304lecture:compression

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itzlinds
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266242
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304lecture:compression
Updated:
2014-03-12 23:13:38
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compression
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compression
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  1. the application of a mechanical force that incrases external pressure on the body is called:
    compression
  2. constant pressure, blood doesnt refill to the area, not that effective is called:
    static compression
  3. list 4 applications of compression:
    • prevent DVT: increased risk after surgery, also a contraindication, could break loose & move to heart
    • residual limb shaping: phantom pain, amputation, so prosthetic will fit snugg
    • facilitation healing of venous ulcers: stagnit blood, get blood moving
    • modify  scar tissue formation: burn victims
  4. list and describe 3 effects of external compression:

    (intermittent vs static)
    • limits outflow from vessel to interstitial area
    • effective in reducing edema, preventing DVT, facilitate healing in venous ulcers

    • intermittent vs static
    • may be more effective (intermittent)
    • compression moves fluid in vessel, relaxation allows filling (single chamber)
    • sequential compression- milking the fluid from proximal to distal (multi chamber)
  5. how does the external compression effect of limiting the size and shape of a limb:
    • acts as a 2nd skin
    • static compression can limit shape and size of new tissue formation

    • extensibility of garment gives differing effects
    • residual limb shaping
    • burn pts.
    • edematous limbs (lymphedema)
  6. how does external compression effect the tissue temperature:
    • increased tissue temperature
    • device acts as an insulator to tissue applied

    • proposed effects in scar management
    • increased temp. may increase enzyme activity (collagenase)  (breaks down scar tissue)
  7. list the 5 clinical indications of compression:
    • acute injury (w/ swelling/edema)
    • edeam
    • -medcial origin
    • -venous insufficiency
    • -lymphedema
    • Deep vein thrombosis (prevention of)
    • venous stasis ulcers
    • control hypertrophic scarring
  8. list the 7 contraindications of compression:
    • CHF or PE
    • recent/acute DVT
    • obstructed lymphatic or venous return
    • arterial insufficiency: not enought aterial BF
    • acute local infection: spread to systemic
    • severe hypoproteinemia: low protein to the kidney (which filters)
    • acute fx
  9. list 5 precautions for compression:
    • impaired sensation and mentation
    • uncontrolled HTN
    • cancer
    • stroke or significant vascular insufficiency
    • superficial peripheral nerve (peroneal, unlar)
  10. how is compression used as a component of RICE care in an acute injury:
    • limits vascular leakage
    • prevent 2ndary tissue damage: slow metabolism; other fluids taking O2
    • expedite inflammatory phase: reduce swelling; reduce time missed
  11. presences of abnormal amounts of fluid in the extracellular tissues spaces is called:
    edema
  12. fluid stasis (stopped/decreased fluid flow) is maintained thru:
    hydrostatic and osmotic pressure
  13. Hydrostatic pressure is determined by:
    BP and gravity


    hydrostatic pressure=the pressure exerted by a fluid in equilibrium due to the effects of gravity (force)
  14. Osmotic pressure (thru the membrane; concentration gradient) is determined by:
    proteins inside and outside of vessels

    osmotic pressure=the pressure which needs to be applied to prevent the inward flow of water into a semipermeable membrane
  15. list 5 possible medical system dysfxn that would produce swelling:
    • cardiac
    • kidney
    • electrolyte imbalances
    • vascular disorder
    • tumor
  16. the venous system is a low pressure system..

    what is the hydrostatic pressure in the venous system of the R atrium:

    what is the average hydrostatic pressure at the ankles:

    how much does hydrostatic pressure increase each cm below the heart:
    • what is the hydrostatic pressure in the venous system of the R atrium: 4.6 mmHg
    • what is the average hydrostatic pressure at the ankles: 90 mmHg
    • how much does hydrostatic pressure increase each cm below the heart: .77 mmHg
  17. explain why they say "dont lock your knees", so you dont get dizzy or ill in prolonged standing:
    • due to low pressure must also utilize muscle contraction
    • -gastroc/soleus contraction gives 200 mmHg (calf rasies)
    • -relaxation pressure falls to 10-30 mmHg
    • muscle contraction is primary factor allowing propulsion of blood and lymph
    • must over come gravity: increase pressure back to the heart
  18. list 4 reasons for venous insufficiency:
    • venous valves prevent backflow of blood thus moving fluid toward the heart
    • lack of activity or valve dysfxn (degeneration or obstruction leads to edema
    • bedrest, prolonged sitting, sedentary liftstyle
    • phlebitis- most common cuase of insufficiency
    • -thicking of walls
    • -damage to valves allow 2 way motion thus increasing HP
    • -exacerbated by gravity
  19. the lymphatic system acts as an accessory channel to return fluid to circulatory system.

    the system of vessels and nodes (filter) throughout body

    Where does the R UE drain to:

    all other areas in the:
    • Where does the R UE drain to: R subclavian vein
    • all other areas in the: thoracic duct and L subclavian

    • fluid flows into lymph system secondary to OP
    • decreased plasma protein particularly albumin causes dysfxn
  20. what is the primary cause of lymphedeam:

    what is the 2ndary cause:
    • primary: congenital disorder of system
    • 2ndary: due to other diseases or dysfxn
    • -flow impaired by blockage or insufficiency
    • -causes: inflammation, pregnancy, radiation, trauma, surgery, tumor, valve dysfxn, or removal of nodes 2ndary to cancer
  21. list 7 consequences of lymphedema:
    • reduced ROM
    • fxn'al limition
    • pain
    • tissue fibrosis due to high protein and increased collagen
    • increased risk of infection 2ndary reduced oxygenation and protein rich environment for bacterial growth
    • cellulitis, ulceration and amputation
    • sign: dermatitis, brown pigmentation, commonly on medial lower leg
  22. slow moving blood allows coagulation and formation of:

    when is this most common:
    • deep vein thrombosis
    • occurs when circulation is poor or inflammation of vein

    • most common when:
    • old age
    • trauma, nursing home, cancer, prior DVT, varicose veins, pralysis, oral contraceptive, pregnancy, hormone therapy
  23. how is DVT commonly tx'ed:
    • prophylactic compression stocking (TEDs)
    • intermittent compression
    • heparin
  24. how much pressure do TEDs exert:

    what does this clincially mean:
    • 16-18 mmHg
    • clinically: 16-18 mmHg is less pressure than what is already happening in the venous system, so there is a minimal increase in pressure
  25. list the 4 mechanisms of compression that indication used of compression for venous stasis ulcers:
    • improve venous circulation
    • increase oxygenation
    • alter white cell adhesion
    • reduce edema
  26. list the 4 mechanism of compression that indicate the used of compression for residual limb shaping:
    • reduces postsurgical edema
    • reduces stretching of soft tissue
    • shapes limbs for protehesis fitting and development of weight bearing strcutures
  27. a common complication of deep burns and soft tissue injury, characterized by un-pliable, have raised edgeds, and loss of identity of skin layers are called:
    hypertrophic scars
  28. list the 6 mechanisms of compression that indicate the use of compression for hypertrophic scars:
    • shape scar and act as mold
    • decrease local edeam
    • improved collagen orientation
    • increase collagenase activity: not O2 dependent
    • decreased O2/hypoxia
  29. pressure that is exerted by elastic bandages (high stretch or long stretch bandage) is called:
    resting pressure
  30. list 7 characteristics of resting pressure:
    • stretch by 100-200%
    • pressure exerted regardless of movement
    • extra gauze may be used around bony prominence to even pressure
    • provides 60-70 mmHg pressure with no working pressure
    • most effective in immobile or pts with paralysis
    • ace wrap, tubigrip
  31. pressure produced by muscles working against more inelastic bandages (short stretch bandage) is called:
    working pressure
  32. list 3 characteristics of working pressure:
    • have low resting pressure and low elasticity (30-90% elasticity)
    • low resting pressure higher pressure with muscle activity thus more appropriate with activity
    • may have components of resting and working pressure thus get compression at rest with activity
  33. a bandage that is impregnated with zinc oxide, and is soft and moldable when wet then hardens is called:

    what is this typically used to tx:
    • unna's boot
    • tx's: venous statis ulcers

    • typicall left on 1-2 weeks
    • 35-40 mmHg presssure
  34. list the following the the application techniques of compression:

    3:1 on/off ratio for ... acute/chronic
    never exceed:
    time:
    • 3:1 ratio
    • acute: 60 sec on/20 sec off (longer pressure to keep swelling from escaping the vessel)
    • chronic: 30 sec on/10 sec off (getting things pumped out of area)

    • never exceed: diastolic BP
    • time: 2-3 hours
  35. intermittent pneumatic compression (IPC) for tx'ing nveous leg ulcers (article review)

    results for IPC plus dressing compared with dressings alone:
    more people healed in IPC than in dressings alone (25/40 62.5% compared with 11/40 27.5%)
  36. intermittent pneumatic compression (IPC) for tx'ing nveous leg ulcers (article review)

    results for IPC plus continuous compression compared with continuous compression alone:
    • 1 trial showed significant difference with IPC
    • 3 trials showed no significant difference
  37. intermittent pneumatic compression (IPC) for tx'ing nveous leg ulcers (article review)

    IPC compared with continuous compression (stockings or bandages)(Teds)
    • no significant difference in healing rates
    • smalller sample size
  38. intermittent pneumatic compression (IPC) for tx'ing nveous leg ulcers (article review)

    comparison of different IPC regimins:
    rapid IPC heals faster than slowe IPC


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