day seven: lympthedema Flashcards
lymph nodes are known as
“filtering stations”
lymph nodes fx:
produce WBC, regulate proteins in lymph
lymph vessels fx:
intrinsic contractions 6-10 x / minutes
list all the anatomy parts of the lymphatic systems :
- lymph nodes
- lymph vessles
- thymus gland
- spleen
- tonsils
- peyer’s patches
four things in a lymp vessel:
capillaries
pre-collectors
collectors
trunks
mechanisms of transportation inside the lymp system:
instrinic contraction respiration arterial / venous pulsation skeletal movement new lymph (creates pressure)
lymph fluid consists of
PROTEINS: water Cells waste products foreign substances fat
bodys move how much lymph a day?
2.-2.5 L
fluid moves through what/
pressure gradients
filtration =
resorption + lymph flow
lymphatic load abb
LL
lymphatic load def:
how much water proteins, cells, etc
lymph time volume abb
LTV
lymph time volume def:
amplitude and frequency fo intrinsic contractions
transport capacity abb
Tc
transport capacity def:
MAX LTV
10x LL in intact system
functional reserve abb
FR
functional reserve def:
difference between TC & LL
normal lymph ratio:
LL < TC
dynamic insufficiency:
overloaded lymphatic system:
- venous insuffiency, cardiac edema DVT
mechanical insufficiency:
lympathic system damaged
- surgery trauma, radiation , etc
- lymphedema always includes mechanical insufficiency
lymphedema always includes what insufficiency?
mechanical
combined insufficiency:
damaged systems and overload
- obesity
CVI
- lipedema
lymphedema def:
an abnormal collection of protein rich fluid in the interstitium which causes chronic inflammation and reactive fibrosis of the affected tissues
- the lymph load exceeds the total capacity of the system
lymphedema prognosis:
there is no cure
- early detection and management and patient ability to self manage yield a good prognosis
if left untreated lymphedema will end in
elephantiasis
primary lymphedema:
mechanical insufficiency of the lymphatic system
- malformation of lymphatic vessles
- congenital or heredity
secondary lymphedema
known cause of lymph
ie: surgery radiation trauma
early s/s of lymphedema:
limb feels heavy skin feels tight limb is achy (not painful) clothing or jewelry is tight can't see wrinkles in skin
stages of lymphedema:
latency
stage 1
stage 2
stage 3
latency stage:
no visible/ palpable edema subjective complaints possible
stage 1:
reversible (elevation, pitting edema often present increased limb girth and heaviness no fibrosis
stage 2
consistent swelling - does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult
stage 3:
lymphocytic elephantiasis, non pitting, fibrosis and sclerosis, skin changes (hyperkeratosis0
lichenification will be
leathery and hard
peau d’orange texture
skin will look like orange pulps because the CSF is leaking out of inflamed hair follicles enlarging them and giving them an orange tint
an infection is a
MEDICAL EMERGENCY
medications for lymphedema
no evidence of any medication that aids in treating lymph
surgeries for lymphedema
no surgeries currently can cure lymphedema
can get a lymph node transplant
debulking or liposuction
venography will rule out
venous problems
lymposcintigraphy is
a nuclear imaging method, tissue injection is transported by lymphatic system and allows assessment of superficial and deep lymphatics, no damage to lymph vessels
stemmers sign:
looks at thickening of skin on the dorsal hand / foot
inability to pinch skin in these areas
CDT is
complete decongestive therapy
MLD is
manual lymphatic drainage
CDT involves:
MLD compression bandaging exercise skin care self care and risk reduction / education
effects of CDT:
decrease swelling by ore than 50%
increase lymph drainage from congested areas
improve skin conditions
improve patients function, quality of life
reduce risk of infection
two phases of CDT are:
reductive phase
maintenance phase
reductives phase is
daily 5x/week treatments until fluid reduction has plateaued
bandages stay on how long in reductive phase?
all the time until you are back for the next appointment
maintenance phase
self management program
replacements of compression garments in the maintence phase happens
every 4-6 months
diaphragmatic breathing:
encourage deep breathing to allow diaphragm move and stimulate lymph nodes in abdomen
MLD fx
increases the movement of lymph/ interstitial fluid, including proteins
MLD improves:
lymph transport capacity, lymph vessel contractility
stretching of the skin affects the
superficial lymph vessels
pressure phase promotes:
fluid movement in a desired direction
relaxation phase causes
a vacuum due to the distention of the tissue and leads to refilling of the lymph vessels
MLD sequencing:
clear proximal regions and nodes
move segmentally
always stretch from distal to proximal
compression bandaging improves
efficiency of muscle pump
compression bandaging prevents
re-accumulation of evacuated fluid
compression bandaging facilitates
softening of fibrotic tissue
compression bandaging def:
non-stretch cotton tubular layer on skin to wick moisture away and protect skin
short stretch is
low elastic bandages provide low resting pressure (allows lymphatics to fill) and high working pressure (improves muscle pump)
where do you start with compression bandaging?
distal
when do you start distal?
with compression bandaging
where do you start with MLD
proximal - trunk
when do you start proximal?
MLD
where do you add the most layering for compression bandaging
distally
what does increase compression distally do?
creates a graduated pressure in the limb
remedial exercise should start with what though
diaphragmatic breathing
when do you want to do remedial exercise
when limb reduction is a goal
remedial exercise def:
active repetitive, non resistive motion; clear proximal then work distal to proximal (ROM / flexibility)
you should do exercise with
compression
pay attention to feelings of _______ with exercise
heaviness, increased swelling
what two types of exercises are beneficial to lymph
resistance
aerobic
with exercise you should always
start slow and be cautious
what should you do with a sign of infection
CALL PHYSICAN OR TO THE ER
prevention of increase lymph include:
pt education skin care exercise maintain proper weight/ nutrition - avoid anti-inflammatory / DRINK WATER
compression garments are designed to
MAINTAIN limb size, not reduce it
when should you not wear a compression garment
at night
class 1 compression grade:
20-30 mm HG
class 1 is
beginning pressure arms
class 2:
30-40 mm Hg
class 2 is
ideal pressure legs
class 3
40-50 mm Hg
