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Acute Care > Lymphedema > Flashcards

Lymphedema Flashcards

1
Q

Name some lymphatic organs (organs that have lymph nodes in them)

A
  1. Bone marrow
  2. Thymus gland
  3. Adenoids
  4. Tonsils
  5. Spleen
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2
Q

How does lymph differ from interstitial fluid?

A

Lymph fluid is ~95% water while the other 5% is proteins, lipids, carbs, ions and some cells

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3
Q

What is the function of the lymphatic system?

A
  1. Fluid balance by draining capillary ultrafiltrates and escaped plasma proteins and returning them to blood circultion
  2. Nutritional function (intestinal lymphatics are responsible for fat absoprtion)
  3. Immune response
  4. Important for self-tolerance
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4
Q

what is lymphedema?

A

a swelling of a body part, usually an extremity and its adjacent trunk quadrant

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5
Q

What causes lymphedema?

A

the abnormal accumulation of protein-rich IF

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6
Q

T/F: lymphedema is cureable

A

FALSE

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7
Q

List some of the physical consequencs of lymphedema

A
  1. Heaviness and decreased motion of limb
  2. Cosmetic issue
  3. Altered lifestyle to prevent exacerbation or infection
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8
Q

List some psychological consequences of lymphedema

A
  1. increased anxiety, depression
  2. constant reminder if caused by cancer
  3. loss of familiar body image
  4. fear
  5. withdrawal
  6. loss of self-esteem
  7. loss of control on life/body
  8. distruct/frustration w/medical staff (if limited or poor knowledge)
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9
Q

what is primary lymphedema?

A

no cause, congenital defect of the lymphatic system

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10
Q

what is secondary lymphedema?

A

started by damage to/blockage of your lymphatic system

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11
Q

what is an axillary dissection?

A

a surgery to remove a malignant node

performed as a biopsy

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12
Q

list some healthy habits for pt edu and individuals w/lymphedema or at risk

A
  1. maintain healthy BMI w/low Na diet and regular exercise
  2. gradually build up duration and intensity of any activity/exercise
  3. Monitor the at-risk extremity during and after activity for change in size, shape, tissue texture, soreness, heaviness, or firmness
  4. keep skin moisturized and protected from dryness, bug bits, sunburn and injury
  5. avoid limb construction
  6. avoid extreme temps or greater than 15 min in hottub
  7. compression garments recommended for air travel
  8. apply first aid to every scratch/puncture on affected limb and monitor for signs of infection
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13
Q

how many stages are there to lymphedema?

A

4

0-3

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14
Q

describe stage 0 lymphedema

A

pre-clinical lymphedema

the lymphatic system is already functioning inadequately, but its still managing to keep from swelling for now

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15
Q

Describe Stage 1 lymphedema

A
  • lymphatic system is overburdened and can no longer keep up with the body’s damage
  • a protein-soft swelling develops in the affected area (pitting edema)
  • elevation improved temporarily
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16
Q

Describe Stage 2 lymphedema

A
  • swelling no longer improves w/elevation
  • high protein concentrations produce fibrosis, increased hardening of tissues called sclerosis
  • stagnant proteins are a perfect environment for bacterial growth
17
Q

Describe Stage 3 lymphedema

A
  • aka elephantiasis
  • swelling is severe, skin is hardened and wart-like growths (papilloma’s) appear
  • the shape of limb is skewed - with bulges of swelling
  • risk for repeated infections is high and skin is susceptible to deep, poor-healing wounds
18
Q

what are the main stages to lypmhedema treatment?

A
  1. good hygiene/skin care
  2. Manual lymphatic drainage (MLD)
  3. Compression therapy w/multi-layered low stretch bandages
19
Q

how is MLD different from massage?

A

MLD is softer and you start proximally to clear out blockages in ducts before moving distally to start pushing lymph back proximally

20
Q

How do you achieve compression therapy?

A
  1. multi-layering of low stretch bandages are applied to limb
  2. muscles contract underneath, pushing against the bandages to pump lymph out
21
Q

T/F: exercising on its own helps reduce lymphedema

A

FALSE

except diaphragmatic breathing

exercising w/compression garments is best

22
Q

what components of the PT eval are necessary to assess the presence and severity of lymphedema?

A
  1. history of swelling
  2. palpation
  3. measurements of circumference of limb and ROM of prox joints
23
Q

what is Stemmer’s sign?

A

use it on hands or feet

if you can tent the skin over the MCP and ICP joints you don’t have lymphedema

if you cannot pull the skin up there its considered a + sign

24
Q

what is typcially involved in a lymphedema treatment session?

A
  1. MLD
  2. compression therapy
  3. Exercising w/bandaging on
25
Q

what is the most important factor in successful treatment of lymphedema?

A

Pt compliance

26
Q

List some factors that can contribute to failure of effective lymphedema treatment

A
  1. non-compliance from pt
  2. inappropriate PT (misdiagnosed)
  3. malignancy
  4. medical considerations or relative CI to trx:
    • acute infection
    • CHF
    • arterial disease
    • active cancer
27
Q

list some positive outcomes from successful lymphedema treatment

A
  1. prevention/reduction of infections
  2. reductions to limb size to near normal
  3. reductions in trunk swelling
  4. breakdown of fibrotic scar tissue
  5. Pt edu and family edu → self management
  6. decreased total impact of the lymphedema on function
  7. lymph flow more rapid
  8. lymph node uptake improved and backflow diminished
28
Q

T/F: elastic support garments help to reduce swelling

A

FALSE

they help to maintain the results of a pre-treated lymphedematous limb

29
Q

List some meds that are commonly prescribed to trx lymphedema

A
  1. diuretics → but shouldnt!
  2. benzoyrones
  3. benstatin/Ketoprofen
30
Q

why shouldn’t diuretics be used to treat lymphedema?

A

commonly used but make the condition worse by drawing off water and leaving behind proteins which cause thickening/hardening of the tissues and increase risk for infections

Acute Care (11 decks)

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