Lymphedema

Question 1

lymphedema

Answer 1

an abnormal accumulation of protein rich fluid in the interstitium which causes chronic inflammation and reactive fibrosis of the affected tissues
Most often found in extremities, can also occur in the face, neck, abdomen, genitals
Does not respond to diuretics

Question 2

edema

Answer 2

excess fluid in the body tissues which is a result of abnormal leakage of fluid across capillaries from the plasma to interstitial spaces
Classified into:
Generalized - concerning the whole body
Local - present in only 1 part of the body

Question 3

primary lymphedema

Answer 3

Due to malformation of lymphatic system
Can be familial
May have more systemic presentation
Bilateral limbs, upper & lower body, etc.

Question 4

secondary lymphedema

Answer 4

Due to another medical condition
s/p lymph node dissection, radiation therapy
s/p orthopedic surgery (i.e. TKA, THA)
Often localized presentation
1 affected limb, dependent on lymph nodes involved

Question 5

complete decongestive therapy (CDT)

Answer 5

Manual Lymphatic Drainage (MLD)
Exercise
Self-Care
Skin Care
Elevation
Compression Bandaging/Garments

Question 6

Manual Lymphatic Drainage

Answer 6

Gentle manual treatment that improves the activity of the lymph vascular system
Re-routes lymph flow around blocked areas into more centrally located healthy lymph vessels that drain into the venous system
Patients are instructed in self-MLD for their home program

Question 7

Exercise with Lymphedema

Answer 7

Performed with compression bandages or garments on to increase the effectiveness of the muscle and joint pumps, lymph vessel activity and venous lymphatic return
Both strength training and aerobic exercise recommended
Slow, gradual exercise progression critical to ? risk of sx exacerbation

Question 8

Compression bandage - type

Answer 8

short stretch

Question 9

compression protocol

Answer 9

2 weeks, day and night

Question 10

compression garments

Answer 10

Compression stockings/sleeves
Alternative Compression Options
Juxtafit (velcro adjusted)
Farrow wraps (velcro adjusted)
Night garments
Donning/Doffing Aides

Question 11

educational components of lymphedema care

Answer 11

Skin and nail care
Elevation
Infection prevention 
Self-bandaging
Donning/doffing garments
Home Exercise Program 
Self-MLD

Question 12

CDT Phase 1

Answer 12

Active Treatment (daily visits)
Meticulous skin and nail care
MLD
Compression bandaging
Exercises
Self-care Training

Question 13

CDT Phase 2

Answer 13

Self-Care Phase (Maintenance)
Compression Garments – daily compliance
Bandaging – prn for “flare-ups” or nighttime
Meticulous skin and nail care
Routine HEP Compliance
Self-MLD or MLD with massage therapist prn
Rehab f/u if pt unable to I’ly maintain reduction

Question 14

inpatient lymphedema therapy contraindications

Answer 14

Absolute: Acute infection - cellulits, decompensated CHF (acute), Acute DVT
Relative: kidney disease, malignant disease
If pt with 1 of the above dx, must get clearance for any and all treatments and notify nurses of sxs to watch for after treatment completed

Question 15

inpatient lymphedema therapy diagnosis

Answer 15

Cancer, CHF, general edema, venous insufficiency

Acute or chronic diagnoses

Question 16

inpatient length of stay

Answer 16

Average acute hospital LOS is 3-5 days,  dependent on: 
reason for admission
meds pts are requiring during their stay
Average treatment 1-5 days
Impact of treatment dependent on above

Question 17

inpatient lymphedema supplies

Answer 17

Dependent upon LOS
Charged through department not able to bill patients
Will sometimes use temp compression unless pt staying in-house for extended period

Question 18

outpatient lymphedema referral diagnosis

Answer 18

Lymphedema Prevention
s/p Lymph Node Dissection prior to sx onset
Primary Lymphedema
Secondary Lymphedema

Question 19

lymphedema prevention

Answer 19

Avoid BP and blood draws on affected limb
Avoid cuts, scratches that could result in infection
Limit exposure to extremes of temperature
Exercise with slow, gradual progression
Consider wear of compression garment at altitude, i.e. air travel

Question 20

outpatient lymphedema evaluation

Answer 20

ROM & MMT
Girth Measurements
4 cm increments to determine limb volume
Sensation
Palpation
Integumentary Inspection
Erythema, warmth, fibrosis, wounds, pitting edema
Functional Mobility
Gait, transfers, balance
Outcome Measures
UE – quickDASH; LE - LEFS

Question 21

lymphedema grades

Answer 21

mild = 1.5-3 cm; moderate = 3 to 5 cm; severe >5 cm

Question 22

early stage lymphedema (stage 1)

Answer 22

pitting or non-pitting (often pitting)
minimized w/ elevation, tends to ? by the end of the day
responds more quickly to treatment

Question 23

late stage lymphedema (II-III)

Answer 23

skin may be discolored with spider-like veins, darkened, or scaly
due to chronicity, skin becomes fibrotic, dry, & flaky; risk of ulcerations
often requires more aggressive treatment, slower response to treatment

Question 24

considerations for OP plan of care

Answer 24

Patient’s ability to attend therapy sessions
i.e. compression bandaging protocol is suggested at 5 days/week x 2 weeks
Insurance Coverage/Authorization
Family Support/Involvement
i.e. spouse’s ability to learn bandaging technique to assist patient at home Socioeconomic Status
i.e. medicare does not cover compression garments; pt ability to pay out of pocket
Length of visit
i.e. >60 mins. for bandaging, MLD, ther ex; also dependent on unilat or bilat involvement
Access to pool – aquatic therapy

Question 25

outpatient prognosis

Answer 25

Patient’s level of fitness/lifestyle/nutrition
Low salt, fat, alcohol diets
Socioeconomic status
Whether pt was able to afford supplies, etc.
can look into funding options, although limited
Family Support
Motivation
Co-morbidities

Question 26

alternative lymphedema therapies

Answer 26

Pumps
Flexitouch vs. Lesser Pumps
Pool Therapy
Acupuncture