Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PT 220 > Kisner ch 25 lymphatic disorders > Flashcards

Kisner ch 25 lymphatic disorders Flashcards

1
Q

What is the primary function of the lymphatic system?

A

collect and transport fluid from interstitial spaces back to the venous circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can cause lymphatic dysfunction?

A

congenital or hereditary abnormality , trauma, infection, treatment for cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What occurs when the lymphatic system is comprised either by impairment of lymphatic structures orby an overload of lymphatic fluid?

A

swelling in the tissue spaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What occurs if the lymphatic system is comprised and does not function efficiently?

A

lymphedema develops & impedes wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is lymphedema?

A

excessive and persistent accumulation of extravascular and extracellular fluid & protein in tissue spaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does lymphedema occur?

A

lymph volume exceeds the capacity of the lymph transport system associated w/ a disturbance of the H2O & protein balance across capillary membranes. An increase of proteins draws larger amounts of H2O into interstitial spaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What system can load the lymphatic system over its capacity and lead to lymphedema?

A

cardiopulmonary system can overload the lymphatic system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the lymphatic system in terms of physiology

A

open system, lymphatic capillaries situated close to blood capillaries pull fluid into the lymphatic circulation, once in the system fluid to lymph nodes to lymph trunks to venous angles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where are the largest groups of lymph nodes located?

A

head, neck, around intestines, axilla and groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What comprises the lymphatic fluid?

A

water & protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the lymphatic load and capacity?

A

load= fluid transported capacity = amount the system can handle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

True or False. An increased lymphatic load or a decreased lymphatic capacity can cause lymphedema?

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause increased lymphatic load ?

A

venous insufficiency b/c the venous system is unable to transport the required amount of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can cause a decrease in transport capacity of the lymphatic system?

A

it can be affected w/ pt’s suffering from cancer were the lymph nodes are removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the types of lymphedema?

A

primary (inherent problem), secondary (injury to structures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe primary lymphedema

A

uncommon, result of insufficient development (dysplasia) & congenital formation of the system, affects more females than males, often in the extremities LE than UE if not treated can cause skin changes (hyperkeratosis), increased skin folds & skin creases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the types of primary lymphedema divided by age?

A

congenital- “milroy’s diease” present at birth
praecox- (early) develops b4 35yr
tarda- develops after 35yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe 2ndary lymphedema:

A

most common!, due to comprehensive management of cancers (breast, pelvis, abdomen) caused by injury to the lymphatic structures (surgery, inflammation/infection, obstruction or fibrosis, combined venous-lymphatic dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why may there be a surgical dissection of the lymph nodes?

A

it is a treatment of a primary malignancy or metastatic disease (ex: axillary lymph nodes in breast cancer to determine extend of the cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can cause inflammation of the lymph vessels (lympphagitis) or lymph nodes (lymphadentitis) & enlargement of lymph nodes (lymphadenopathy)?

A

can be a result of a systemic infection or local trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe dependent peripheral edema

A

long periods of sitting or standing causes an accumulation of fluids in the peripheral aspects of the limbs, edema decreases if the limbs is elevated, dull or tiredness in the affected extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can chronic venous insufficiency & varicose veins cause lymphatic dysfunction?

A

b/c they are associated w/ venous statis & accumulation of edema in extremities, over tie the lymphatic system begins to lose efficiency w/ increased workload imposed leads to mixed edema results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is indicated when a pt w/ lymphedema has a clear, yellow tinged fluid thicker than vascular fluid leaking out of their pores?

A

the fluid has increased viscosity b/c of increased protein and signals a SEVERE condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe pitting edema and its severity level of lymphedema

A

1st level, pressure eon edematous tissue causes an indentation of the skin that persists for several seconds after the pressure is removed. demonstrates short term edema w/ no fibrotic changes in skin or subcutaneous tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe drawing edema and its level of severity

A

2nd level, feel hard w/ palpation, reflects more severe form of interstitial swelling w/ progressive fibrotic changes in subcutaneous tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

describe weeping edema and its level of severity

A

most severe and long duration form of lymphedema, fluid leaks from cuts or sours, wound healing is significantly impaired, almost exclusive to LE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does increased weight and girth of the affected limb affect the skin?

A

w/ increased volume and girth the skin becomes more taught and susceptible to breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the possible sensory disturbances lymphedema can cause?

A

paresthesia (tingling, itching, numbness) or occasionally mild, aching pain maybe felt in the fingers or toes but most of the time the pt only perceives the heaviness of the limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Name the stages of lymphedema and which stages has the greatest possibility for reducing the onset of worsening lymphedema

A

stage 0- latency stage, stage 1- reversible stage, stage 2-spontaneously irreversible, stage 3- lymhostatic elephantiasis
(((stage 0 may reduce onset of lymphedema)))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Associate the stages of lymphedema the type of edema (severity)

A

stage 1- soft or pitting edema, stage 2-brawny edema, stage 3- possibly weeping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

In what stages of lymphedema has a positive stemmer sign?

A

stage 2 , 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

describe stage 2 lymphedema

A

spontaneously irreversible, fibrosis of the tissue, brawny edema, welling is no longer pitting, positive stemmer sign, frequent infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

describe stage 3 of lymphedema

A

positive stemmer sign, increased limb volume, typical skin changes noted (hyperkeratosis, papillomas, deep skin folds, bacterial & fungal infections of the skin & nails

34
Q

What objective measures should be taken of the effected limb?

A

integrity of the skin, location of edema, w/ the limb in a dependent position palpate the skin to determine type & severity of lymphedema, describe thickness & density of tissue, describe ares of pitting, brawny or weeping edema, color of skin (usually shiny & red)

35
Q

True or false?tenderness may or may not indicate ongoing infection or serious disease when palpating lymph nodes

A

true but warm, enlarged, tender, painless or adherent nodes should be reported to a dr.

36
Q

What is a positive stemmer sign?

A

If the skin on the dorsal surface of the fingers or toes cannot be pinched or is difficult to pinch compared w/ the uninvolved limb. it can indicate a worsening condition

37
Q

How does bioimpedence measure extracellular fluid in the edematous limb?

A

using electrical current the more extracellular fluid the more resistance the flow. must be done pre and post surgery

38
Q

Can lymphedema be cured?

A

no, treatment is used to hopefully return lymphedema to latency stage

39
Q

What is the overall objective of management of lymphedema?

A

improve drainage of obstructed areas and theoretically to channel fluids into more centrally located lymph structures to carry the fluid to the venous system

40
Q

How can interstitial pressure increase help the lymphatic system?

A

external forces that cause an increase in interstitial pressure help increase the uptake of fluid, increase lymph production as more fluid enters the lymphatic system and increase resorption of fluid by the venous system

41
Q

In what stage of lymphedema can elevation assist fluid return ?

A

stage 1

42
Q

Describe how dynamic pressure changes in the body can assist in lymphatic flow

A

diaphragmatic breathing or w/ muscle contractions can chang intrathroacic pressure and cause in uptake of lymph fluid in lymphatic trunks and ducts, active muscle contractions changes pressure in localized area

43
Q

what are the 2 phases of treatment for lymphedema?

A

phase I intensive treatment goal is reduction, phase 2 is maintenance phase goal is long term management

44
Q

What is manual lymphatic drainage (MLD)?

A

type of drainage that involves slow, very light repetitive stroking & circular massage movements done in a specific sequence w/ the involved extremity elevated whenever possible, proximal congestion is cleared first to make room for fluid from the more distal areas , direction of massage is toward specific lymph nodes and usually involves distal to proximal stroking

45
Q

exercise can be performed wearing a …..?

A

compressive garment or bandage

46
Q

During phase I of treatment what type of bandages are used when can it be worn?

A

low stretch bandages (no ace wraps), low resting pressure the bandage can be worn day & night , padding can be used in combination w/ foam ads to aid in softening and reduction of fibrotic tissue

47
Q

What bandages are recommend for phase 2of lymphedema treatment?

A

transition from low stretch bandage to high resting pressure and low working pressure compression garment, used to maintain limb size during the day but pt should wear low stretch at night or times of inactivity

48
Q

Describe the mmHg for garment compression and their indication for use

A 
class 1 20-30mmHg mild lymphedema, use UE, pt w/ fragile skin (elderly)
class 2 30-40mmHg most commonly for stage 2 lymphedema, UE min compression for LE
class 3 40-50mmHg typically stage 2 LE
class 4 50-60 mmHg rarely used, only for LE, custom made garments
49
Q

What is the criticism of compression therapy w/ a pneumatic compression pump as a type of compression therapy?

A

it pumps fluid in a distal to proximal sequence, which is the opposite of manual lymphatic drainage (massage)

50
Q

Lymphedema predisposes the pt skin to ..?

A

skin breakdown, infection, delayed wound healing

51
Q

Axillary dissection and exposure to radiation is associated w/ the degree of risk for lymphedema and is most likely a treatment for?

A

breast cancer

52
Q

In addition to the effects of lymph node removal and radiation therapy that in term causes fibrosis tissue what else can be impaired as the result of incisional pain, delayed wound healing and skin ulcerations?

A

should motion and weakness of the muscles of the shoulder girdle

53
Q

What is a mastectomy?

A

removing the entire breast, may involve removing fascia over the chest muscle, even removal of the pectoralis muscle w/ invasive breast cancer, leads to muscle weakness and impaired shoulder function

54
Q

What is a lumpectomy?

A

also known as segmental mastectomy; involves excision of the mass & margin of healthy surrounding breast tissue

55
Q

True or false? currently the axillary lymph nodes is dissected a standard part of a mastectomy to determine disease presence.

A

false, currently the sentinel lymph node biopsy is used to determine disease presence in the axilla, therefore sparing the removal of uninvolved lymph nodes when possible

56
Q

Where is the incision located for breast cancer treatment (mastectomy or lumpectomy)?

A

transverse incision across the chest wall

57
Q

Are there any postoperative vascular and pulmonary complications following breast cancer treatment

A

decreased activity & extended time in bed increase venous statis and risk of DVT, increased risk of pulmonary complications such as pneumonia, incisional pain makes the pt reluctant to cough or breathe deeply

58
Q

What can chest wall adhesion lead to following breast cancer surgery?

A

post-operative pulmonary complications, restricted mobility of the shoulder, postural asymmetry & dysfunction & discomfort in the neck, shoulder girdle and upper back

59
Q

What muscles are often tender to palpate and can restrict active shoulder motion post breast cancer surgery

A

levator sacpulae, teres major & minor, infraspinatus

60
Q

What is lymphatic cording or axillary web syndrome (AWS) and what causes it?

A

common in pts treated for breast cancer, caused by interruption of the lymphatics in the axilla following a sentinel lymph node biopsy or axillary dissection w/ resulting thrombosis of lymphatic channels, “cords” that are visible w/ shoulder abduction extend from axilla distally to the antecubital space into the forearm. Can be painful & limit ROM in UE

61
Q

What are some factors that contribute to impaired shoulder mobility after breast cancer surgery ?

A

incisional pain, muscle guarding, fibrosis of soft tissues, adhesions, weakness of shoulder girdle muscles, rounded shoulders/kyphotic trunk posture, decreased use of UE function for ADLs, axillary web syndrome

62
Q

If the long thoracic nerve is traumatized during axillary dissection and removal of lymph nodes what muscles maybe weak or compromised?

A

serratus anterior and compromised stability of the scapula, limiting active flexion and abduction of the arm

63
Q

Faulty shoulder mechanics and use of substitute motions w/ the upper trap and levator scap during overhead reaching can cause what shoulder pathology? That can be a precursor to frozen shoulder

A

it can cause subacromial impingement and shoulder pain

64
Q

What type of psychological effects does breast cancer have on the pt?

A

anxiety, agitation, anger, depression, sense of loss, significant mood swings

65
Q

To minimize postoperative swelling, what are some possible pt interventions?

A

elevation of the involved UE on pillows abt 30degrees , squeeze a ball on the operative side to produce a pumping action in the muscles **avoid static, dependent positioning of the arm ***

66
Q

Why is shoulder motion performed w/in protected ROM, usually no more than 90 elevation of the arm post breast cancer surgery?

A

surgical drains are still in place

67
Q

What are some possible post operative risks following breast cancer surgery?

A

pulmonary complications, thromboemboli, lymphedema, loss of shoulder mobility

68
Q

What 3 areas should a post operative exercise program focus on (breast cancer)?

A

improve shoulder function, regain an overall level of fitness, reduce the risk of or manage lymphedema

69
Q

List some exercise precautions during the treatment of breast cancer:

A

exercise only at moderate levels (never to the pt that the extremity feels heavy even w/o lymphedema), adjust exercise timing during cycles of radiation or chemotherapy, avoid exercise 1-2 after blood drawn, be aware of blood counts (wbc, hemoglobin, platelet counts)

70
Q

Why are programming considerations needed for a pt undergoing chemotherapy for breast cancer?

A

the drugs can cause peripheral neuropathy, proximal muscle weakness, differing fatigue patterns; exercise should be progressed gradually and excessive fatigue should be avoided

71
Q

What are some recommendations for exercise for pt w/ breast cancer ?

A

integrate ROM, flexibility, strengthening exercises, implement posture awareness training, moderate intensity aerobic conditioning, progress all forms of exercise gradually, teach pt parameters based on individual condition/surgery

72
Q

What is the reasoning to incorporate deep breathing and relaxation exercises into the exercise routine w/ a pt suffering from lymphedema ?

A

abdominal-diaphragmatic breathing assists in the movement of lymphatic fluid as the diaphragm descends during a deep inspiration & the abdominals contract during a controlled max expiration. changes in intra-abdominal pressures creates a pumping action that moves fluids in the central lymphatic vessels and drain into the venous system in the neck

73
Q

Why are flexibility exercises incorporated for the management of lymphedema?

A

help minimize soft tissue and joint hypomobility particularly in proximal areas

74
Q

What is the recommended mode, frequency and duration of cardiovascular conditioning exercises for the management of lymphedema?

A

aerobic (UE ergometry, swimming, cycling , walking), 30 min , 40-50%HRR

75
Q

What is the purpose of lymphatic drainage exercises?

A

move fluids through lymphatic channels proximal areas first then distal

76
Q

What can the pt incorporate during lymphatic drainage exercises to further enhance lymph drainage?

A

self massage into the exercise sequence

77
Q

What should the pt start w/ before beginning UE or /LE lymphatic exercises?

A

deep breathing & total relaxation, ppt & partial curl up, cervical ROM, bilateral scapular movements

78
Q

What are some examples of UE exercises prescribed for lymphedema management?

A

bilateral movements of arms while on FR, shoulder stretches (towel, doorway, wand), active elbow,forearm,wrist exercises of involved arm, bilateral h.abd & add GH joint , overhead press while standing, finger exercises, partial curl ups, @ the end rest w/ involved UE elevated

79
Q

List lower extremity exercises prescribed for the management of lymphedema

A

unilateral/bilateral knee to chest, glut sets, ppts, ER of hips while supine w/ both legs elevated on wall or wedge, supine heel slides, supine ankle ROM, supine cycling, scissoring movements w/ legs elevated, bilateral knee to chest followed by partial curl up , @end rest w/ LE elevated

80
Q

What is the sequence of self massage after general lower body, neck, shoulder exercises?

A

self massage first to axillary lymph nodes on the involved side of the body , then massage the lower abdominal area superiorly to the waist & laterally & superiorly to the axillary area of the involved side

PT 220 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions