Lymphatics and Integumentary Flashcards
Lymphatic System - what is it?
One-way system designed to transport lymph fluid through specific deep and superficial vessels called lymph vessels & nodes Lymph fluid contains water, fatty acids, proteins, WBC’s, bacteria and other cellular debris
Normal vs infected/inflamed vs Malignant
Normal Lymph Nodes Supple Non-tender Mobile Infected or Inflamed Lymph Nodes Firm and Enlarged Tender Warm Mobile Malignant Lymph Nodes Firm and gradually growing in size Non-tender but also can be tender Matted or immobile
A patient presents to a routine follow up appointment with a new onset of anterior neck pain. An examination of the painful area reveals lymph nodes that are warm and enlarged. The nodes are tender to touch but mobile. Which of the following is the BEST course of action?
A.Decrease exercise intensity and monitor vitals
B.Ask the patient about the recent onset of a fever
C.Refer the patient immediately to the primary care physician
D.Have the patient schedule an appointment with the oncologist
PT does not treat infected lymph nodes
We can’t do anything about infected lymph nodes, so we should refer out
A: Not in our scope
B: This doesn’t help us at all, we would still refer
C: CORRECT
D: No indication of cancer
How do we measure a limb
•Water Plethysmography (Water Displacement Method)
•Gold standard for measuring limb volume for the hands and feet
- Based on principle that an object displaces its own volume of water
- Circumferential Measurement (Tape Measure method)
- Standard and most common means of measuring limb volume
STAGES OF LYMPHEDEMA
- There are 4 stages in total (0-3)
- Stage 0
–No visible changes
•Stage 1 (Mild)
–Slight reversible swelling
–Pitting edema occurs
–Stage 2 (Moderate)
- Moderate irreversible swelling
- Pitting edema (early stage 2)
- Non-pitting edema (late stage 2)
- Stemmer’s Sign
–Stage 3 (Severe)
- Severe swelling
- Skin is permanently damaged/deformed
- Large skin folds
A patient with stage 2 lymphedema presents with an unexpected increase in right lower extremity edema. The patient has itching and burning over the anterior right shin with symptoms of excessive sweating, low grade fever, and dizziness. Which of the following is the MOST likely present?
A.Dermatitis
B.Pulmonary embolism
C.Right sided CHF
D.Cellulitis
Excessive sweating, low grade fever, dizziness – sounds like an infection.
A: Is is not an infection. Localized to an area; more of an allergic reaction
B: More shortness of breath
C: Doesn’t come with fever, sweating, etc.
D: This is an infection.
COMPLETE DECONGESTIVE THERAPY
There are 2 phases
- Comprehensive lymphedema treatment composed of two phases
- Phase I – Treatment Phase
–Manual Lymph Drainage
–Compression bandages
–Exercise
–Meticulous Skin Care
•Phase II – Self-Management Phase
–Continuous bandaging or compression (garment during the day/bandages at night)
–Exercise
–Skin Care
–MLD as needed
Manual lymph Drainage Theory and Procedure
•Theory
–Improving lymphatic flow by guiding the fluid gently around blockages and into proximal ducts for removal.
•Procedure
–Patient should be lying supine with affected extremity elevated
–Central areas and uninvolved proximal nodes are cleared first
–Light and gentle strokes distal to proximal starting at the most proximal aspect of the extremity first.
TYPES OF COMPRESSION
Short Stretch Bandage
•Short Stretch Bandages (Comprilan)
–Latex-free elastic bandage
–Stretches to 60% of resting length
–High Working Pressure
•temporary resistance to the muscle produced as the muscle contracts
–Low Resting Pressure
•Constant pressure of the bandage in the absence of muscle contraction
•Long Stretch Bandages (Ace Bandage)
–Low Working Pressure
•temporary resistance to the muscle produced as the muscle contracts
–High Resting Pressure
•Constant pressure of the bandage in the absence of muscle contraction
–Often times cuts off the lymphatic flow in superficial lymphatic vessels exacerbating the lymphedema
•
•Custom vs. pre-fabricated garments
- Custom vs. pre-fabricated garments
- Turnover rate
- Number of garments needed
- Changes in limb size
Pneumatic Compression
- High pressures in the 70 to 100 mm Hg range can damage lymphatic vessels in as few as 3 to 5 minutes.
- Therefore it is very likely that high pump pressures could damage lymphatic vessels.
•20 to 60 Normal PSI range
–40 – 50 mmHg with lower extremities
–30 – 40 mmHg with upper extremities
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A patient post right radical mastectomy and lymph node resection has developed stage 1 right upper extremity lymphedema. Which of the following findings is MOST characteristic of stage 1 lymphedema?
A. Edema that improves with elevation
B. Positive stemmer’s sign
C. Large skin folds and loss of skin integrity
D. Presence of non-pitting edema
A. Edema that improves with elevation
EXERCISE PRINCIPLES
- Exercise should never be performed without adequate compression
- Exercise should be gradually progressed
- Always monitor the girth of affected extremities during exercises
•Avoid isometric holds, overhead resistance, and heavy weight
- increases pressure in the limb, squeeze and cut off the lymphatic system
- asking for mm to overwork – more mm activity and can compress the lymphatic system.
STAY AWAY FROM INTERNAL PRESSURE
- Low impact aerobic exercises at most appropriate walking, bicycling, and swimming
- Avoid DOMS, eccentric based exercises, and high impact
Eccentric exercises creates microtears in mm. Causes inflammation and leads to worse lymphedema
•Always exercise the proximal musculature first and trunk comes before the extremity
A patient with secondary bilateral lower extremity lymphedema is being treated in aquatic therapy. The therapist would like to secure the best parameters to reduce the edema. Which of the following is MOST recommended:
A. Exercise in water at hip height
B. Exercise in water at waist height
C. Exercise in water at chest level
D. Each water height is equally beneficial
Hydrostatic pressure
Which one of these will have the most hydrostatic pressure
A: Same as b
B: same as a
C: Most pressure
D:
