Lymphedema Flashcards
lymphedema
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
edema
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
primary lymphedema
Due to malformation of lymphatic system
Can be familial
May have more systemic presentation
Bilateral limbs, upper & lower body, etc.
secondary lymphedema
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
complete decongestive therapy (CDT)
Manual Lymphatic Drainage (MLD) Exercise Self-Care Skin Care Elevation Compression Bandaging/Garments
Manual Lymphatic Drainage
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
Exercise with Lymphedema
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
Compression bandage - type
short stretch
compression protocol
2 weeks, day and night
compression garments
Compression stockings/sleeves Alternative Compression Options Juxtafit (velcro adjusted) Farrow wraps (velcro adjusted) Night garments Donning/Doffing Aides
educational components of lymphedema care
Skin and nail care Elevation Infection prevention Self-bandaging Donning/doffing garments Home Exercise Program Self-MLD
CDT Phase 1
Active Treatment (daily visits) Meticulous skin and nail care MLD Compression bandaging Exercises Self-care Training
CDT Phase 2
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
inpatient lymphedema therapy contraindications
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
inpatient lymphedema therapy diagnosis
Cancer, CHF, general edema, venous insufficiency
Acute or chronic diagnoses
inpatient length of stay
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
inpatient lymphedema supplies
Dependent upon LOS
Charged through department not able to bill patients
Will sometimes use temp compression unless pt staying in-house for extended period
outpatient lymphedema referral diagnosis
Lymphedema Prevention
s/p Lymph Node Dissection prior to sx onset
Primary Lymphedema
Secondary Lymphedema
lymphedema prevention
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
outpatient lymphedema evaluation
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
lymphedema grades
mild = 1.5-3 cm; moderate = 3 to 5 cm; severe >5 cm
early stage lymphedema (stage 1)
pitting or non-pitting (often pitting)
minimized w/ elevation, tends to ? by the end of the day
responds more quickly to treatment
late stage lymphedema (II-III)
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
considerations for OP plan of care
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
