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Practice topics Exam 3 > Lymphedema Exam and Eval > Flashcards

Lymphedema Exam and Eval Flashcards

1
Q

History - other than typical questions, what should you ask more specifically about

A

Surgeries (post op care)
Time of surgery to time of edema development
Trauma or other precipitating factor
Elevation of a body part - effect of it

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2
Q

Systems review - what do you need to rule out

A

Hepatic involvement
CHF
Venous insufficiency

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3
Q

Physical exam

A

Anthropometric measurements - height and weight, girth or volume measures (B), palpatory edema
Stemmers sign

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4
Q

Physical exam - palpatory edema measures

A

0-1/4 = 1+ = mild - rebounds within 15 sec
1/4-1/2 = 2+ = moderate - rebounds within 30 sec
1/2-1 in = 3+ = severe - takes longer than 30 sec to rebound
Over 1” = 4+ = very severe

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5
Q

Physical exam - stemmers sign

A

Pinch skin of 2nd toe

very valid for lymphedema if positive but if negative doesnt mean you can rule out lymphedema

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6
Q

Methods of limb edema measurement - volumetric water displacement - Pros and Cons

A

Pros = Accurate and easy to use on irregular shapes

Cons = impractical for whole leg, bulky equipment and clean up, open wounds could be a problem, limited ROM

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7
Q

Methods of limb edema measurement - Circumferential - Pros and Cons

A

Pros = Portable, easy to use, can be used on pts with limited ROM, consider foot board to increase accuracy

Cons = Multiple B measures needed, expertise needed, repeat measures are more difficult

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8
Q

Methods of limb edema measurement - Optoelectric (uses infrared) Pros and Cons

A

Pros = Quick and easy, measurements automatically stored and graphed, segmental data at 1/2 cm intervals possible

Cons = Accuracy depends on proper positioning, limited ROM, high equipment cost

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9
Q

Tests and Measures

A 
Arousal, attention, cognition
Assistive and adaptive devices 
Gait, balance
Integumentary integrity
Orthoic, protective and supportive devices
Pain
ROM
Sensory integrity 
Ventilation, respiration, circulation
Ask what they have had to change in their life because of the edema
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10
Q

Differentials - heart failure mechanical insufficiency

A

Increased venous pressure

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11
Q

Differentials - hypoproteinemia (nephrotic syndrome, malnutrition, liver disease)

A

Dec plasma oncotic pressure shifting fluid to interstitial space
Proteinuria, hypoalbuminemia, hyperlipidemia

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12
Q

Differentials - chronic venous insufficiency

A

venous hypertension

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13
Q

Differentials - lipedema

A

Angiopathy of adipose in the LEs
Inc in adipose
Symmetrical
Ankles and feet spared

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14
Q

Differentials - myxedema (thyroid dysfunction)

A

Protein and mucopolysaccharide accumulation

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15
Q

Classification - Stage 1

A

None to minimal changes in size and skin condition
Edema is pitting and may dec with elevation
Mild pain with subjective feelings of tightness
ROM WNL
Reversible

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16
Q

Classification - Stage 2

A 
Larger than other limb
Taut, stretched skin
Reddening and dryness of skin noted 
Pain with paresthesia 
Dec ROM
Spontaneously irreversible
17
Q

Classification - Stage 3

A 
Elephantiasis
Irregular shape, very large and heavy limb
Skin is brawny, course, may leak fluid
No pitting
Pain with paresthesia 
Limb is heavy and fatigue is problem
Motion impairments limit function
Dec coordination and motor function
18
Q

Lipedema

A 
Abnormal deposits of adipose in the LEs
Hip, thigh, and leg
Bilateral
Affects primarily women
Stemmers sign will be negative (no involvement of ankle and foot)
Little pitting but often pain with palpation
Cause is unknown
Very limited treatment
19
Q

Thickened skin?

Lymphedema
Lipedema
C. venous

A

Lymphedema - severely
Lipedema - no
C. venous - lipodermatosclerosis

20
Q

Consistency

Lymphedema
Lipedema
C. venous

A

Lymphedema - spongy, until late
Lipedema - Fatty
C. venous - woody, brawny

21
Q

Pigmentation

Lymphedema
Lipedema
C. venous

A

Lymphedema - no, until late
Lipedema - no
C. venous - yes

22
Q

Relief with elevation

Lymphedema
Lipedema
C. venous

A

Lymphedema - mild early stages
Lipedema - minimal to none
C. venous - yes

23
Q

Distribution of edema

Lymphedema
Lipedema
C. venous

A

Lymphedema - distal
Lipedema - ankle, foot spared
C. venous - ankle, feet spared

24
Q

Severity of pain

Lymphedema
Lipedema
C. venous

A

Lymphedema - none, leg fatigue
Lipedema - sensitive, tender to palpation
C. venous - leg is heavy, may have significant pain

25
Q

Side

Lymphedema
Lipedema
C. venous

A

Lymphedema - may or may not be B
Lipedema - always B
C. venous - occasionally B

Practice topics Exam 3 (9 decks)

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