Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physical Agents > Lymphedema Management > Flashcards

Lymphedema Management Flashcards

1
Q

What is CDT?

A

Most common treatment for lymphedema.
Currently recognized as the gold standard of care of lymphedema.
2 phases - intensive phase and maintenance phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the goals of the CDT phases?

A

Intensive Phase - maximum volume reduction and normalization of tissue texture.
Maintenance Phase - maintain volume reduction that was achieved in the intensive phase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does intensive phase consist of?

A

Manual Lymphatic Drainage (MLD)
Compression bandaging
Patient education
Skin care and exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does maintenance phase consist of?

A

Compression garment fitting
Exercise — really important
Self MLD
Possible maintenance MLD by a qualified provider
Skin care
Instructions in self care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Manual Lymphatic Drainage?

A

Light but very specific hands on technique
Occasionally administered alone but is often part of CDT — NOT intended for a stand alone treatment.
*breast edema shows the most improvement when MLD is performed.
*reduction of subjective symptoms including tension, heaviness, and pain as well as improved QOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the goals of MLD?

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for MLD?

A

Primary Lymphedema
Secondary Lymphedema
Venous edema
Post traumatic edema
Post surgical edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the contraindications to MLD?

A

Untreated acute infection
Untreated cardiac edema
Renal edema
Acute DVT — need to be anticoagulated for a minimum of 6 weeks.
Aortic aneurysm
Neck treatment
Abdominal treatment
don’t want to push fluid it wont be able to get through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the principles of MLD?

A
  • Patient is positioned comfort, treatment areas are supported, body is appropriately draped.
  • Effleurage over area to be treated is used to begin and end treatment
  • Pressure is generally light, directed to the superficial fascia tissue layer
  • Each stroke has a working pressure ON and a resting pressure OFF stage.
  • Each stroke has a spiral component.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the working stage?

A
  • About 1 second, stroke needs to be repeated 5-7 times in one area.
  • Working stage is directed toward intact lymphatic pathways — toward uninvolved nodes around involved nodes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What typically begins and ends the treatment?

A

Abdominal breathing — stimulates the thoracic duct.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is general sequence of MLD?

A
  1. Diaphragmatic breathing
  2. Treat venous angles
  3. Intact regional lymph nodes
  4. Appropriate anastomoses
  5. Treat extremity from proximal to distal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the types of compression?

A

UE and LE short stretch and long stretch bandages
Una boot or paste bandages
Four layer wrap
Pneumatic compression/compression pumps
Compression garments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the purposes of compression therapy?

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the first phase of compression therapy (CDT)?

A

INTENSIVE PHASE
Phase 1 of CDT - compression is done using multi-layered short stretch bandaging
* worn around the clock
* considered in-elastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the second phase of compression therapy (CDT)?

A

MAINTENANCE PHASE
Phase 2 of CDT — compression is designed to maintain the limb volume achieved in phase 1
— non custom or custom compression garments during the day
— if they need nighttime compression will utilize short stretch bandages or night time compression garments.

17
Q

Indications for compression

A

UE/LE lymphedema
Venous edema in LE
Edema from post surgery or post trauma
To shape the residual limb post amputation

18
Q

Contraindications for compression?

A

Acute untreated infections
Acute untreated DVT
Untreated cardiac edema
Renal edema
Edema without dx

19
Q

Precautions for compression?

A

Cardiac edema
Arterial disease/wounds
DM
Sensory deficits
Paralysis
Altered mental status
Malignancy
Sensitivity to compression products
Inability to perform home management

20
Q

What is involved with resting pressure during bandaging?

A

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

21
Q

What is involved with the working pressure during bandaging?

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, una boot)

22
Q

What is a short stretch bandage?

A

Can be elongated 10-100% of resting length
LOW RESTING PRESSURE + HIGH WORKING PRESSURE
Minimally elastic
Prevent circulatory compromise and tourniquet effect
Minimize fluid re-accumulation
Loses pressure over time

23
Q

What is a long stretch bandage?

A

Can be elongated >100% resting length
LOW WORKNG PRESSURE + HIGH RESTING PRESSURE
Highly elastic — ace wrap s
May compromise circulation at rest — esp if pulled too tight
Poor support when muscles are working
Maintain pressure over time

24
Q

What are the determinants of compression

A
  1. Elastic component of the bandage
  2. Degree of tension when the bandage is applied — tension on the bandage should approach 50% of the ability of the bandage to stretch
  3. Number bandages applied
  4. Condition of the bandage or garment
25
Q

What is the law of laplace?

A

Pressure that is exerted on the tissues from the bandaging system
Pressure = tension/radius
- Tension = is delivered from the bandage system. Each bandage is applied with even tension
- Radius = smaller the radius of the limb, the greater the pressure exerted no the tissues

26
Q

Why and where do we use padding?

A
  • padding provides equal compression around the limb
    Needs to be applied
  • areas of concavity
  • areas to increase the radius of the limb
  • any areas of concern for the soft tissues
27
Q

How do you apply a short stretch application ?

A
  1. Apply stockinette over moisturized skin
  2. Pad skin and bony prominences
  3. Apply multiple bandages of varying widths — 6cm, 8cm, 10cm, and 12cm
  4. Overlap bandages by 50%
  5. Stretch bandage by 50% for even tension
28
Q

What is the 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
  • should feel more firmness in the lower led and gets squishy as we move up the leg
29
Q

Bandages vs. Garments

A
  • role of compression bandages is to achieve a stable edema reduction of the limb
  • the role of compression garments is to MAINTAIN the treatment results
30
Q

What is the purpose of compression garments?

A
  1. Aid in maintaining interstitial fluid homeostasis
  2. Used for management and prevention
    * should be replaced every 6-9months
31
Q

What is CCL 1?

A

Compression class level 1 — family history varicose veins, mild lymphedema, prevention of venous ulcers, DVT prophylaxis, mild venous insufficiency
20-30 mmHG!!!

32
Q

What are the pressure levels for CCL 2 and 3

A

CCL 2= 30-40 mmHg
CCL 3= 40-50 mmHg

33
Q

How does exercise help lymphedema treatment?

A
  • aimed specifically at promoting lymphatic flow and reducing swelling
  • active, repetitive, resistive OR non resisted motion of the involved body part
  • Should be performed with compression — bandages OR garments
    — allows the muscle to contract against resistance = therefore more effective muscle pump enhancing lymphatic and venous return.
34
Q

Why is skin care important with these patients?

A

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

35
Q

Why is patient education important with these patients?

A
  • Lymphedema is managed not cured
  • Lymphedema exacerbations are not uncommon over time
  • Well managed edema results from adherence with massage, bandaging, compression, and proper skin care
  • Encourage maintainence of ideal weight
  • Psychological issues
36
Q

What is included in home management for these patients?

A
  • Self MLD
  • Self bandaging
  • Compression garments - day and/or night
  • Exercise
    ** LIFELONG MANAGEMENT **
37
Q

What are patient goals with lymphedema management?

A
  • Independence in self management including self bandaging, self MLD, exercise, and skin care
  • Volume reduction
  • Independence in donning and doffing compression garments
  • Demonstrate knowledge of how to care for garments and proper wear schedule
  • Understanding of the etiology, risk, and risk reduction strategies for lymphedema
  • Functional limitations

Physical Agents (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions