NPTE Study Guide: Lymphatics & Integumentary Systems Flashcards

Flashcards based on the provided lecture notes for NPTE review, covering Lymphatics and Integumentary Systems.

What are the two main purposes of the lymphatic system?

Immune defense and fluid balance.

What fluid does the lymphatic system drain and return to venous circulation?

Interstitial fluid (lymph).

Name at least five components of the Lymph System.

Lymph nodes, tonsils, thymus, spleen, thoracic duct, bone marrow.

What is the correct order of lymph flow pathway?

Capillaries → Vessels → Nodes (filtration) → Trunks → Ducts → Subclavian veins.

Which body regions does the Right Lymphatic Duct drain?

Right upper extremity & face.

Which body regions does the Thoracic Duct drain?

Left UE/face and bilateral LEs.

List the LE Lymph Drainage Pathway. Hint: PILLCTS

Popliteal lymphnodes → Inguinal lymphnodes → Lateral aortic lymphnodes → Lumbar trunk → Cisterna chyli → Thoracic duct → Subclavian vein

What is the amount of fluid the lymphatic system must move?

Lymphatic Load

What is the Maximum amount the lymphatic system can carry.

Transport Capacity

When happens when lymphatic load exceeds transport capacity (load > capacity)?

Lymphedema

How can venous insufficiency affect lymphedema?

It can worsen it due to pooling of fluid.

Give one example of Primary Lymphedema.

Milroy’s Disease(0-2), Lymphedema Praecox(10-25), Lymphedema Tarda(35+)

Give one example of Secondary Lymphedema.

Lymph node removal, infection, tumor, chronic venous insufficiency, fibrosis, filariasis.

Describe Pitting edema.

Soft, indentation remains; early stage; short duration, little to no fibrotic changes to skin/subQ tissue.

Describe Brawny edema.

Hard, fibrotic changes in sub-Q tissue; NO pitting edema.

Describe Weeping edema.

Severe, fluid leaks, wound healing impaired, almost exclusively lower extremity.

Describe the Stemmer Sign and what stage of lymphedema it indicates.

Inability to pinch skin on dorsum of hand/foot; indicates Stage II or III lymphedema.

Describe Stage 0 Lymphedema.

Latency; no edema, heaviness reported, (-) stemmer sign, tissue and skin appears normal.

Describe Stage I Lymphedema.

Reversible; soft pitting edema, edema reduces with elevation, stemmer sign negative.

Describe Stage II Lymphedema.

Spontaneously Irreversible; Early stages Stemmer Sign (-), late stages Stemmer Sign (+), tissue appears fibrosclerotic, proliferation of adipose.

Describe Stage III Lymphedema.

Lymphostatic elephantiasis; edema present, severe non-pitting brawny edema, Stemmer sign (+), skin changes (hyperkeratosis, papillomas, deep skin fold, warty protrusions).

Describe Grade 1+ Pitting Edema. (only stage 1 lymphedema)

Mild, barely perceptible indentation, <15 sec rebound time, <1/4 inch depth.

Describe Grade 2+ Pitting Edema. (only stage 1 lymphedema)

Moderate, mod indent, <15 sec rebound time, 1/4–1/2 inch depth.

Describe Grade 3+ Pitting Edema. (only stage 1 lymphedema)

Severe, visible indentation, 15–30 sec rebound time, 1/2–1 inch depth.

Describe Grade 4+ Pitting Edema. (only stage 1 lymphedema)

Very Severe, visible indentation, >30 sec rebound time, >1 inch depth.

How does Lymphedema distribution typically present?

Unilateral or asymmetrical (affecting one leg more).

How does Lipedema distribution typically present?

Bilateral LE (butt & thighs), symmetrical (not ankles/feet).

Is distal edema present in Lymphedema?

Yes.

Is distal edema present in Lipedema? (ankles)

No.

Is Stemmer sign positive in Lymphedema?

Yes, Stage II or III

Is Stemmer sign positive in Lipedema?

No.

Is pain with pressure present in Lymphedema?

Absent.

Is pain with pressure present in Lipedema?

Present.

Is cellulitis common in Lymphedema?

Yes.

Is cellulitis common in Lipedema?

Rare.

What 3 tools are used to measure edema? When do you use each?

Girth measurement (proximal)

Volumetric displacement (distal)

Bioimpedance (pre/post op)

What does Lymphoscintigraphy assess?

Lymphatic insufficiency at rest and with exercise.

What does Doppler Ultrasound differentiate?

Venous vs. lymphatic insufficiency.

What does tender lymph nodes usually indicate?

Infection/inflammation.

What do hard, fixed (immobile), non-tender lymph nodes indicate?

Malignancy → refer to MD.

What does persistent enlargement of lymph nodes indicate?

Lymphadenopathy.

Define Lymphangitis.

Infection/inflammation of vessels.

Define Lymphadenitis.

Infection of nodes.

Define Lymphadenopathy.

Enlarged nodes.

What does CDT stand for?

Complete Decongestive Therapy.

What are the interventions in Phase 1 (Intensive) of CDT?

Manual drainage, multilayer compression bandage, skin/nail care, exercise.

What are the interventions in Phase 2 (Maintenance) of CDT?

Compression garment (day), multilayer bandaging (night), self-MLD, exercise, skin and nail care, exercise.

When performing MLD, which areas should you start with?

Proximal areas (trunk, groin, axilla).

What type of bandage do you use for Compression Therapy?

Short-stretch/low-stretch bandages, low resting pressure with high working pressure, wrapping distal to proximal. Avoid ACE wraps.

Which condition is compression therapy contraindicated?

Arterial insufficiency.

What is the compression garment pressure for UE?

30–40 mmHg.

What is the compression garment pressure for LE?

40–50 mmHg.

What are the exercise guidelines for lymphedema?

Light resistance, AROM, stretching. Exercise proximal to distal. Always use compression garment or wrap during exercise.

How to perform skin and nail care for patients with Lymphatic conditions.

Prevent breakdown, infection. Keep skin dry, use neutral temperature. Never take BP on affected extremity.

Name 3 functions of the skin.

Protection, insulation, holds organs together, sensation, fluid balance, temperature control, UV radiation absorption, metabolizing vitamin D, synthesizing epidermal lipids

What cells are contained within the Epidermis layer?

Keratinocytes, melanocytes, langerhans cells, basal cells

What is contained in the Dermis layer?

Collagen, reticulum, Fibroblasts, macrophages, lymphatic glands, blood vessels, nerve fibers.

What is contained in the Hypodermis layer?

Fat, connective tissue, larger blood vessels.

Which skin layer is most important?

Dermis.

What does Meissner Corpuscles sense?

Fine touch.

What does Merkel Disks sense?

Light/crude touch, texture.

What does Krause Bulbs sense?

Cold.

What does Pacinian Corpuscles sense?

Pressure, vibration.

What does Ruffini Endings sense?

Heat, stretch.

What does Free Nerve Endings sense?

Pain, pressure, temperature, itch and tickle detectors.

Describe the appearance of a 1st degree/superficial burn.

Pink/red with erythema.

Describe the tissue layer(s) impacted in a 1st degree/superficial burn.

Epidermis.

Describe the clinical presentation of a superficial partial thickness burn.

Mottled red Intact, weeping blisters, blanches to pressure with quick capillary refill, extremely painful

Describe the clinical presentation of a deep partial thickness burn

Epidermis Dermis, Mixed Red and White areas, Blanched to pressure with slow capillary refill, Decreased pinprick sensation

Describe the appearance of a full thickness burn.

Dry, rigid, leathery eschar

Describe the tissue layer(s) impacted in a full thickness burn.

Epidermis, Dermis and Some Subcutaneous Tissue

Describe the tissue layer(s) impacted in a subdermal burn.

Epidermis, Dermis, Subcutaneous Tissue

Describe the location of a venous ulcer

Medial malleolus

Describe the edges of a venous ulcer

Irregular, shallow

Describe the pain associated with a venous ulcer

Mild-mod * elevation alleviates

Describe the location of an arterial ulcer

Distal ⅓ leg, Dorsum of foot or toes, lateral malleolus

Describe the edges of an arterial ulcer

Punched-out, smooth, well defined

Describe the pain associated with an arterial ulcer

Severe *elevation aggravates

Where are diabetic ulcers found/

WB surfaces (heel, met pads, great toe)

What is the description of a Grade 0 Wagner Classification (Diabetic Ulcers)?

Pre-ulcerative skin(skin intact)

What is the description of a Grade 4 Wagner Classification (Diabetic Ulcers)?

Gangrene of digit

What is the description of a STAGE 1 pressure injury?

Intact, non-blanchable redness

What is the description of a STAGE 4 pressure injury?

Full thickness, bone/tendon exposed(Bone 4 letters phase 4)

What is the description of a Unstageable pressure injury?

Eschar-covered

What is the description of a DTI pressure injury?

Bruising beneath intact skin

What is the description of intermittent claudication scale Grade 1?

Mild discomfort

What is the description of intermittent claudication scale Grade 4?

Unbearable pain

Wound exams should include?

Wound location and size measured by length x with x depth, Tissue type, Wound drainage and color, Wound edges

A wound that is clear with a tinge of blood/brown is labeled as?

Serosanguineous: normal and indicated healing

A wound that is bloody, bright red is labeled as?

Sanguineous: indicated inflamed wound

Selective Debridement involves?

Removal of only non-viable(necrotic tissue) “SEA” Sharp, Enzymatic, Autolytic

A dressing that is used for wounds with heavy exudate is?

Calcium alginate, hydrofiber

In RYB wound care, what color wound care involves insulating (maintain moist) and protecting?

RED

In RYB wound care, what color wound care involves cleaning/ remove yellow moisture-retentive dressing?

YELLOW

In RYB wound care, what color wound care involves debriding the wound as ordered?

BLACK

What is the description of a keloid scar?

Raised, extends beyond wound margins

How does herpes zoster (shingles) present/other info?

Pain and tingling on localized area, fever and chills, red (fluid filled) papules in a dermatomal distribution, pink with silvery white, Unilateral CN III and V, airborne AND contact precaution, anti-viral meds

How does herpes simplex present/other info?

Vesicular eruptions on face and mouth Type 1 : oral areas, above waistline, Type 2 : below the waistline

How does dermatitis present/other info?

swelling irritation, (itchy and dry"may blister ooze or flake, contact precautions