Lymphedema Flashcards
lymph vessels rely on _________ to pump fluid
external forces
substances not drained or reabsorbed by the blood stream. Lymph content
lymphatic loads LL
Lymphatic loads LL is made mostly of… (4)
protein, water, fat, cell fragments
the average person is born w/ ______ lymph nodes
600-700
first line of defense for the body
regional nodes
3 regional nodes areas
- axillary
- inguinal
- cervical
the abnormal accumulation of protein and water in the interstitial spaces, causing swelling of soft tissues
lymphedema
TF lymphedema is not a disease and has no cure
true
2 ways lymphedema develops through inadequate transport
- mechanical insufficiency
2. dynamic insufficiency
impairment of the lymph transport system; limb is “at risk”
mechanical insufficiency
lymph load exceeds transportation capacity TC
dynamic insufficiency
hypertrophied mm walls in lymphatic system decreases effectiveness of pumping ability
chronic lymphedema
LL < transport capacity TC =
fluid balance, no edema
difference between edema and lymphedema
edema= water. can go away lymphedema= protein and water. lifelong
movement of lymph and activation of vessels
lymphangiomotoricity
transportation vessels adjacent to each other. Drains area toward same REGIONAL LYMPH NODES
territories
linear areas separating territories. Upper/lower horizontal, sagittal/median, gluteal
watersheds
connections that re-route LL from impaired quadrants towards healthy quadrants
anastomoses
anastomoses btwn lymph collectors in same territory
intra-territorial (w/in)
anastomoses connections btwn 2 adjacent territories
inter-territorial (btwn)
anastomoses (5)
- AAA
- PAA
- AI/IA
- AII
- PII
“hidden” lymphedema. Does not develop visible symptoms
stage 0
spontaneously reversible. Pitting edema present
stage 1
spontaneously irreversible. Not reversible w/ elevation. Non pitting edema
stage 2
lymphostatic elephantiasis.
stage 3
lymphedema developed due to malformation of lymphatic system. Idiopathic. Typically LE
primary
lymphedema present following a known insult to lymphatic system. Surgery, radiation, infection, trauma. Typically UE
secondary
Lymphedema s/s (2)
- pitting in early stages
2. not relieved by elevation
shows lymph flow, lymph node uptake, and backflow
lymphangiography
size of indention and the time it takes to go back to normal
1t-4t pitting assessment
effective treatment only if edema is due to sodium retention
diuretics
4 components of Complete Decongestive Therapy CDT. Gold standard
- skin care
- manual lymph drainage MLD
- Compression garments/bandage
- decongestive exercise
PT goal for lymphedema
reduce swelling and maintain reduction
absolute contraindications for CDT (4)
- acute infection
- cardiac edema
- acute DVT
- acute bronchitis
precautions for CDT (3)
- malignancies
- bronchial asthma
- hypertension
CDT goal to decongest involved extremity. Ends when measurements plateau or pt is I w/ self management
phase 1- intensive
CDT goal to improve and/or maintain phase 1 accomplishments
phase 2- improvement
TF you do not need to be certified to perform manual lymph drainage MLD
false
w/ MLD strokes are…
dist-prox strokes moving prox-dist (clear the traffic jam)
MLD 4 stroke techniques
- stationary circle
- pump
- rotary
- scoop
MLD parameters
1 sec during working phase, 5-7 reps in one area
TF you do not have to be certified for compression and bandaging
true
first goal w/ bandaging
get pt I w/ bandaging in first week
compression phase w/ stockinette and short-stretch bandages
phase 1
compression phase w/ compression garments during the day and bandages as needed at night
phase 2
long stretch bandages that has low working pressure and does not counteract mm pump
ACE bandages
decongestive ex must be performed w/ compression to counter….
pressure mm pump
decongestive ex schedule
20-30min, 2x/day. Elevate limb x30 min post-ex
Pt education (4)
- avoid skin injury
- avoid mosquito bites
- avoid heat
- know s/s
lymphedema measurements should be made…
at least 1x/week
