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NPTE > Lymphatic > Flashcards

Lymphatic Flashcards

1
Q

Flow of lymph

A

Capillaries > collecting vessels > nodes > trunks > ducts > subclavian veins.

Mnemonic: CV? Not To Day.

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2
Q

Lymphatic Duct drains from…

A

RUE
R face

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3
Q

Thoracic Duct drains from…

A

LUE
BLE
L face

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4
Q

Lymphatic Load definition

A

amount of fluid that must be transported

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5
Q

Lymphatic Capacity definition

A

max amount of fluid the lymphatic system can transport

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6
Q

What happens to lymphatic Load & Capacity with lymphedema?

A

Load increases.
Capacity decreases.

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7
Q

Lymph node removal causes:
a) load increase
b) load decrease
c) capacity increase
d) capacity decrease

A

d) capacity decrease

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8
Q

Venous insufficiency causes:
a) load increase
b) load decrease
c) capacity increase
d) capacity decrease

A

a) load increase

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9
Q

Primary Lymphedema: definition & examples

A

Caused by a disorder of the lymphatic system.
Milroy’s Disease (age 0-2)
Meige Disease (age 10-20)
Lymphedema Tarda (age 35+)

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10
Q

Secondary Lymphedema: definition & examples

A

Results from an injury to the lymphatic system.
Lymph node removal.
Infections, tumors, trauma.
Venous insufficiency.
Fibrosis.
Filariasis (mosquito infection).

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11
Q

List the types of edema from least to most severe

A
  1. Pitting
  2. Brawny
  3. Weeping
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12
Q

Pitting Edema definition

A

Takes several seconds to rebound.
Little to no fibrotic changes.

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13
Q

Brawny Edema definition

A

Hard to palpation.
No pit forms w/ pressure.
Progressive fibrotic changes.

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14
Q

Weeping Edema definition

A

Typically affects LE only.
Cuts & sores form.
Fluid leaks out.

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15
Q

Stemmer’s Sign

A

Pinch & lift on the dorsum of fingers/toes.
(+) if skin cannot be pinched/lifted.
(+) indicates Stage 2 or 3 Lymphedema.

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16
Q

Is Stemmer’s Sign reversible? (i.e., once it’s positive, can it later be negative?)

A

NO

17
Q

Stage 0 Lymphedema

A

No edema, skin normal.
Stemmer’s (-).
Occasional reports of limb heaviness.

18
Q

Stage 1 Lymphedema

A

Pitting edema.
Stemmer’s (-).
Edema increases w/ standing or activity.
Edema decreases w/ elevation.

19
Q

Stage 2 Lymphedema

A

Hard edema (progresses to Brawny).
Stemmer’s (+) but may be (-) in early Stage 2.
Edema does NOT decrease w/ elevation.
Fibrosclerotic (hard) tissue.

20
Q

Stage 3 Lymphedema

A

Severe Brawny edema.
Possible Weeping edema.
Stemmer’s (+).
Skin changes, frequent infections.

21
Q

How is pitting edema graded?

A

Depth of pitting & time to rebound.

22
Q

Grade 1+ Pitting Edema

A

Depth: <1/4in

23
Q

Grade 2+ Pitting Edema

A

Depth: 1/4 to 1/2in
Time to rebound: 15s

24
Q

Grade 3+ Pitting Edema

A

Depth: 1/2 to 1in
Time to rebound: 15-30s

25
Q

Grade 4+ Pitting Edema

A

Depth: >1in
Time to rebound: >30s

26
Q

What is Lipedema? How is it different from Lymphedema?

A

Lipedema: bilateral & symmetrical, affects proximal LEs (buttocks, thighs). Feet less often affected. Stemmer’s (-) bc feet intact.
Lymphedema: usually unilateral; can be bilateral, but will still be asymmetrical.

27
Q

Methods of measuring edema

A

Girth: circumferences at landmarks 10cm apart along limb.
Volumetric: place limb in water tank.
Bioelectric Impedance: higher resistance = more fluid present.
Lymphoscintigraphy: tests for lymphatic insufficiency.

28
Q

Best way to measure PROXIMAL edema?

A

Girth

29
Q

Best way to measure DISTAL edema?

A

Volumetric

30
Q

Best way to measure PRE-POST SURGERY edema?

A

Bioelectric Impedance

31
Q

Palpating nodes: what’s NORMAL?

A

Soft
Non-tender
Non-palpable
<1cm

32
Q

Palpating nodes: what’s ABNORMAL?

A

Hard
Tender
Immobile/fixed
Persistent enlargement

33
Q

Complete Decongestive Therapy - Phase 1

A

Intensive Phase:
Manual Lymph Drainage (MLD).
Compression bandaging.
Skin & nail care.
Exercise.

34
Q

Complete Decongestive Therapy - Phase 2

A

Maintenance Phase:
Self-MLD.
Compression garments.
Multiple layer bandaging at night.
Skin & nail care.
Exercise.

35
Q

Manual Lymph Drainage

A

Work proximal to distal areas.
Stroking goes distal to proximal (towards specific nodes).

36
Q

What type of compression bandage should be used? Why?

A

Low-Stretch (AKA Short-Stretch).
Has high working pressure & low resting pressure.
High Working Pressure: provides resistance to force mm to work harder, pushes fluid into vascular system.
Low Resting Pressure: not much resistance at rest, so OK to wear at night.

37
Q

How should compression bandages be applied?

A

More pressure distally

38
Q

How to take blood pressure with lymphedema?

A

NEVER on affected extremity

39
Q

Exercise considerations

A

Proximal to distal: start w/ trunk, core, neck. Then progress to shoulder > elbow > wrist/hand.
Breathing exercises BEFORE proximal exercises (if breathing exercises included).
Lower intensity if wearing compression.
Aquatic/swimming good bc provides compression.

NPTE (28 decks)

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