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KN JD NPTE: CARDIAC > Lymphatic System > Flashcards

Lymphatic System Flashcards

1
Q

Lymphatic system is network of lymphatic vessels that withdraws excess ____ from body’s ____, filters through ____ ____, and returns it to bloodstream via _____.

A

Fluid (lymph)
Interstitial spaces
Lymph nodes
Venous system

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2
Q

Components

A 
Lymphatic vessels
Lymph fluid
Lymph nodes
Lymph tissues
Organs
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3
Q

Name the lymph nodes of the UE

A 
Supraclavicular
-Axillary
-Central
-Subscapular
-Pectoral
-Humeral
Cubital
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4
Q

Name the lymph nodes of the LE

A

Iliac
Inguinal
Popliteal

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5
Q

What are the other 2 lymph nodes (not UE or LE)?

A

Parasternal

Mesenteric

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6
Q

What are the lymph organs?

A

Spleen
Tonsils
Thymus
Bone marrow

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7
Q

Flow of lymph

A

Lymphatic capillaries > lymphatic vessels > large lymphatic ducts (R lymphatic due, thoracic duct) > subclavian veins

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8
Q

Lymphatic vessel contraction occurs by:

  1. ____ and ___ nerve stimulation
  2. Contraction of ___ ___.
  3. ___ and ___ cavity pressure changes during normal breathing
  4. Mechanical stimulation of ___ tissues
  5. ___ changes within individual lymph vessels
A 
Autonomic and sensory
Adjacent muscles
Abdominal and thoracic
Dermal
Volume
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9
Q

Lymphedema
Chronic disorder characterized by excess accumulation of lymph fluid due to ___ ___ of lymphatic system (____ of lymph flow or ____ of ___ ___).

A

Mechanical insufficiency
Obstruction
Removal of lymph nodes

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10
Q

Lymphedema
What happens to fluid volume?
What does this result in?

A

Volume exceeds transport capacity/capability of lymph vessels. Results in swelling of soft tissues of UE/LE.

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11
Q

What is primary lymphedema?

A

Congenital or hereditary disorder with abnormal lymph node or lymph vessel formation

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12
Q

What is secondary lymphedema?

A

Acquired insult to lymphatic system

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13
Q

When is secondary lymphedema seen? What are possible causes?

A

Most common: After surgery breast or cervical cancer

  • surgery, including lymph node removal
  • tumors, trauma, or infection involving lymphatic system structures
  • radiation therapy
  • chronic venous insufficiency
  • filariasis (parasitic infection of lymph system)
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14
Q

Stages of lymphedema:

Stage 0- at risk, swelling is ___ ___ ___ despite ___ transport capacity of system. Also called the ___ or ___ stage.

A

Not yet evident
Reduced
Latent
Pre-clinical

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15
Q

Stages of lymphedema:
Stage 1- ____, early accumulation of fluid with visible swelling; ___ edema that resolves with ____; _____ sign is negative

A

Reversible
Pitting
Elevation
Stemmer’s

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16
Q

Stages of lymphedema:

Stage 2- spontaneously ____; increase in swelling; ___ does not reduce swelling; (+) ____ ____

A

Irreversible
Elevation
Stemmer’s sign

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17
Q

Stages of lymphedema:

Stage 3- ______; fibrotic deep skinfolds; may change color; skin changes may limit ____

A

Elephantitis

Mobility

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18
Q

Differential diagnosis is ?

A

Lipedema

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19
Q 
Lipedema:
Excessive \_\_\_ \_\_\_ deposition
Appearance may be similar to \_\_\_\_\_
Normal function of \_\_\_\_ \_\_\_\_
\_\_\_\_ swelling of extremities
Negative \_\_\_ \_\_\_
Seen typically in \_\_\_\_
A 
Subcutaneous fat
Lymphedema
Lymphatic system
Symmetrical
Stemmer’s sign
Women
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20
Q

What is lymphadenopathy? What causes it?

A

Enlargement of lymph nodes, with or without tenderness

Usually from infection

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21
Q

Local vs generalized lymphadenopathy

A

Local is enlargement of nodes in 1 body segment, generalized is enlargement of nodes in 2+ body segments

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22
Q

What is lymphadenitis?

A

Lymphadenopathy accompanied by signs of inflammation (red, tender)

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23
Q

What is lymphangitis?

What does it appear as?

A 
Acute bacterial (often streptococcus) or viral infection that spreads throughout lymphatic system
Red streaks often seen in skin PROXIMAL to infection site
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24
Q

Known risk factors for lymphedema?

Primary

A

Primary (idiopathic): congenital abnormality— hypoplasia, hyperplasia, aplasia

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25
Q

Known risk factors: secondary (acquired) from known insult to lymphatic system
Most common from what kind of CA and what treatments?

A

Breast/cervical, lymph node removal or radiation therapy

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26
Q

Volumetric measurements: U/L disease lymphedema is considered present if > ____ % increase compared to unaffected side

A

10%

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27
Q

Dilation of lymph vessels, may appear as blister-like protuberances

A

Lymphangiectasia

28
Q

Leakage of lymph from skin surface

A

Lymphorrhea

29
Q

Development of warty growths on skin that contain dilated lymph vessel and fibrous tissue

A

Papillomatosis

30
Q

Thickening and hardening of subcutaneous tissue and brown skin discoloration. Associated with CVI and when severe can damage lymph tissue.

A

Lipodermatosclerosis

31
Q

Thickened fold of skin at base of 2nd toe or 2nd finger. Positive if skin cannot be lifted but only grasped as lump of tissue. Negative if skin can be normally grasped and pulled away from underlying tissue.

A

Stemmer’s sign

32
Q

Vascular assessment- use (3) assessments

A

Pulse ox, distal pulses, tests for arterial and venous insufficiency

33
Q

Do not assess _______ on affected side

A

BP

34
Q

What does normal lymph node feel like?

A

Soft, moveable, nontender

35
Q

What if lymph node is soft and tender but moves easily?

A

Sign of inflammation and/or infection

36
Q

Pt should be referred to MD if lymph node is ___

A

Hard

37
Q

___ and ___ lymph nodes are typically indicative of metastatic cancers.

A

Hard, immobile

38
Q

Procedural pain is

A

Pain asssociated with tx of lymphedema

39
Q

Incident pain is

A

Pain caused by daily activities

40
Q

Background pain is

A

Intermittent or continuous pain at rest

41
Q

Look for ___ with neurological assessment

A

Paresthesias

42
Q

Diff dx lymphedema from other disorders that affect extremities U/L or B/L.
U/L:

A

Acute DVT, PTS, arthritis, Baker’s cyst

43
Q

Diff dx lymphedema from other disorders that affect extremities U/L or B/L.
B/L:

A 
CHF
chronic venous insufficiency
dependency or stasis edema
renal dysfunction
Hepatic dysfunction
Lipedema
44
Q

Dx testing that may be used?

A

U/S: assess soft tissue for fibrosis/thickening
Doppler U/S: rule out DVT
Lymphoscintigraphy: identifies lymphatic insufficiency (at rest/exercise)
CT/MRI: skin thickening, “honeycomb” patterns in soft tissue

45
Q

Lymphedema vs. lipedema

Which swells into hands/feet, which stops at ankles/wrists

A

Lymphedema into feet/hands, lipedema stops

46
Q

Lymphedema vs. lipedema

Stemmer sign results

A

Stemmer sign may be positive in lymphedema, negative in lipedema

47
Q

Lymphedema vs. lipedema

Which is hormone related?

A

Lipedema: appears to be estrogen-related, starts at time of hormonal change

48
Q

Interventions for asymptomatic patients who are at risk for lymphedema: includes what? (5 things)

A
  1. Meticulous skin/nail care (moisturize, prevent infections)
  2. Lifestyle management (weight, sunscreen)
  3. Avoid limb constriction
  4. Compression garments
  5. Avoid temperature extremes (no temp above 102 degrees)
49
Q

Phase I management: edema secondary to lymphatic dysfunction

what is the main treatment?

A

Complete decongestive therapy (CDT)

50
Q

Phase I management: edema secondary to lymphatic dysfunction

What does CDT include? (5)

A
  1. MLD
  2. Compression bandaging/garments
  3. Exercise
  4. Skin care
  5. Pt education
51
Q

For MLD:
Massage technique is what?
Decongest prox or distal first?

A

Low pressure effleurage strokes

Decongest PROXIMAL segments first

52
Q

MLD:
Decongest proximally at R lymphatic duct for ____ involvement
Decongest proximally at thoracic duct for ___ involvement

A

RUE

LUE, trunk, LEs

53
Q

Bandages preserve and advance changes associated with MLD and account for ___ of improvement in symptoms

A

50%

54
Q

RED FLAG: Pts with poorly controlled ___ ___ may become unstable if unable to tolerate potential increase in ___ ___ caused by lymphedema reduction

A

Cardiopulmonary disease

Plasma volume

55
Q

Phase I short-stretch compression bandages should be worn ____ hrs/day

A

24

56
Q

RED FLAG: excessively high pressures will occlude ___ ___ capillaries and restrict fluid ____

A

Superficial lymph

Absorption

57
Q

Should pts exercise with bandaging?

A

YES

58
Q

RED FLAG: strenuous activities (jogging, ballistic movements, ___ activities contraindicated) as they ___ ___

A

Rotational

Exacerbate lymphedema

59
Q

Be aware of lymph overload symptoms including? (4)

A
  1. Discomfort
  2. Aching
  3. Pain in proximal lymph areas
  4. Change in skin color
60
Q

What should skin pH be maintained at?

A

5.0

61
Q

Contraindicated modalities include?

A

Electrotherapeutic modalities greater than 30Hz

Modalities that increase vasodilation or increase lymph load (paraffin, heat, ice, hydrotherapy, saunas, contrast bath)

62
Q

Phase II Management-
Continue with CDT, skin care, compression bandaging, exercise, pneumatic compression pumps with caution— what kind of pump is preferred and why?

A

Low pressure sequential pumps preferred—

  1. High pressures can damage lymph nodes
  2. May move water instead of proteins
  3. Use on LE increases risk of genital lymphedema
63
Q

Phase II management- pneumatic compression pumps can only be used for pts in stage __ lymphedema

A

I

64
Q

RED FLAG: pneumatic compression pumps with pressure >___ mmHg is contraindicated

A

45

65
Q

Surgical reduction: _____ subcutaneous tissue and skin in severe cases of those who are risk and considerably symptomatic. Significant risk of ____ post-op.

A

De-bulking

Morbidity

66
Q

Restoring lymph flow: lymphovenous anastomoses and lymphatic vessel grafting and lymph node transplantation. Successful in pts with _____ distal/proximal lymph obstruction

A

Intact

67
Q

Liposuction: may be considered for pts with _____ _____ and when other conservative measures have failed. Must use ____ ____ post-op.

A

Nonpitting edema

Pressure garments

KN JD NPTE: CARDIAC (21 decks)

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