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Physical Agents > Lymphedema Management > Flashcards

Lymphedema Management Flashcards

1
Q

what is complete decongestive therapy

A
  • Most common treatment for lymphedema
  • Currently recognized as the “gold standard” of care of lymphedema
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2
Q

two phases of CDT

A

intensive phase
maintenance phase

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3
Q

intensive phase

A
  • Goal: maximum volume reduction and normalization of tissue texture
  • Consists of manual lymphatic drainage (MLD), compression bandaging, patient education, skin care and exercise
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4
Q

maintenance phase

A
  • Goal: maintain volume reduction that was achieved in the intensive phase
  • Consists of compression garment fitting, exercise, self MLD, possible maintenance MLD by a qualified provider, skin care, and instruction in self care
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5
Q

goals of manual lymphatic drainage

A
  • Reduce edema utilizing the anatomy of the lymphatic system
  • Direct fluid away from the affected quadrant
  • Facilitate uptake in the uninvolved lymphatics
  • Break up protein stasis and soften fibrotic tissue
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6
Q

is MLD intended to be stand alone treatment?

A
  • no
  • often part of CDT
  • breast edema shows the most improvement when MLD is performed
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7
Q

reduced subjective symptoms after MLD

A
  • tension
  • heaviness
  • pain
  • QOL
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8
Q

indications of MLD

A
  • Primary lymphedema
  • Secondary lymphedema
  • Venous edema
  • Post traumatic edema
  • post-surgical edema
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9
Q

contraindications of MLD

A
  • Untreated acute infecƟons
  • Untreated cardiac edema
  • Renal edema
  • Acute DVT
  • Aortic aneurysm
  • Neck treatment
  • abdominal treatment
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10
Q

principles of MLD

A

*Patient is positioned comfort; treatmentareas supported; body
appropriately draped
*Effleurage over area to be treated is used to begin and end treatment
*Pressure –> generally light, directed to the superficial fascia
tssue layer
*Each stroke has a working “pressure on” and a resting “pressure
off” stage
*Each stroke has a spiral component

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11
Q

working stage of MLD

A
  • about 1 second
  • repeated 5-7 times
  • always directed toward intact lymphatic pathways (towards uninvolved nodes, around involved nodes_
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12
Q

what begins and ends MLD and why

A

abdominal breathing to stimulate thoracic duct

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13
Q

MLD general sequence

A

treat venous angles
regional lymph nodes
appropriate anastomoses
treat extremity from proximal to distal

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14
Q

types of compression

A

*UEand LE short stretch and long stretch bandaging
*Unna boot or paste bandages
*Four layer wrap
*Pneumatic compression/Compression pumps
*Compression garments

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15
Q

what does compression therapy do?

A

*Reduces arterial filtration
*Reduces venous reflux
*Enhances valve competence
*Prevents re-accumulation of fluid
*Increases the calf-muscle pump
*Assists in breakdown of fibrosis
*Provides support for tissues that have lost elasticity

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16
Q

compression therapy: phase I

A

In Phase I of CDT, compression is done using multi-layered short
stretch bandaging

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17
Q

compression therapy phase II

A

In Phase II of CDT, compression is designed to maintain the limb
volume achieved in phase I
* Non-custom or custom compression garments during the day
* Patients requiring nighttime compression will utilize short stretch
bandaged or night time compression garments

18
Q

compression indications

A
  • Upper or lower extremity lymphedema
  • Venous edema in the lower extremity
  • Edema from post surgery or post trauma
  • To shape the residual limb post amputation
19
Q

compression contraindication

A
  • Acute untreated infections
  • Acute untreated DVT
  • Untreated Cardiac Edema
  • Renal edema
  • Edema without diagnosis
20
Q

compression precautions

A

Cardiac edema
* Arterial disease/wounds
* Diabetes: small vessel (arteriole insufficiency)
* Sensory deficits
* Paralysis
* Altered mental status
* Malignancy (relative)
* Sensitivity to compression products
* Inability to perform home management

21
Q

review guidelines for compression therapy slide 19

A
22
Q

resting pressure

A
  • Constant pressure externally applied by the bandage
  • Constant pressure may hinder refill of superficial vessels
  • Highest values achieved with strong, very elastic bandages (ace wrap, 4-layer wrap)
23
Q

working pressure

A
  • Temporary pressure that is generated with muscle contraction
  • Increases the efficiency of the muscle pump
  • Highest values achieved with more rigid dressings (short stretch, Unna boot)
24
Q

short stretch bandage

A
  • Can be elongated 10-100% of resting length
  • Low resting pressure and High working pressure
  • Minimallyelastic
  • Prevent circulatory compromise and tourniquet effect
  • Minimize fluid re-accumulation
  • loses pressure over time
25
Q

long stretch bandage

A
  • Can be elongated >100% resting length
  • Low working pressureand High resting pressure
  • Highly elastic: ACE wraps
  • May compromise circulation at rest
  • Poor support when muscles are working
  • maintain pressure over time
26
Q

determinants of compression

A

*Elastic component of the bandage
*Degree of tension when the bandage is applied
—- Tension on the bandage should approach 50% of the ability of the
bandage to stretch
*Number bandages applied
*Condition of the bandage or garment

27
Q

Law of LaPlace

A

pressure that is exerted on the tissues from the bandaging system
Pressire = tension/radius

28
Q

tension =

A

is delivered from the bandage system. Each bandage is applied with
even tension (same degree of stretch)

29
Q

radius =

A

the smaller the radius of the limb, the greater the pressure exerted on
the tissues

30
Q

padding

A
  • Provides equal compression around the limb
  • Different forms of padding
31
Q

when does padding need to be applied

A
  • In areas of concavity
  • In areas to increase the radius of the limb
  • Any areas of concern for the soft tissues
32
Q

short stretch application

A

*Apply stockinette over moisturized skin
*Pad skin and bony prominences
*Apply multiple bandages of varying widths
* 6cm, 8cm, 10 cm and 12 cm
*Overlap bandages by 50%
*Stretch bandage by 50% for even tension

33
Q

pressure gradient

A

*Pressure should steadily decrease from a distal to proximal direction
*Highest pressure is located at the ankle/wrist
*Pressure gradient is assessed after application of each bandage
*Assess pressure gradient by feeling the stiffness of the bandage system

34
Q

role of compression bandages

A

to achieve a stable edema reduction of the limb

35
Q

role of compression garments

A

maintain the treatment results

36
Q

what are compression garments

A

*Aid in maintaining interstitial fluid homeostasis
*Used for management and prevention
*Available in custom made or prefabricated varieties
*Available in different “classes” (level of compression)
*Gradient format design
* Distal compression greater than proximal
*Should be replaced every 6-9 months

37
Q

compression classes

A

slide 30

38
Q

exercise

A
  • Aimed specifically at promoting lymphatic flow and reducing swelling
  • Active, repetitive, resistive or non-resistive motion of the involved body part
  • Should be performed with compression (bandages or garment)
    — Allows the muscle to contract against resistance more effective muscle pump enhancing lymphatic and venous return
39
Q

benefits of exercise

A
  • Reduce fatigue
  • Increase strength and flexibility
  • Improve body image
  • improve overall QoL
40
Q

skin care

A

*Lymphedema places patients at increased risk ofskin infection
*High protein content of lymphatic fluid serves as a medium where bacteria may thrive causing cellulitis
*In skin care education, patients learn how to keepthe skin
supple and protected from breaks andtears and how and why to
use pH-neutral creams or lotions and low pH soaps to discourage
bacterial colonization

41
Q

patient education

A

*Lymphedema is MANAGED, not cured
*Lymphedema exacerbations are not uncommon over time
*Well managed edema results from adherence withmassage,
bandaging, compression and proper skincare
*Encourage maintenance of ideal weight
*Psychological issues

42
Q

home management

A

*Self MLD
*Self bandaging
*Compression garments: day and/or night
Exercise
** lifelong management

Physical Agents (11 decks)

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