Lymphedema Intervention

Question 1

Interventions - Medical

Answer 1

Pharmaceutical agents - Diuretics, antimicrobials, antimycotic, antibiotics, Benzopyrenes (not FDA approved due to liver toxicity)

Question 2

Interventions - Surgical

Answer 2

Microsurgery
Reconstruction
Excisional or resections AKA debulking

Question 3

Interventions - coordination, communication and documentation

Answer 3

Discharge planning

Dietary consultation - weight control, protein intake guidelines

Question 4

Interventions - pt/client related instructions

Answer 4

Avoid injury
No BP measures or injections in affected limb
Avoid fatigue/overuse of limb
Weight control
Recognition of s/s of infection

Question 5

Interventions - skin care of limb

Answer 5

Cleanse skin

Use of low pH creams to lubricate

Question 6

Procedural interventions

Answer 6

Elevation
ROM exercises
Mobiliztion
Complete decongestive therapy
Compression garment
Pneumatic compression devices

Question 7

Complete decongestive therapy (CDT) phase 1

Answer 7

Skin care
MLD as needed
Compression 
Exercises - AROM and flexibility
Pt education - infection and complications

Question 8

CDT - phase 2

Answer 8

same as phase 1
this phase is after appropriate edema reduction
skin care continues
Exercise - add strengthening and more aggressive stretching
MLD as needed
Fit for compression garments
Pneumatic compression pumps

Question 9

CDT - phase 3

Answer 9

Same as phase 1 and 2

Bandaging with greater focus on dec fibrotic tissue

Question 10

Remember - Lymphedema is a risk factor for

Answer 10

infection of the limb!

Question 11

Remember - typical massage

Answer 11

will worsen the condition - it is likely to harm

Question 12

Remember - complications associated with….

Answer 12

complication associated with cancer treatments must be evaluated - radiation effects, seromas

Question 13

Effects of MLD

Answer 13

Inc lymph capillary function - uptake, inc contraction freq
Relaxation effect - parasympathetic response
Redirect lymphatic flow

Question 14

Strokes

Answer 14

Always start an area with effleurage strokes
5-7 strokes in each area
Stationary circles - has a working phase and a relaxation phase
Pump technique - extremities and rounder body parts
Combination - thorax

Question 15

Effects of compression

Answer 15

Inc hydrostatic pressure of interstitial spaces (inc lymphatic flow and dec venous pressure)
Dec build up of fibrin
Dec pain

Question 16

Compression bandages - Short stretch

Answer 16

Low resting pressure
High working pressure
Stretches up to 20% of original length

Question 17

Compression bandages - Long stretch

Answer 17

High resting
Low working
Stretches up to 190% of original length
Spiral application (50% stretch, 50% overlap)

Question 18

Factors that affect the amount of pressure

Answer 18

Type of bandage and amount of elasticity
Amount of tension applied during application
Number of layers
Law of laplace

Question 19

Law of laplace

Answer 19

Pressure = tension/radius of the limb

Pressure applied is inversely proportional to the radius of the body part

More pressure at foot and ankle than at thigh with all else being equal - because foot and ankle have smaller radius