EDEMA
What is Edema?
Local or Systemic swelling of our body
Fluid retention in the interstitial tissue spaces...
Fluid retention in the interstitial tissue spaces...
Causes
1. Increased permeability of the capillaries
2. Obstruction of the lymphatic flow
usually d/t...
Infection
Parasites in the lymphatic system
Lymphadenectomy
3. Increased capillary pressure or venous pressure
usually d/t...
HT failure
Thrombophlebitis
Pregnancy
Allergic response ie hives
4. Decrease of plasma protein
accompanying LIV and KID dz
high flow low protein edema
2. Obstruction of the lymphatic flow
usually d/t...
Infection
Parasites in the lymphatic system
Lymphadenectomy
3. Increased capillary pressure or venous pressure
usually d/t...
HT failure
Thrombophlebitis
Pregnancy
Allergic response ie hives
4. Decrease of plasma protein
accompanying LIV and KID dz
high flow low protein edema
Types of edema
1.Lymphedema
Systemic condition
affects the entire body
Local lymphatic obstruction
involves the whole limb distal to the edema site
2. Non-pitted edema
firm and discoloured
usually result from coagulation of serum protein in the interstitial spaces d/t local infection or trauma
3. Pitted edema (Boggy to touch)
usually found in chronic pathology
If you have patient with edema, what kind of question should you ask?
Overall health and surgery history
How did they get it?
Onset of edema?
Are they pregnant?
Have they had edema before?
Did they get checked by MD?
Hot to touch?
Redness?
Any OTC or Rx taking currently?
SE of medication?
Do they wear compression socks?
Provocative?
Palliative?
Where and what do you look for and palpate?
Where is it swollen? Any other area?
Colour
Temperature
Texture
Tone
Tenderness
Contraindication to treatment?
Full body lymphatic drainage
Local or distal techniques (b/o thrombophlebitis or deep vein thrombosis. They could cause embolism!)
Hydrotherapy
Any infection, Fever
Acute TB
Associated with AIDs
What is the treatment goals?
Reduce edema
Improve ROM
Decrease pain if there is pain
What are the steps of massage therapy?
Acute (Wrist edema as an example)
Elevate the wrist
Lymph drainage
Axilla >> Biceps >> Forearm
Diaphragmatic breathing during treatment
to facilitate lymphatic return.
Direction=proximal to distal
Tech= Effleurage, stroking
PROM of proximal and distal to the site of edema
Caution! Don't disturb hematoma if present
Maintain ROM
Cool to cold hydrotherapy
Prevent adhesion formation where appropriate
Lymphatic drainage from proximal to distal
Mid range PROM is used proximal and distal to the edema
Contraindication: Local lymph drainage is still
Cold to touch = warm application to flush out the tissue
Warm to touch = cool application
PROM to the joint proximal and distal to the edema
AROM of upper limbs
Both are for decreasing the swelling
Frequency of the treatment
Acute and Subacute
30 mins 3tx/week
Chronic
45mins 1tx/week
Improve ROM
Decrease pain if there is pain
What are the steps of massage therapy?
Acute (Wrist edema as an example)
Elevate the wrist
Lymph drainage
Axilla >> Biceps >> Forearm
Specific treatment for Acute Edema
Main goal is to reduce the swellingDiaphragmatic breathing during treatment
to facilitate lymphatic return.
Direction=proximal to distal
Tech= Effleurage, stroking
PROM of proximal and distal to the site of edema
Caution! Don't disturb hematoma if present
Maintain ROM
Specific treatment for Early subacute
Main goal is to Reduce painCool to cold hydrotherapy
Prevent adhesion formation where appropriate
Lymphatic drainage from proximal to distal
Mid range PROM is used proximal and distal to the edema
Contraindication: Local lymph drainage is still
Specific treatment for Late Subacute
Diaphragmatic breathing
Hydrotherapy: Cold/Warm contrast
As edema diminishes, duration of lymph drainage techniques decreases
If safe, increase PROM
Specific treatment for Chronic
Hydrotherapy - depending on tissue health and temperatureCold to touch = warm application to flush out the tissue
Warm to touch = cool application
PROM to the joint proximal and distal to the edema
Home care
Buerger's exercise to promote circulation (raising leg)AROM of upper limbs
Both are for decreasing the swelling
Frequency of the treatment
Acute and Subacute
30 mins 3tx/week
Chronic
45mins 1tx/week
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