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musculoskeletal exam two > day seven: lympthedema > Flashcards

day seven: lympthedema Flashcards

1
Q

lymph nodes are known as

A

“filtering stations”

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2
Q

lymph nodes fx:

A

produce WBC, regulate proteins in lymph

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3
Q

lymph vessels fx:

A

intrinsic contractions 6-10 x / minutes

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4
Q

list all the anatomy parts of the lymphatic systems :

A
  1. lymph nodes
  2. lymph vessles
  3. thymus gland
  4. spleen
  5. tonsils
  6. peyer’s patches
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5
Q

four things in a lymp vessel:

A

capillaries
pre-collectors
collectors
trunks

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6
Q

mechanisms of transportation inside the lymp system:

A 
instrinic contraction 
respiration 
arterial / venous pulsation 
skeletal movement 
new lymph (creates pressure)
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7
Q

lymph fluid consists of

A 
PROTEINS: 
water 
Cells 
waste products 
foreign substances 
fat
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8
Q

bodys move how much lymph a day?

A

2.-2.5 L

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9
Q

fluid moves through what/

A

pressure gradients

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10
Q

filtration =

A

resorption + lymph flow

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11
Q

lymphatic load abb

A

LL

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12
Q

lymphatic load def:

A

how much water proteins, cells, etc

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13
Q

lymph time volume abb

A

LTV

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14
Q

lymph time volume def:

A

amplitude and frequency fo intrinsic contractions

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15
Q

transport capacity abb

A

Tc

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16
Q

transport capacity def:

A

MAX LTV

10x LL in intact system

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17
Q

functional reserve abb

A

FR

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18
Q

functional reserve def:

A

difference between TC & LL

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19
Q

normal lymph ratio:

A

LL < TC

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20
Q

dynamic insufficiency:

A

overloaded lymphatic system:

- venous insuffiency, cardiac edema DVT

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21
Q

mechanical insufficiency:

A

lympathic system damaged

  • surgery trauma, radiation , etc
  • lymphedema always includes mechanical insufficiency
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22
Q

lymphedema always includes what insufficiency?

A

mechanical

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23
Q

combined insufficiency:

A

damaged systems and overload
- obesity
CVI
- lipedema

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24
Q

lymphedema def:

A

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

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25
Q

lymphedema prognosis:

A

there is no cure

- early detection and management and patient ability to self manage yield a good prognosis

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26
Q

if left untreated lymphedema will end in

A

elephantiasis

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27
Q

primary lymphedema:

A

mechanical insufficiency of the lymphatic system

  • malformation of lymphatic vessles
  • congenital or heredity
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28
Q

secondary lymphedema

A

known cause of lymph

ie: surgery radiation trauma

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29
Q

early s/s of lymphedema:

A 
limb feels heavy 
skin feels tight 
limb is achy (not painful) 
clothing or jewelry is tight 
can't see wrinkles in skin
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30
Q

stages of lymphedema:

A

latency
stage 1
stage 2
stage 3

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31
Q

latency stage:

A

no visible/ palpable edema subjective complaints possible

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32
Q

stage 1:

A

reversible (elevation, pitting edema often present increased limb girth and heaviness no fibrosis

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33
Q

stage 2

A

consistent swelling - does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult

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34
Q

stage 3:

A

lymphocytic elephantiasis, non pitting, fibrosis and sclerosis, skin changes (hyperkeratosis0

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35
Q

lichenification will be

A

leathery and hard

36
Q

peau d’orange texture

A

skin will look like orange pulps because the CSF is leaking out of inflamed hair follicles enlarging them and giving them an orange tint

37
Q

an infection is a

A

MEDICAL EMERGENCY

38
Q

medications for lymphedema

A

no evidence of any medication that aids in treating lymph

39
Q

surgeries for lymphedema

A

no surgeries currently can cure lymphedema
can get a lymph node transplant
debulking or liposuction

40
Q

venography will rule out

A

venous problems

41
Q

lymposcintigraphy is

A

a nuclear imaging method, tissue injection is transported by lymphatic system and allows assessment of superficial and deep lymphatics, no damage to lymph vessels

42
Q

stemmers sign:

A

looks at thickening of skin on the dorsal hand / foot

inability to pinch skin in these areas

43
Q

CDT is

A

complete decongestive therapy

44
Q

MLD is

A

manual lymphatic drainage

45
Q

CDT involves:

A 
MLD
compression bandaging 
exercise 
skin care 
self care and risk reduction / education
46
Q

effects of CDT:

A

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

47
Q

two phases of CDT are:

A

reductive phase

maintenance phase

48
Q

reductives phase is

A

daily 5x/week treatments until fluid reduction has plateaued

49
Q

bandages stay on how long in reductive phase?

A

all the time until you are back for the next appointment

50
Q

maintenance phase

A

self management program

51
Q

replacements of compression garments in the maintence phase happens

A

every 4-6 months

52
Q

diaphragmatic breathing:

A

encourage deep breathing to allow diaphragm move and stimulate lymph nodes in abdomen

53
Q

MLD fx

A

increases the movement of lymph/ interstitial fluid, including proteins

54
Q

MLD improves:

A

lymph transport capacity, lymph vessel contractility

55
Q

stretching of the skin affects the

A

superficial lymph vessels

56
Q

pressure phase promotes:

A

fluid movement in a desired direction

57
Q

relaxation phase causes

A

a vacuum due to the distention of the tissue and leads to refilling of the lymph vessels

58
Q

MLD sequencing:

A

clear proximal regions and nodes
move segmentally
always stretch from distal to proximal

59
Q

compression bandaging improves

A

efficiency of muscle pump

60
Q

compression bandaging prevents

A

re-accumulation of evacuated fluid

61
Q

compression bandaging facilitates

A

softening of fibrotic tissue

62
Q

compression bandaging def:

A

non-stretch cotton tubular layer on skin to wick moisture away and protect skin

63
Q

short stretch is

A

low elastic bandages provide low resting pressure (allows lymphatics to fill) and high working pressure (improves muscle pump)

64
Q

where do you start with compression bandaging?

A

distal

65
Q

when do you start distal?

A

with compression bandaging

66
Q

where do you start with MLD

A

proximal - trunk

67
Q

when do you start proximal?

A

MLD

68
Q

where do you add the most layering for compression bandaging

A

distally

69
Q

what does increase compression distally do?

A

creates a graduated pressure in the limb

70
Q

remedial exercise should start with what though

A

diaphragmatic breathing

71
Q

when do you want to do remedial exercise

A

when limb reduction is a goal

72
Q

remedial exercise def:

A

active repetitive, non resistive motion; clear proximal then work distal to proximal (ROM / flexibility)

73
Q

you should do exercise with

A

compression

74
Q

pay attention to feelings of _______ with exercise

A

heaviness, increased swelling

75
Q

what two types of exercises are beneficial to lymph

A

resistance

aerobic

76
Q

with exercise you should always

A

start slow and be cautious

77
Q

what should you do with a sign of infection

A

CALL PHYSICAN OR TO THE ER

78
Q

prevention of increase lymph include:

A 
pt education 
skin care 
exercise 
maintain proper weight/ nutrition 
- avoid anti-inflammatory / DRINK WATER
79
Q

compression garments are designed to

A

MAINTAIN limb size, not reduce it

80
Q

when should you not wear a compression garment

A

at night

81
Q

class 1 compression grade:

A

20-30 mm HG

82
Q

class 1 is

A

beginning pressure arms

83
Q

class 2:

A

30-40 mm Hg

84
Q

class 2 is

A

ideal pressure legs

85
Q

class 3

A

40-50 mm Hg

musculoskeletal exam two (6 decks)

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