Exam & Tx of Edemas

Hemosiderin staining: bilateral, lower leg only

Atrophic changes: decreased dermal thickness→ shiny skin, thin fragile skin, decreased skin mobility/flexibility

Maybe: varicose veins or spider veins, ulcers/wounds (Shallow, highly exudative)

Observations seen w/ CVI skin changes

No hemosiderin staining, hyperkeratosis/papillomas, or wounds

Peau d’orange

Deeply pitting, symmetrical, & extending into knees/thighs

Also: Jugular distention in neck, Superficial edema or ascites in abdomen

Observations seen w/ Cardiac Edema

Bacterial infection of skin, Common w/ lymphedema

Red, warm, painful, edematous area w/ clear borders to “rash”

Progresses rapidly (hrs)

w/o tx, spreads rapidly to other organs (constitutional symptoms develop)

Tx: oral or IV antibiotics

Med Emergency- send to ED or urgent care for immediate antibiotic prescription

Cellulitis

palpation of cardiac edema

boggy

palpation of mild venous or lymphedema

spongy

palpation of moderate venous or lymphedema

firm

what is a qualitative skin assessment for presence of fibrosis?

If positive, indicates presence of intradermal fibrosis

stemmers sign

What types of edema have positive stemmer sign?

only lymphedema

what is assessed by applying gentle, steady, moderately deep pressure down to level of fascia/muscle. Hold for 3 seconds. Release hand & observe/measure depth of “pit” & rate of refill

pitting edema 1+ to 4+ (mild to severe)

how is pitting edema documented?

describe location, timing, & extent of pitting

what can pitting edema indicate?

Low protein edema (CHF, DVT, venous edema)

Early lymphedema (stage 1-2)

Before fibrosis develops

score for when Skin bounces back immediately, no indentation

0 (No Pitting)

what is pitting score when Barely perceptible pit (around 2mm), rebounds quickly?

1+ (Mild)

what pitting score has Deeper pit (around 4mm), disappears w/in 15 seconds?

2+ (Moderate)

what pitting score has a noticeably deep pit (around 6mm), takes up to 30 seconds to rebound?

3+ (Deep)

what pitting score has Very deep pit (8mm or more), takes over 30 seconds to rebound?

4+ (Very Deep)

what lymph nodes are common metastatic sites for lung & breast cancers?

Supraclavicular

what nodes implicate tumors arising in the legs, perineum, prostate, or gonads?

inguinal

what first sign is often painless enlargement of 1 or more peripheral lymph nodes?

lymphoma

what is a reliable clinical tool to assess for DVT?

Wells Criteria