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Health Promotion - Final > 3: Lymphedema > Flashcards

3: Lymphedema Flashcards

1
Q

What is the definition of lymphedema?

A
  • Chronic disease
  • Increased collection of lymphatic fluid causing swelling
  • Leads to skin and tissue changes
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2
Q

What are the two classifications of lymphedema?

A
  1. Primary/Genetic
  2. Acquired/Secondary
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3
Q

What are the six components of lymph?

A
  1. WBC
  2. Triglycerides
  3. Bacteria
  4. Cell debris
  5. Water
  6. Protein
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4
Q

What are typical symptoms of lymphedema?

A
  • Distal swelling
  • Proximal swelling
  • Decreased ROM
  • Skin discoloration
  • Pain and altered sensation
  • Limb heaviness
  • Difficulty fitting into clothes
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5
Q

What are the three subtypes of primary lymphedema?

A
  1. Congenital
  2. Lymphedema praecox
  3. Lymphedema tarda
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6
Q

Describe congenital primary lymphedema

A

Present at birth or recognized within two years

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7
Q

Describe lymphedema praecox

A

Occurs at puberty through the start of the third decade

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8
Q

Describe lymphedema tarda

A

Begins after age 35

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9
Q

What is the general cause of secondary lymphedema?

A

Injury or obstruction of the lymphatic system

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10
Q

What is the most common cause of secondary lymphedema worldwide?

A

Infection - wuchereria bancrofti

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11
Q

How does lymphedema develop from infection?

A

Parasitic infestation in the lymph nodes due to mosquito bites

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12
Q

What is the second most common cause of secondary lymphedema?

A

Malignancy or related treatments - breast cancer specifically

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13
Q

What is the incidence of primary lymphedema?

A

1/100,000

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14
Q

What is the incidence of secondary lymphedema in women with breast cancer?

A

20%

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15
Q

What % of people with head and neck cancer develop lymphedema?

A

90%

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16
Q

What % of women treated for gynecologic cancer develop lymphedema?

A

37%

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17
Q

What are important questions to include in you history related to lymphedema?

A
  • Duration of swelling
  • Distribution
  • Past infection
  • International travel
  • Cancer
  • Liver or cardiac dysfunction
  • Prior surgery
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18
Q

Describe how lymphedema presents in the initial stages?

A
  • Resembles general edema,
  • Pitting is present
  • Skin is soft
  • Elevation will resolve swelling
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19
Q

Describe how lymphedema begins to progress?

A
  • Pitting no longer visible
  • Skin hardening
  • No change with elevation
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20
Q

What are the 4 key lymphedema symptoms?

A
  1. Edema in extremity
  2. Hyperkeratosis
  3. Lymphangioma
  4. Lymphorrhea
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21
Q

What is hyperkeratosis?

A

Skin thickening and scaly presentation

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22
Q

What is lymphangioma?

A

Small bumps and blisters on the skin

23
Q

What is lymphorrhea?

A

Leakage of lymph fluid from skin

24
Q

What is Stemmer’s Sign?

A

Inability to pinch a fold of skin at the second toe

25
Q

When will Stemmer’s Sign be present?

A

Develops after stage 1

26
Q

What are the two components of a physical exam for lymphedema?

A
  1. Size of limb
  2. Imaging
27
Q

What difference in limb size is considered to be mild or moderate?

A

< 20%

28
Q

What difference in limb size is considered to be severe?

A

> 20%

29
Q

What are the four types of diagnostic imaging for lymphedema?

A
  1. Lymphscintigraphy
  2. MRI
  3. CT
  4. Ultrasound
30
Q

What are 6 treatment options for lymphedema?

A
  1. Decongestive lymphedema therapy
  2. Manual lymph drainage
  3. Compression
  4. Skincare
  5. Exercise
  6. Surgery
31
Q

What is decongestive lymphedema therapy (DLT)?

A

Moderate to severe lymphedema to mobilize lymph and dissipate fibrosclerotic tissue

32
Q

What is manual lymph drainage (MLD)?

A

Lymph massage to increase lymphatic flow

33
Q

Describe compression to treat lymphedema?

A
  • Assists with drainage
34
Q

What are two risks of compression as a treatment for lymphedema?

A
  • Skin irritation
  • Increased risk of infection
35
Q

Why is skincare important in lymphedema management?

A

Secondary infection prevention

36
Q

Why is exercise important for lymphedema treatment?

A

Promotes lymph drainage and protein absorption vis muscle contraction

37
Q

What are the 4 stages of lymphedema?

A

0 = Latency Stage
1 - Spontaneous
2 = Spontaneously Irreversible
3 = Lymphostatic Elephantiasis

38
Q

Describe Stage 0

A

At risk for lymphedema due to injury or lymph vessel but lack clinical signs of lymphedema

39
Q

What patients are in Stage 0?

A

Pts with breast cancer who have undergone biopsy or radiation that

40
Q

Why are patients in Stage 0 at risk for developing lymphedema?

A

Decreased lymph transport predisposing patient to lymphatic overload and resultant edema

41
Q

How should you monitor pt’s in Stage 0?

A

Volumetric measures repeated every 3 months for the first year - then twice a year for up to 5 years

42
Q

What are interventions for Stage 0?

A
  • Education
  • Self massage
  • Compression garments
  • Complete Decongestive Therapy
43
Q

What exercises are Grade A recommendations for Stage 0?

A
  • Progressive resistance training
  • Individualized aerobic exercise program
  • Monitor for exercise tolerance and adverse effects weekly
44
Q

What are the three characteristics of Stage 1?

A
  • Reversible
  • Pitting edema
  • Swelling is soft and will respond to elevation
45
Q

What interventions are Grade A recommendations for Stage 1?

A
  • Compression garment fitting
  • Exercise program
  • Education
46
Q

What interventions are recommended for Stages 2 and 3?

A
  • Manual drainage
  • Compression
  • K tape
  • Self care management
  • IPC
  • Laser
47
Q

What are the characteristics of Stage 2?

A
  • Tissue fibrosis/induration
  • No change with elevation
  • Skin and tissue thickening occurs as limb volume increases
  • Pitting may be present but difficult to assess due to fibrosis
48
Q

What are the characteristics of Stage 3?

A
  • Pitting edema
  • Fibrosis
  • Skin changes
  • Papillomas, infection, cellulitis, dry skin
49
Q

Describe massage for lymphedema?

A

Start proximal and work distal

50
Q

How should exercise be designed for lymphedema?

A

Proximal to distal exercises incorporating diaphragmatic breathing to improve volume reduction

51
Q

Is yoga effective for limb volume reduction?

A

No, but it is safe

52
Q

What is the prognosis for lymphedema?

A
  • No cure
  • Treatment focused to lessen disease progression and prevent complications
53
Q

What should be included in pt education?

A
  • Self massage
  • Infection prevention
  • Exercise
  • Weight control
  • Compression
54
Q

What two things are contraindicated with lymphedema?

A
  1. Venipuncture in affected extremity
  2. BP measures on affected extremity

Health Promotion - Final (4 decks)

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