Lymphedema Lecture during Lab on 10/12

Question 1

What are two causes of lymphedema?

Answer 1

1. increase in volume of lymph produced

2. Major reduction in capacity for lymph transport

Question 2

What % of US pop has lymphedema?

Answer 2

1%

Question 3

1999 World Wide Incidence

Answer 3

Parasite caused 90 mil case
Breast Cancer caused 20 mil cases
Primary (birth defect) caused 2-3 million cases

Question 4

What % of women with breast cancer will develop some stage of lymphedema?

Answer 4

25-49%

Question 5

Does Complete Decongestive Therapy (CDT) have side effects?

Answer 5

According to the PPT, no.

Question 6

What is the gold standard of treatment?

Answer 6

CDT

Question 7

What are the 4 components of CDT? (Plus one she added, so 5 total)

Answer 7

Manual Lymph Drainage (massage)
Compression bandaging
Remedial Exercise
Meticulous Skin and Nail Care
(Education of Self Care)

*MLD, compression, exercise, skin care

Question 8

What are the two phases of CDT?

Answer 8

1. Active Phase (3-5x week)

2. Maintenance phase

Question 9

What makes up Phase 1 (active phase)?

Answer 9

Meticulous skin care
MLD
Bandaging
Exercise
Self wrapping and self-massage
—
Lasts 2 to 12 weeks depending on the amount of swelling and tissue firmness.
Complete decongestive therapy for one-hour sessions, 4 to 5 days per week.
Bandages with foam are worn 23 hours per day.

Question 10

What makes up phase 2 (maintenance)

Answer 10

Compression Garments (days)
Bandaging (nights)
Skin care
Exercise (daily)
MLD as needed
—
In order to prevent the area from swelling constant attention is needed.
Elastic compression garments that fit like a second skin are worn during the day.
Often bandages with foam are worn at night to decrease daily daytime swelling.
Exercises are done while wearing compression.
Self manual lymphatic drainage is done for 20 minutes per day.

Question 11

What are the 4 stages (1+3) of lymphedema?

Answer 11

Pre-Stage: Latency Stage
First Stage: Pitting Edema
Second Stage: Spontaneously Irreversible Lymphedema
Third Stage: Lymphostatic Elephantiasis

Question 12

What happens during Stage 1

Answer 12

Symptoms worsen during the day.
Reversible
Relieved w/ elevation

Question 13

Stage 2?

Answer 13

Skin hardens and no longer resolves upon waking. If skin is pressed upon, an indentation will remain. Not resolved with elevation

Question 14

Stage 3?

Answer 14

Skin changes –> textured

lymphostatic elephantiasis, is nonpitting edema. At this point the disease has progressed to the point where permanent skin changes appear very hard. It is difficult to grasp the skin of the affected area with two fingers.

Question 15

How does MLD work? Where does the lymph go?

Answer 15

Lymph flows around blocked areas and into more centrally located healthy lymph vessels

Question 16

Advantages and disadvantages of MLD?

Answer 16

Improved lymph production
Inc lymphangio-motoricity (inc contraction of lymph vessels)
Inc volume transported in lymph system
Special techniques help break down fibrotic areas
Promotes relaxation
Analgesic effect
NO KNOWN DISADVANTAGES!

Question 17

General contraind.?

Answer 17

heart problems
acute infection
renal disease
maligant disease
antibiotics
--- neck:
arrhythmia
Age 60+
thyroid problems
Hyper or hypo thyroidism
--- abd:
preg or menstrating
recent abd surgery
Crohn's
Diverticulitis
Cirrohsis
unexplained pain
aortic aneurysm
Radiation fibrosis

Question 18

What bandages are used in compression? What is enhanced and/or maintained

Answer 18

Short-stretch

*Diffusion and osmosis are enhanced and maintained

Question 19

What are overall CDT benefits in wound care? (due to edema reduction)

Answer 19

Improved tissue-gas exchange, acid-base balance, bacterial dynamics, cellular transport, increased PO2 (coolagen cross linking, angiogenesis, epithelialization, improved neutrophil function, improved resistance to infection)

Question 20

When do you wear elastic support garments? How much pressure is needed? How often do you wear it?

Answer 20

AFTER CDT phase 1 to PREVENT limb swelling
Uncomfortable if worn when limb is swollen; does nothing to correct underlying edema (just prevents)
*30-40mmHg - MUST WEAR DAILY

Question 21

Do you do exercises with bandages and support garments in place?

Answer 21

Yes. Do low exertion, slow, rhythmic. Include diaphramatic breathing. Inc blood flow

Question 22

Why should you include diaphragmatic breathing?

Answer 22

(increases lymph transported by thoracic duct)

Question 23

What do you need to consider (what are disadvantages) when using bandaging?

Answer 23

Bulky, hot

Need to use caution with other vascular diseases!

Question 24

What are advantages to bandaging?

Answer 24

Reduces ultrafiltration rate
Improve efficiency of the muscle and joint pumps
Prevents re-accumulation of evacuated lymph fluid
Helps break up deposits of accumulated scar and connective tissue
During Rx, bandages stay in place until next MLD treatment

Question 25

What are contraindications to bandaging?

Answer 25

``` All gen. contraind. Arterial dieases ---precautions:--- HTN Paralysis DM Branchial asthma, etc CHF Renal disease ```

Question 26

What are benefits for meticulous skin and nail care?

Answer 26

Hygiene appropriate for body habitus Moisturizers vs medicated powders Eliminate bacterial and fungal growth Avoid injury (nicks, bites, burns, etc) Clean ALL injuries immediately, call healthcare provider with any signs of infection Podiatry visits for nail care, especially if unable to reach nails

Question 27

What are the effects of lymphedema on the skin?

Answer 27

Results in skin hypertrophy, destruction of elastic fibers --> fibrosis, cracking of epithelial/dermal layers Degraded immune system --> chronic inflammation and susceptibility to fungal and bacterial infections *See Associated Skin Conditions in PPT