MF3 TRANS BLOOD VESSELS, ARTERIAL DISEASE, PERIPHERAL VASCULAR DISEASE.pdf

Philippine College of Health Sciences (PCHS) MF3 TRANS MF3 2 Capillaries Anatomy of Blood Vessels Microscopic vessels in the fo...

Philippine College of Health Sciences (PCHS) MF3 TRANS MF3 2 Capillaries Anatomy of Blood Vessels Microscopic vessels in the form of a network connecting the arterioles to the venules 3 layers: Arteriovenous Anastomosis A. Tunica Intima Direct connections between the Innermost Layer & the Thinnest Coat Arteries and Veins without the intervention of the Capillaries & are Consists of a Layer of Endothelial usually found in Fingers & Toes. Cells. Lymphatic system A delicate Lamina Propria Type of connective tissue that contains large number of lymphocytes. & internal elastic limiting Includes the following organs & structures: membrane Thymus, Lymph Nodes, Spleen & B. Tunica Media Lymphatic Nodules Middle layer Essential for the immunologic Consists mainly of smooth muscle defences of the body against bacteria & viruses. C. Tunica Adventitia Contains Vasa Vasorum & Nervi Assists the CV system in the removal of Vasorum tissue fluid from the tissue spaces of the body. 3 Types: Characteristics of an Ischemic Extremity 1. Arteries A. Reduced/Absent Hair Transport blood from the Heart & distribute it to the various Tissues of B. Retarded Growth of toe/ Finger the body; Nails Smallest are referred to as Arterioles C. Taut, Thin, Shiny Skin [.1mm in Dia]; D. Muscle Atrophy especially in the Joining of branches is called Post Compartment if Lower Limb is Anastomosis. involved. 2. Veins E. Thickened Nail-plate with Vessels that Transport Blood back to Roughened Transverse ridges the Heart; smallest is called Venules; Medium sized Deep Arteries are often F. [+] Pallor accompanied by 2 veins called Venae Comitantes G. In some cases, [+] purple – blue cyanosed appearance TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS H. Possible signs of Trophic Changes, 8. Infarction Pregangrenous Ulcerations & Condition in which the blood supply is Gangrene so inadequate that it leads to a Definition of terms: circumscribed area of coagulation necrosis which is subsequently 1. Thrombosis organized into scar tissue. An abnormal Blood Condition in which Common Peripheral Vascular Diseases a Clot develops within a Blood Vessel of the body. 2. Embolus I. Arterial Disease A foreign object such as Large Bubble A. Chronic Gas or Air, a bit of Tissue or Tumor or a Arteriosclerosis Obliterans piece of Blood Clot that travels through the Bloodstream & become lodged in a Thromboangiitis Obliterans Blood Vessel, usually in the Heart, Lung or Brain. Diabetic Angiopathy 3. Atheroma B. Acute Most common type of arterial Arterial Thrombosis thrombosis 4. Atherosclerosis Embolic Thrombosis Formation of plaque with consequent Vasospastic Disease narrowing of the arterial lumen. II. Venous disease 5. Arteriosclerosis A. Chronic Intimal smooth muscle proliferation Varicose Veins and/or elastic tissue proliferation which is eventually replaced by Chronic Venous Insufficiency hyalinized fibrotic connective tissue. B. Acute Venous Thrombosis 6. Aneurysm III. Lymphatic disease Local dilatation of an artery or a chamber of the heart due to A. Primary [Congenital] Lymphedema weakening of the wall. B. Secondary [Acquired] Lymphedema 7. Ischemia Peripheral Vascular Disease Condition of inadequate blood supply to an area of tissue. A group of disorders involving the Arterial, Venous and Lymphatic systems resulting in Ischemia/Infection of Limbs. TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS Arterial Disorders become impaired to the point that pain is present even at rest. Types: The clinical evaluations of a patient with this pathology reveal diminished 1. Arteriosclerosis Obliterans or absent pedal pulses Also called Atherosclerotic Occlusive Disease or Progressive Arterial And [+] signs of rubor of dependency. Occlusive Disease, is the most common of all the Arterial Disorders As the process becomes more affecting the Lower Extremities. pronounced, trophic changes begin to occur and the foot becomes colder to It is a Peripheral Manifestation of the touch. generalized Disease, Atherosclerosis. 2. Thromboangiitis Obliterans Approximately 95% of all cases of Also called Burger’s disease chronic arterial disease are of this type. It is the 2nd most common form of chronic occlusive arterial disease. It is slowly developing; degenerative process and its manifestations occur It is a disease involving thrombosis and insidiously. inflammation of small peripheral arteries and veins. It is believed that the disease begins with monocyte adherence to the The disease process is similar to that of endothelial wall following some form the Arteriosclerosis Obliterans but is of physical damage such as trauma, unique in that it tends to occur HPN, or a biochemical process predominantly in Young, Male Smokers. ; A fatty streak begins to develop and subsequently results in the production It is 1st manifested in the distal aspects of an atheromatous plaque in the of the extremities and progresses intima of an artery proximally. ; As the plaque increases in size, the It has been demonstrated that lumen is narrowed and linear blood cessation of smoking arrests the flow is impaired. disease. The disease is most common often The pathology responsible for the seen in elderly patients and is clinical symptoms of decreased tissue commonly associated with DM. perfusion One of the earliest presenting [Cold distal extremities and eventual symptoms in this disease is tissue necrosis, is an inflammatory intermittent claudication; as the process in the veins and the arteries disease progresses, arterial flow may that appear to be directly related to tobacco use] TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS t most affects the arterioles and small ; Nicotine is also a very potent arteries of the fingers. vasoconstrictor and is responsible for the more immediate decrease in skin It is caused by an abnormality of the temperature seen in smokers. sympathetic nervous system and is usually seen in young adults. 3. Acute Arterial Occlusion Acute loss of blood flow to the Characterized by Changes in the Skin peripheral arteries may be caused by a Color and Temperature thrombus [blood clot], embolism or trauma to an artery ; This is in contrast to the findings of intermittent claudication and tissue ; The most common location of an necrosis seen in other arterial arterial embolus is at the femoral disorders. popliteal bifurcation, although an embolus can occur at the other arterial Raynaud’s phenomenon can be bifurcation in the extremities; precipitated by exposure to cold or by emotional stress Crush injuries to the Vessels of the extremities can disrupt arterial blood ; The phenomenon is manifested by flow and must be surgically repaired changes in skin Color of the Digits; quickly to restore circulation and prevent Tissue Necrosis. The Color changes range from pallor to cyanosis and rubor; pain and An occlusion will result in absent or numbness tend to occur with the diminished pulses and pallor and cyanosis ; Complete or partial interruption of ; The condition can occur secondarily circulation to an extremity. with such conditions as scleroderma, thoracic outlet syndrome and The severity of a problem is dependent occlusive arterial disease. upon the location, and size of the Signs and Symptoms: occlusion and the availability of collateral circulation. 1. Changes in Skin Color and Temperature Pallor: A Chalky, White Color, If little or no collateral circulation is Blanching of the Skin available, an acute arterial occlusion will cause tissue ischemia and possibly Shiny and waxy appearance of the skin gangrene of the distal limb. and decreased hair growth distal to the 4. Vasospastic disease insufficiency. Include such processes as Livedo Decreased skin temperature Reticularis and Acrocyanosis, is most frequently referred to as Raynaud’s Dryness of skin phenomenon. Ulcerations particularly at weight bearing areas and bony prominences. TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS A burning, tingling pain in the Gangrene extremities occurs as a result of severe ischemia. 2. Secondary disturbances Decreased tolerance to Hot or Cold It frequently occurs at night because Temperatures the heart rate and volume of blood flow to the extremities decreases with Paresthesia rest. Tingling and eventual numbness in the A partial or complete relief of pain distal portion of the extremities. may be achieved if the leg is placed in a dependent position, for example, Susceptibility to Wound Infections over the edge of the bed. Note: after Minor Skin Abrasions. Edema formation may occur. 3. Pain Elevation of the limb will cause an Intermittent claudication [exercise increase in pain pain] 4. Paralysis Exercise pain [Muscle Cramping] Atrophy of muscles and eventual loss occurs when there is insufficient blood of motor function particularly in the supply and Ischemia in an exercising hands and feet, occurs with muscle. progressive arterial vascular disease. Cramping occurs in a musculature Loss of motor function is compounded distal to the occluded vessel by pain, which further comprises functional capabilities. ;The most common site of Evaluation of Arterial disorders intermittent claudication is the calf muscle as the result of occlusion of 1. Palpation of pulses the femoral artery The basis of any evaluation of the integrity of the arterial system is the ; Exercise pain can also occur in the detection of the pulses in the distal foot when the popliteal artery is portion of the extremities. occluded or less commonly in the buttocks or low back if the iliac or Pulses are described as normal, aortic arteries are the site of diminished or s; occlusion. pulselessness is a sign of severe Pain slowly diminishes with rest. arterial insufficiency. Exercise tolerance progressively The Femoral, Popliteal, Dorsalis Pedis, decreases and ischemic pain occurs and Posterior Tibial Pulses are more readily as the disease commonly palpated in the Lower progresses. Extremity. TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS The Radial, Ulnar and Brachial Pulses The legs are then placed in a are often Palpated in the Upper dependent position and the color of Extremity. the feet is noted. 2. Skin temperature Normally, a pinkish flush appears in Temperature of the skin can be grossly the feet after several seconds. assessed by palpation; a limb with diminished arterial blood flow will be In occlusive arterial disease, a bright reddening or rubor of the distal legs ; Cool to touch. and feet occurs. If a discrepancy exists between an The rubor may take as long as 30 involved and uninvolved extremity, a seconds to appear. quantitative measurement of Skin Alternative Procedures: Temperature should be made with an electric thermometer. Reactive Hyperemia can also be evaluated by temporarily restricting 3. Skin integrity and pigmentation blood flow to the distal portion of the Diminished or absent arterial blood lower extremity with a blood pressure flow to an extremity causes trophic cuff. changes in the skin peripherally. This restriction causes an The patient’s skin is Dry and Color is accumulation of CO2 and lactic acid in Diminished [Pallor] the distal extremity ;Hair loss is and a shiny appearance to ; These metabolites are vasodilators the skin also occur; Skin ulcerations and affect the vascular bed of the may also be present. blood flow-deprived area. 4. Test for Rubor/ Reactive Hyperemia Changes in Skin Color that occurs with When the cuff is released and blood elevation and dependency of the limb flow resumes to the extremity, a as the result for Altered Blood Flow are normal Hyperemia [Flushing] of the evaluated. extremity should occur within 10 seconds. Procedure: The legs are elevated for several In arteriosclerotic vascular disease, it minutes above the level of the heart may take up as long as 1-2 minutes for while the patient is lying supine. a flush to appear. Pallor [Blanching] of the skin will occur NOTE: this method of assessing in the feet within 1 minute or less if reactive hyperemia is quite painful arterial circulation is poor. and is not tolerated well in either. 5. Claudication time The time necessary for blanching to develop is noted. An objective assessment of Exercise Pain [Intermittent Claudication] is TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS performed to determine the amount movement of the dye, indicating a of time a patient can exercise before complete or partia occlusion for blood experiencing cramping pain and pain flow. in the distal musculature. Although this is an invasive procedure, A common test is to have the patient it gives the most accurate picture of walk at a Slow Predetermined Speed the location and extent of arterial on a level Treadmill [ 1-2 mph] obstruction. Treatment: ; The time that the patient is able to walk before the onset of pain or pain 1. Acute Arterial Diseases prohibits further walking is noted. It is often a medical or surgical This measurement should be taken to emergency determine a baseline for exercise tolerance before initiating a program ; The viability of the limb will depend to improve exercise tolerance. on the location and extent of the occlusion and the availability of Collateral Circulation 6. Plethysmography ; Medical or surgical measures must be Can be used to measure mean blood taken to reduce Ischemia and restore flow by recording the rate of increase Circulation. in limb volume after sudden interruption of venous outflow. The most common surgical treatment for an acute occlusion is a Thrombo To perform a Plethysmographic flow Embolectomy Measurement, the limb is placed in a neutral, relaxed position and the ; If circulation cannot be significantly venous occlusion cuff is rapidly inflated improved or restored, gangrene will develop in a very short time and ; Blood that flows into the limb amputation of the extremity will be becomes trapped and the limb necessary. expands. General Treatment Goals: 7. Arteriography To decrease ischemia by restoration or It is an invasive procedure and is improvement of blood flow. usually the last test to be performed To protect the limb. ; It is performed by a vascular surgeon prior to reconstructive vascular Plan of care: surgery. Medical: A radiographic dye is injected in an Bed Rest artery. Complete Systemic Anticoagulation A series of x-ray examinations are Therapy taken to detect any restriction of TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS Physical: measures are also useful in the management if thromboangiitis and Reflex heating of the torso or opposite Raynaud’s disease. extremity Precautions: In all cases, patients must be advised to stop Smoking and alter their diet, Local, Direct Heating of the Extremity including Limitation or Avoidance of is contraindicated, because it can Salt, easily cause a burn to an ischemic tissue Sucrose and Alcohol to lower their Blood Pressure, Triglyceride and ; Use of support hose is also Cholesterol Levels; these measures contraindicated as they may increase may not cure chronic arterial peripheral resistance to blood flow. disorders but will minimize the risk factors. Positioning the patient in bed, with the head slightly raised, will increase In patients with mild disease, a graded the blood flow to the distal portion of program of walking or bicycling should the extremity. be initiated to improve exercise tolerance and functional capacity in Thromboembolectomy and activities of daily living reconstructive arterial or bypass graft surgery are alternatives to ; A regular program of mild to nonoperative treatment. moderate level exercise has been shown to decrease the occurrence of The limb must be protected from any exercise pain [Intermittent trauma; pressure on skin must be Claudication] minimized by special mattress, implementation of a turning schedule Buerger or Buerger-Allen exercises, and periodic repositioning of the which were develop many years ago patient. to progressively promote collateral Precautions: circulation, involved a series of positional changes of the affected Avoid any pressure at the surgical site limb coupled with active ankle by restrictive clotting that could dorsiflexion and plantarflexion occlude blood flow. exercises. 2. Chronic Arterial Disease Reconstructive vascular surgery, such Chronic arteriosclerotic vascular as bypass grafts, may be indicated for disease can often be constructively patients with pain at rest treated by medical and physical means ; A graded exercise program after revascularization surgery may help ; Arteriosclerotic vascular disease maintain peripheral circulation; does not usually require emergency patients with vasospastic disease may medical or surgical care except in the benefit from sympathetic blocks or very advanced stages; conservative sympathectomies to increase blood TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS flow; if patients develop ulcerations VENOUS DISORDERS and gangrene that cannot be treated Types: medically or with conservative surgical procedures, amputation of the limb will be necessary. 1. Acute Thrombophlebitis General treatment goals: An acute inflammatory condition with To improve exercise tolerance for ADL occlusion of a superficial or deep vein and decrease the incidence of by a thrombus intermittent claudication. A. Superficial venous thrombosis To relieve pain at rest If a blood clot is lodged in one of the superficial veins, the conditions To prevent joint contracture and usually resolves without long-term muscle atrophy, particularly if the complications. patient is confined to bed. B. Deep venous thrombosis [DVT] To prevent skin ulcerations VIRCHOW’S TRIAD To promote healing of any skin Venous stasis ulcerations that develop Plan of Care: Damage to the Vessel Wall Hypercoagulability Regular, graded aerobic exercise program of walking or bicycling Thrombophlebitis of one of the deep veins can result in a pulmonary Vasodilation of iontophoresis and embolism and is life-threatening. reflex heating Phlebothrombosisis another term Sleep with the legs in a dependent used to described the occlusion of a position over the edge of the bed or vein by a blood clot. with the head of the bed slightly elevated. Acute venous disorders usually affect the lower extremities. Active mild resistance ROM exercises to the extremities. Risk Factors Associated with Patient education in the proper care Thrombophlebitis: and protection of the skin, particularly 1. Immobility and bed rest over a the feet, proper shoe selection and fit, prolonged period. avoid use of support hose. 2. Obesity A wide variety of procedures for treating ischemic ulcers including 3. Age of the patient [Risk increase electrical stimulation [ES] and oxygen with Age] therapy are use clinically. 4. Orthopedic Injuries TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS ; For recanalization can require a 5. Postoperative Patients period of several months or more 6. Congestive Heart Failure ; Fibrous bands or strictures can form in the vein; usually but not always, 7. Malignancy venous valves are destroyed or lose their normal function as the fibrotic 8. Use of Oral Contraceptives process thickens the venous wall and cusp 9. Pregnancy ; Superficial Venous Thrombosis alone 2. Chronic heart disorders is not thought to have any serious Varicose veins morbidity unless a saphenous vein thrombus propagates and involves the Chronic venous insufficiency common femoral vein. Risk factors: These chronic disorders are associated with venous hypertension and stasis in 1. Prior History of DVT the lower extremities and inadequate return of blood to the heart. 2. Immobilization The venous valves are not competent 3. Postoperative State and exercise no longer increases venous return. 4. Age [older than age 70] Chronic venous insufficiency or 5. Cardiac Disease development of a varicosity may follow an acute episode of 6. Limb Trauma thrombophlebitis. 7. Post - Thrombotic State or Etiology and Pathogenesis: Coagulation Abnormalities Thrombi frequently arise from the clot formation in the cusps of venous 8. Hormonal Therapy channel 9. Pregnancy ; Another site for thrombus development is at the entrance of a 10. Postpartum State tributary vein 11. Pregnancy ; The thrombus can go on to occlude a major venous channel by a prograde or 12. Obesity retrograde propagation; fortunately, many small venous large thrombi 13. Advanced neoplasm undergo rapid thrombolytic Clinical S/Sx’s: dissolution 1. Acute Thrombophlebitis TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS Swelling of the extremity, most 2. Girth Measurements of the Extremity commonly seen in DVT Circumferential measurements of the involved extremity are made to detect Pain Edema or atrophy. Tenderness of the calf muscles that The girth of the involved extremity increases when the ankle is may be compared with the girth of the dorsiflexed uninvolved extremity. Inflammation and discoloration of the If consistent methods are used in extremity taking measurements, the therapist 2. Chronis Venous Insufficiency can determine the effectiveness of treatment overtime. Dependent Edema One accepted method is to take Associated with standing and sitting circumferential measurements every for a prolong periods of time. 10 along the entire length of the extremity. Usually worse at the end of the day. Edema decreases if the leg is elevated 3. Competence of the Great Saphenous vein while the patient lies supine. [ Percussion Test] Aching or tiredness in the legs. A test used for patients with varicose veins. Increased pigmentation and stasis of the limb Procedure: Ask the patient to stand until the Skin ulcerations and secondary varicosities in the leg fill with blood. infection, which can lead to cellulitis. Evaluation: Palpate a portion of the saphenous vein below the knee and then sharply 1. Phlebography percuss the vein above the knee. A test used by the physician in If a thrust of blood is felt with the addition to observation and physical palpating finger below the knee, the examination to diagnose venous valves are incompetent. disorders. 4. Test for possible deep vein thrombosis An invasive procedure similar to arteriography, using X-Ray study and Homan’s sign radiopaque dye injected into the venous system With the patient supine, forcefully dorsiflex the foot and squeeze the ; The procedure is used to detect posterior calf muscles. Venous Thrombosis. TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS Many patients, but not all, with c. Daily Passive ROM if Active Exercise thrombophlebitis will experience is not possible because of a significant pain in the calf muscles. neuromuscular or medical condition. Application of blood pressure cuff 5. While the postoperative patient is Eesting around the calf. in Bed, the Legs can be Elevated Periodically. Inflate the cuff until the patient Treatment: experiences pain the calf. 1.Acute thrombophlebitis Patients with acute thrombophlebitis Immediate medical management is usually cannot tolerate pressure above essential in this life threatening 40 mmHg. disorder. When the cuff is inflated, there is little During the initial stages of treatment, additional increase in venous volume the patient will be on complete bed and after tourniquet release the return rest and systemic anticoagulant to baseline is delayed. therapy and the involved extremity will Prevention of thrombophlebitis be elevated. 1. Every effort should be made to Movement of the extremity will cause prevent the occurrence of pain and will increase congestion in the thrombophlebitis in patients at risk. venous channels in the early inflammatory period. 2. It is well established that venous return decreases with prolonged NOTE: passive or active ROM periods of bed rest exercises are contraindicated during this initial inflammatory period. 3. Bed rest is the primary cause of acute postoperative thrombosis in the General treatment goals: deep veins of the legs. 1. To relieve pain during the Acute Inflammatory Period. 4. The risk of postoprative thrombophlebitis can be minimized 2. In the Later Stages, as the by symptoms Subside, regain Functional Early Ambulation and Exercise such as: Mobility. A. Active pumping exercises[ 3. To prevent recurrence of the Acute dorsiflexion, circumduction of the Disorder. ankle] performed regularly throughout the day while the patient Plan of care: is in bed. Individually tailored pressure-gradient support stockings should be worn B. Active or Mild Resistive ROM to during ambulation. both lower extremities if the post operative condition permits. Manual massage of the extremity in a distal to proximal direction. TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS Use of intermittent compression anastomosis and proteolytic activity of tissue pump macrophages] are exhausted. Inflammatory cells accumulate and progressive Regular ambulation, cycling or an fibrosis, sclerosis and elephantiasis develop. active exercise program. Lymphoangiosarcoma, a severe late Note: instruct patient to elevate the complication of secondary LE after graded ambulation until the lymphedema is rare. HR returns to normal. Signs & Symptoms: Avoid prolonged periods of standing 1. Lymphedema still, sitting with legs dependent. [Painless Swelling] of the Distal Extremity is most often seen over the Elevation of the foot of the bed during Dorsum of the Hand or Foot rest ;Pitting Edema indicates short duration Proper Skin Care. swelling while brawny Edema [hand Lymphatic Disorders Edema] is associated with long-term venous insufficiency. Etiology: Lymphedema is the abnormal accumulation of water and protein in 2. Increased weight or heaviness of the skin and subcutaneous tissues. the extremity. Classifications: 3. sensory disturbances [Paresthesia] of the hand or foot 1. Primary Is due to Aplastic or Hypoplastic 4. Stiffness of the Fingers or Toes Lymphatic Trunks. 5. Tautness of Skin 2. Secondary Can occur after recurrent Infection, 6. Susceptibility to Skin Breakdown Tumor ,Lympho Proliferative Disease or injury to the Lymphatic System 7. Decreased resistance to infection stemming from Surgical Excision, causing frequent episodes of cellulitis. Trauma or Irradiation. Evaluation: Lymphedema develops when the 1. Girth Measurements of the Extremity lymphatic load exceeds the transfer capacity of the lymphatic system. 2. Volumetric Measurements of the It is manifested if all the compensatory Extremity mechanisms [Collateral Lymphatic Circulation, Spontaneous The involved extremity is immersed in Lymphoventous a tank of water. TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO  Philippine College of Health Sciences (PCHS) MF3 TRANS The amount of water displaced as the Prevent infection and cellulitis extremity is lowered into the water is Plan of Care: measured. Intermittent mechanical compression 3. Palpation of the Dependent Limb with a pneumatic pump and sleeve or To differentiate pitting Edema from bag for several hours daily. brawny Edema with subcutaneous fibrosis. Elevation of the extremity above the level of the heart [about 30-45 4. MRI degrees] while sleeping and as often as Performed if soft tissue sarcoma is possible during the day. suspected. Manual massage from distal to 5. Lymphoscintigraphy proximal along the length of the Provides a functional assessment of extremity lymph transport capacity and identifies major morphological abnormalities of Isometric and isotonic pumping the Lymphatic System. exercises of the distal muscles. Treatment: Elastic support stockings or sleeve The majority of patients seen by individually measured and fitted to the therapists in clinical settings have patient Lymphedema secondary to obstruction of the lymphatic system Regular elevation of the extremity from Trauma, Infection, Radiation or Surgery. Avoidance of sources of increased load on the lymphatics If a patient is at risk for developing Such As: Lymphedema, prevention is the best goal. Static, Dependent Positioning External compression of skin Application of Local Heat To increase lymphatic drainage, Prolonged use of Muscles for even increases hydrostatic pressure of Light Tasks tissues. Hot Environment Elevation of limb Care of Skin Abrasions, Small Burns To increase Lymphatic and Venous and Insect Bites. Return Avoidance of Harsh Chemical and General treatment goals Detergents Reduces Lymphedema Frequent application of Moisturizers Prevent further Edema Use of antibiotics TRANSCRIPT BY: GABRIEL, JOHN MICHAEL ORQUEZA PROF: DR. PHILILIP OBILO