 Patient Care 1 – Exam 2 Review

Cryotherapy

Indications Precautions / Notes Tx Dosage / Duration

Contraindications
 decrease muscle spasm  cold-sensitivity symptoms: cold  Store in refrigeration unit or  Use a towel over the skin
and spasticity urticaria or Raynaud’s syndrome household freezer at -5°C for at to prevent skin damage
 decrease pain  over circulatory compromised least 2 hours prior to use
 prevent excessive edema areas: PAD  The greater the gradient  Tx: 15-20 mins
formation  HTN or arteriosclerosis between the skin and the
 decrease tissue  sensory loss cooling source, the greater the
metabolism and /or  multiple myeloma resulting tissue temperature  The deeper the tissue, the
Cold Packs bleeding change longer the time required to
 treat myofascial pain  Subcutaneous tissue and lower the temperature
syndrome muscle require longer for
gradient change
Advantages: Disadvantage:
 inexpensive to purchase  Could cause frostbite if directly applied to skin
 many different types: ice packs, gel packs, frozen vegetables
 over a small area: muscle  cold-sensitivity symptoms: cold Pt will experience:  Use ice, frozen cup, or
belly, tendon, bursa, urticaria or Raynaud’s syndrome  Burning cryostick
trigger point  over circulatory compromised  Aching
 small, painful, areas: PAD  Analgesia  Make sure to overlap your
circumscribed muscle  HTN or arteriosclerosis o burning and aching usually circles
spasm  sensory loss lasts 1-2 mins; if longer, it may
 acute musculoskeletal  multiple myeloma be too large an area or the
injuries patient may have
Ice Massage
 prior to deep pressure hypersensitivity to cold
massage
Advantage: Disadvantage:
 Used to achieve an anesthetic effect  A prolonged phase of aching or burning may result if the
 Can teach some patients to do this themselves area covered is too large or if a hypersensitive response is
 Minimal risk of frostbite and risk of damaging tissue imminent
 Skin temperature will usually not drop below 59°F when the ice
is moved continuously
 Patient Care 1 – Exam 2 Review

 Spray and Stretch: to
temporarily relieve pain
before stretching
 Trigger point therapy
 Local muscle spasms
Vapocoolant
Spray
Advantage:
 Temporarily relieves pain to stretch a patient
 cold-sensitivity symptoms: cold
urticaria or Raynaud’s syndrome
 over circulatory compromised
areas: PAD
 HTN or arteriosclerosis
 sensory loss
 multiple myeloma
 When the bottle is inverted and
the trigger released, the spray
comes out into the air and
evaporates, causing a cooling
effect
 Trigger point therapy: Spray
from the trigger point out and
over the referred pain zone
while you stretch
 Make sure to spray proximal to
distal
Disadvantage:
 Some products may be environmentally hazardous
 Hold 12 – 18 inches away
from skin during spray
application
 Apply a few sweeps
across the skin while
maintaining and gently
increasing the passive
stretch
 Repeated Tx during the
same session are done
only after the skin has
been rewarmed to avoid
frostbite

 Decrease pain  cold-sensitivity symptoms: cold Manual recirculation is

 Decrease edema urticaria or Raynaud’s syndrome recommended every 1 to 2
 Increase ROM  over circulatory compromised hours to maintain the cooling
areas: PAD effect
 HTN or arteriosclerosis
Cold  sensory loss
Compression  multiple myeloma
Units
Advantages: Disadvantages:
 Adjustable temperature for units ranging from 50°F to 77 °F  Specific temperature monitoring and adjustment are not
 Variety of sizes and shapes of cuffs and sleeves to conform to possible with all units
any joint or extremity  Can be very expensive to buy a unit
 Adjustable levels of compression at variable intervals
 Better outcomes postoperatively than an ice pack
 Patient Care 1 – Exam 2 Review

Edema

Terms Definitions
Edema Local or generalized condition in which the body tissues contain an excessive
amount of tissue fluid
Inflammatory Response The tissue and cellular changes that occur with inflammation; the hemodynamic
and permeability changes and migration of leukocytes to an area of tissue injury
that attempt to produce a localized protective action
Fasciotomy Surgical incision and division of fascia
Escharotomy Removal of the eschar (slough) found on the skin and underlying tissue of
severely burned areas
Pitting Edema When a finger is firmly pressed into the edematous area, an indentation results
that remains awhile and slowly fills
Non-pitting Edema With firm finger pressure, no persistent indentation occurs because the fluid in the
edematous area has coagulated
Girth Tape Measure Using a standard tape measure, take pre- and post- treatment measurements at
various points on the limb, using fixed, bony landmarks as guides

Conduction The most common method used for transfer of a cooling agent

Evaporation Energy is transferred through evaporation

Manual Lymph Drainage A unique lymphatic massage technique to empty and decompress obstructed
lymph vessels
Exercise in lymphatic drainage The “pumping” action of muscles on the circulatory vessels will assist in fluid
return to the cardiovascular and lymphatic systems.
 Patient Care 1 – Exam 2 Review

Effect of Hydrostatic Pressure: Effect of Osmotic Forces: Difference in Net Pressures:

At arteriole end of capillary: total
pressure gradient forcing fluid OUT
of capillary = 30.3 mmHg
At venule end of capillary: total
pressure gradient forcing fluid OUT
of capillary = 15.3 mmHg
NET Colloid Osmotic Pressure Total pressure forcing fluids out of the capillary = Cap. hydrostatic
(COP) = 22 mmHg forcing fluid pressure and the negative interstitial pressure. Total pressure
INTO capillary forcing fluids into the capillary = plasma colloid osmotic pressure
(PCOP) minus interstitial fluid colloid osmotic pressure (IFCOP).
The net pressure at the arteriole end is 8.3 mmHg, which forces
Plasma colloid osmotic pressure (28 fluids out of the capillary. The net pressure at the venule end is 6.7
mmHg) – Interstitial fluid colloid mmHg, which forces fluids into the capillary. Thus, 1.6 mmHg
osmotic pressure (6 mmHg) difference in pressure tends to force fluid out of the capillary into
the interstitial space.
Flow out of vessels due to hydrostatic pressure
Flow into vessels due to osmotic pressure

Factors altering normal exchange of fluids at capillary membranes

Physiological increased capillary increased capillary Reduced plasma colloid Increased interstitial Lymphatic
factor change: membrane permeability hydrostatic pressure osmotic pressure colloid osmotic obstructions
pressure
Cause:  Inflammatory  Arterial dilatation  Reduced plasma  Increased protein  Systemic
process  Systemic protein caused by in interstitium diseases
 Temperature problem hypoproteinemia with  Excessive  Lymphatic
change  Renal problems severe burns or extracellular resection
 Release of causing fluid physical disruption of sodium
histamine, kinines, retention capillaries (trauma)
or other vasoactive
chemicals

Result: increased flow out of the increased flow out of reduced flow into the increased flow out of Lymphedema
capillary (edema) the capillary (edema) capillary from the the capillary (edema)
interstitium (edema)
 Patient Care 1 – Exam 2 Review

Common Causes Causes of Edema Pitting Scale

of Edema: unilateral Assessment
edema:
 Trauma  Trauma  To differentiate
 Burns  Cellulitis pitting from 1+ Slight indentation (2mm)
Normal contours
 Heart Failure  Osteomyelitis non-pitting
Associated with interstitial fluid volume 30% above normal
 Infections /  Ruptured edema, press
your finger 2+ Deeper pit after pressing (4 mm)
Inflammation Baker’s Cyst Lasts longer than 1+
 Deep Vein  Deep vein against a
Fairly normal contour
Thrombosis thrombosis swollen area 3+ Deep pit (6 mm)
(DVT) for 5 seconds, Remains several seconds after pressing
 Lymphatic and then Skin swelling obvious by general inspection
obstruction remove it 4+ Deep pit (8mm)
quickly. Remains for a prolonged time after pressing, possibly mins
 The amount of Frank swelling
edema is Brawny Fluid can no longer be displaced secondary to excessive
graded based interstitial fluid accumulation
on the amount No pitting
and Tissue palpates as firm or hard
persistence of Skin surface shiny, warm, moist
indentation.
 Patient Care 1 – Exam 2 Review

IPC

Indications: Precautions: Contraindications: Notes: Tx Dose/ Duration:

 Control of edema:  Impaired sensation  Congestive heart failure  circumferential  Typically, set on-off
o Traumatic or mentation or acute pulmonary measurements or dials to the desired
edema  Local edema limb volume inflation-deflation
o Venous dermatological  Recent or acute DVT, measurement times (typically 3:1
insufficiency infections thrombophlebitis, or before and after ratio)
edema  Recent skin graft pulmonary embolism IPC every 2-3  For massive
o Lymphedema  Uncontrolled (dangerous if already inches marked edema: 2-4 hours
 Prevention of hypertension formed!)  Record  Tx: 30-60 minutes
DVT,  Cancer  Obstructed lymphatic or measurements in the clinic
thrombophlebitis  Stroke or significant venous return  Stockinette to be  Typically distal to
 Venous stasis vascular  Severe peripheral placed on part proximal to push
ulcers insufficiency arterial disease or ulcers being treated to fluid back to the
Intermittent  Residual limb  Superficial due to arterial absorb heart, but if it
Pneumatic shaping after peripheral nerves insufficiency perspiration and doesn’t work
Compression amputation  Acute local skin infection for hygiene because it is too
 Control of  Acute fracture or other  Elevate limb occluded then you
hypertrophic trauma being treated should try proximal
scarring  Monitor BP and to distal to alleviate
 Arterial do not exceed the blocking
insufficiency diastolic pressure edema.
 Remove all  Monitor BP during
jewelry and don’t exceed
 Cover all wounds diastolic pressure

Advantage: decreases edema, patient can be left alone, Disadvantage: time consuming
easy to assemble