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INTRODUCTION

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LEARNING OBJECTIVES

  1. Understand basic concepts about the anatomy, physiology, and pathophysiology of the vascular, lymphatic, and integumentary systems.

  2. Describe wound physiology as it relates to normal and abnormal wound healing.

  3. Recognize the characteristics and risk factors of common disorders of the vascular, lymphatic, and integumentary systems.

  4. Identify the components of a comprehensive examination of a patient with a disorder related to the vascular, lymphatic, and/or integumentary systems.

  5. Analyze and integrate wound examination data to complete the physical therapy evaluation.

  6. Interpret the rationale for skin and wound care treatment with particular attention to moist wound healing, arterial wound hydration, venous wound compression, lymphedema treatment, and foot care for the patient with diabetes.

  7. Design an appropriate plan of care for an individual with a vascular, lymphatic, and/or integumentary disorder.

  8. Using the case study example, apply clinical decision making skills to design a plan for advanced wound care.

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Patients and clients with disorders of the vascular, lymphatic, and integumentary systems have complex and often interrelated health problems to be understood before healing can occur. In recent years options for intervention have expanded significantly, providing the physical therapist with challenging and rewarding clinical treatments for clients. This chapter provides foundational material on which to build sound clinical decisions. Though interrelated, the systems discussed have unique characteristics and functions. This chapter facilitates understanding of the separate systems and then illustrates how the systems are intricately and essentially related. The elements of examination and the intervention strategies for all of the disorders are combined to ensure that the overlapping signs, symptoms, impairments, and activity limitations will be addressed and considered in the plan of care (POC). In this text, information about thermal injuries is complementary and supplemental to the information in this chapter (see Chapter 24, Burns).

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ANATOMY AND PHYSIOLOGY OF THE VASCULAR, LYMPHATIC, AND INTEGUMENTARY SYSTEMS

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In the microscopic world of circulation, blood and lymph vessels permeate most tissues, carrying oxygen and nutrients while removing carbon dioxide and wastes. Not all vessels involved are the "large tubes" so often associated with the circulatory system. Capillaries are woven throughout most of the tissues of the body, around muscle fibers, through connective tissues, and below the basement membrane of the epithelium.1 Since arteries and veins are too large and too thick to allow diffusion between the bloodstream and surrounding tissues, a delicate network of blood and lymph capillaries controls all chemical and gaseous exchange between blood, interstitial fluid, and lymph.1 In the normal system, homeostatic mechanisms adjust blood flow across the capillary walls to meet the needs of peripheral tissues. Every year, new information is uncovered that further elucidates the complexities of the circulatory system and how it interacts with the other systems of the body. It is important to have a clear understanding of the delicate vessels that carry blood to the peripheral tissues and the normal processes that occur there to gain insight into ...

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