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Medcon Rehab IV > Lymphedema Part 2+Quiz > Flashcards

Lymphedema Part 2+Quiz Flashcards

1
Q

Review: Lymphatic Vessels

Smallest to largest

A

Lymph Caps→ Lymph precollectors→ Lymph collectors→ Lymphatic trunks→ Lymphatic ducts

*Network runs Distal → Proximal

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2
Q

Direction of Lymphatic Network

A

Distal → Proximal

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3
Q

Lymphatic Vessels

Lymph Capillaries (smallest)

A

small, thin w swinging flaps→ capable of absorbing macromc’s

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4
Q

Lymphatic Vessels

Lymph PREcollectors

A

Oriented vertically; connect lymph caps to deeper lymph vessels; may or may not have valves*

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5
Q

Lymphatic Vessels

Lymph Collectors

A

Innervated by SNS; contain valves w/ “lymphangions”→ contract to help move lymph fluid proximally

→ Lymhangiomotoricity

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6
Q

Lymph Vessels

Lymphatic Trunks

A

Larger; innervated SNS; contain valves

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7
Q

Lymph Vessels

Lymphatic Ducts

LARGEST*

A

LARGEST; transport lymph fluid TO R & L venous angles; RETURN fluid into vascular system

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8
Q

Lymph Flow====

A

Distal → Proximal

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9
Q

Fluid Transport in the Lymphatic System

IMPORTANT PART***

A
  • NORMAL lymphatic system, in absence of patho:
    • Working 1/10 as hard as it is MAXIMALLY capable of working***
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10
Q

Link bw Lymphatic & Circulatory Systems, and Edema

A
  • Edema→ excess accumulation of interstitial fluid
  • Edema is prevented if fluid OUT of capillaries EQUALS amt of fluid ABSORBED by venous & lymphatic capillaries

Edema→ inc’d cap hydrostatic pressure, inc interstitial osmotic pressure, incd venule permeability, overwhelmed lymphatic system

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11
Q

Link bw Lymphatic System & Edema

A
  • Edema→ persists when lymphatic insuff.
    • transport capacity SMALLER vs amt fluid needs to be transported
    • 3 types:
      1. Dynamic (most common*), transient maybe
      2. Mechanical (something wrong w/ parts)
      3. Combined
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12
Q

Lymphatic Insufficiencies:

Dynamic Insuff.

A
  • Amt of fluid (H20 or H20+PRO) needing to be transported (lymph load) EXCEEDS transport capacity of anatomically and functionally intact lymph system
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13
Q

Lymphatic Insufficiencies:

Dynamic Insuff.

Causes

A

Cardiac Insuff (CHF), Pregnancy, Immobility, Chronic Venous Insuff.

NOTE: Long-term dynamic insuff. can cause damage to lymphatic system===> Mechanical Insuff.

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14
Q

Lymphatic Insufficiencies:

Dynamic Insuff.

Treatment*

A
  • Geared towards reducing lymphatic load
    • Elevation: med clearance for cardiac insuff.
    • Compression: med clear for cardiac insuff.
    • Exercise*******
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15
Q

Acute Edema due to Trauma, Injury, Inflammation

This would be an ex. of ___________ Insuff.

A

DYNAMIC Insuff.

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16
Q

Acute Edema due to Trauma, Injury, Inflammation

A
  • Local edema due to trauma or injury→ NORMAL part of inflammatory process
    • Exudation→ incd permeability and vasodilation of blood vessels→ INCd filtration of fluid and PROs into interstitium surrounding injured area
      • Goal: bring PROs and circulating cells TO site of injury
  • Once cause of injury removed, normal healing takes place, tissues return to normal size and structure, edema resolves
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17
Q

Lymphatic Insuff

Mechanical Insuff (something wrong w/ parts)

A
  • Reduced transport capacity due to functional or anatomical deficits in the lymphatic system
    • cannot manage normal or inc’s in lymph load
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18
Q

Lymphatic Insuff

Mechanical Insuff (something wrong w/ parts)

Functional and/or anatomical deficits caused by:

A
  • Sx
    • lymph node dissection, sx interferes w/ lymph system due to scar tissue or removal lymph caps
  • Radiation Tx
    • scar/fibrosis of tissue and lymph vessels
  • Trauma to lymph vessels
    • long term lymphedema, valvular insuff, lymph stasis, lymph fibrosis
  • Congenital/Genetic factors, inflammation, infx/parasite
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19
Q

Lymphatic Insuff

Mechanical Insuff (something wrong w/ parts)

Treatment:

A

Complete Digestive Therapy (CDT)

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20
Q

Lymphatic Insuff’s

CHART*

A

Just know Dynamic and Mechanical***

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21
Q

Lymphatic Insuff’s

Dynamic

Broken down into simpler facts

A
  • Anatomically and functionally INTACT lymph system
  • Lymphatic Load > Transport Capacity (TC)
  • Tx: Elevate, Compression, Exercise
  • MLD NOT effective*
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22
Q

Lymphatic Insuff’s

Mechanical Insuff.

Broken down

A
  • Anatomically and/or functionally NON-intact lymph system (structurally different)
  • TC < Norm lymphatic load
  • Tx: Complete Decongestive Tx, MLD, Compression, Exercise**
  • Avoid cond’s that inc net filtration
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23
Q

Lymphedema is now considered to be a _____________________

A

Chronic, Inflammatory disease

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24
Q

What is Lymphedema?

Def. #1

A

Swelling of soft tissues that results from the accumulation of PRO-rich fluid in the extracellular spaces.

Caused by DEC lymphatic transport capacity and/or INC lymph load and is most commonly see in the extremities, but can occur in head, neck, abdomen, genitals

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25
Q

What is Lymphedema?

Def #2:

A

When collection of PRO-rich fluid persists in specific area, it can attract more fluid and thus worsen swelling.

In addition to INCd fluid in area, body experiences an inflammatory rxt resulting in scar tissue called fibrosis in the affected area

Tell-Tale Sign→ Darker spots (fibrosis/scar tissue)***

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26
Q

Primary vs. Secondary (seen more commonly) Lymphedema

A

see chart and note highlighted areas

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27
Q

Primary Lymphedema

Etiology and Assocd W/:

A
  • Etiology:
    • “Lymphangiodysplasia”→ developmental abnorm in lymphatic system
      • Hypoplasia→ less vessels (# or size)
      • Hyperplasia→ greater than normal # or size of vessels
  • Assocd MOST w/:
    • Classified by age of onset
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28
Q

Secondary Lymphedema (seen more commonly)

Etiology and Assocd W/:

A
  • Etiology:
    • Lymph. sytem develops normally, and lymphedema develops due to 2* causes
  • Assocd MOST w/:
    • CVI
    • Lymph node dissection & Cx
      • breast, head, neck, melanoma, Genito-urinary
    • Under-developed countries, filariasis infx
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29
Q

Primary Lymphedema

Milroy’s Disease (Nonne-Milroy-Syndrome)

important stuff

A
  • Congenital (appears @ birth)
  • Boys>girls
  • One leg and/or one arm and/or face and/or genitals
  • Type I congenital hereditary lymphedema
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30
Q

Primary Lymphedema

Meige’s Syndrome

A
  • Presents @ puberty
  • Girls > Boys
  • Hormonal?
  • U/L LE
  • Type II NON-congenital hereditary lymphedema
  • Lymphedema Praecox (occurs before 35yo)
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31
Q

Primary Lymphedema

Lymphedema Tardum

A
  • AFTER 35yo
  • MAYBE B/L
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32
Q

Primary Lymphedema

3 types:

A
  1. Milroy’s Disease (Nonne-Milroy-Syndrome)
    1. Congenital (@ birth)
    2. one leg and/or one arm and/or face and/or genitals
  2. Meige’s Syndrome
    1. @ Puberty
    2. U/L LE
  3. Lymphedema Tardum
    1. AFTER 35yo
    2. maybe B/L
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33
Q

Secondary Lymphedema

Primary cause?

A

Filariasis

*mosquito-born parasite Filaria

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34
Q

Secondary Lymphedema

Primary vs Secondary Causes

A
  • Primary→ Filariasis
    • Indigenous peoples
  • Secondary→ Cx and comps from Cx and tx
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35
Q

Secondary Lymphedema

Western Hemisphere and Developed Countries

A

2* effect from Sx or radiation due to Cx & lymph node dissection

  • Chronic venous insuff.
  • Trauma to lymph tissue
  • Self-induced lymphedema
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36
Q

1 cause of LE Edema IN GENERAL……

A

VENOUS DISEASES

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37
Q

Venous Diseases & Edema

A
  • #1 Cause of LE edema in general****
  • Common cause of Secondary Lymphedema
  • DVT, Varicose Veins, Chronic Venous Insuff. w/ Hemosiderin Staining
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38
Q

Venous Diseases

#1 Cause of LE Edema

Characteristic Chart

A

See Chart

*Just KEEP READING IT!!!!

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39
Q

Venous Diseases→ #1 cause LE edema

  • Asymptomatic, dull ache, tight feeling
  • U/L, sudden onset
  • Tenderness or pain in calf
  • Leg or calf swelling
  • Dilation of superf. veins
  • Pitting edema
  • Warm, red
  • Hx of trauma, immobility, cx, post-sx, genetic predispo.
A

DVT

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40
Q

Venous Diseases→ #1 cause LE edema

  • Asymptomatic, Gradual dull ache
  • Heaviness, tension, fatigue
  • Sx’s INC w/ standing
  • Elevation provides relief
  • Cramping→ esp @ night
  • Skin changes/Hemosiderin staining
  • Thinning of skin
  • Can result blood clots, phlebitis, ulcers
A

Varicose Veins

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41
Q

Venous Diseases→ #1 cause LE edema

  • Sx’s INC in standing- painful, burning, throbbing, sudden onset
  • Progressive edema may be severe
  • Hemosiderin staining→ brown discoloration due to breakdown HgB
  • Venous stasis ulcers
  • Thinning of skin or thickening
  • Fibrosis of tissue
  • Dermatitis or cellulitis
  • May lead to lymphedema (venous system cannot mng fluid load, and lymph system overwhelmed)
A

Chronic Venous Insuff

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42
Q

Lymphedema

Gen Characteristics→

A
  • SLOW onset, starts distally
  • Asymmetrical/U/L
  • Cellulitis common SE
  • Early→ Pitting Later→ Fibrosis
  • No pain, but achy, heavy
  • Ulcerations not common unless w/ CVI
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43
Q

Whats the big deal about swelling?

SEs acute/chronic edema

A
  • Impaired mobility of pt and/or body segment→ impaired function
  • INCd pain
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44
Q

Whats the big deal about swelling?

SEs acute/chronic edema

Impaired delivery of nutrients to tissue and impaired ability to remove waste products

A

More edema in interst. space==> lg dist bw blood vessels and tissue==> delivery of nutrients and removal of waste diff.

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45
Q

Whats the big deal about swelling?

SEs acute/chronic edema

Risk of converting acute or vascular edema into lymphedema or phlebolymphedema

A

Skin and tissue fibrosis

Dermato. cond’s

INCd risk infx (cellulitis)

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46
Q

2* Tissue Change

Fibrosis

A

Collagen produced as norm resp. to inflamm. In lymphedema→ OVERproduction of collagen

  • Tissue becomes→ firm, indurated, NON-pitting
  • May be direct result:
    • chronic edema
    • radiation
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47
Q

2* Skin Changes

Hyperkeratosis

A

Overly thickened epidermis

  • Occurs in presence of lymph stasis
  • Wart like, hard calluses, Lichenization (see pics)
  • Starts @ toes
  • Meticulous skin care, Rx ointments
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48
Q

2* Effects of Lymphedema: Cellulitis

KNOW THIS ONE!!!!!!

Due to:

A
  • *Cellulitis NOT correlated w/ amt of edema
  • Due to:
    • Local bacteria/viral infx (cut/scrape, bug bite)
    • Presence of PRO-rich fluid
    • Moist warm environ.
    • Dmg to lymph. system→ immune syst. deficit
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49
Q

2* Effects of Lymphedema: Cellulitis

KNOW THIS ONE!!!!!!

S/S

A
  • Expanding reddened area, Pain, warm/hot touch, fever, gen feeling of being sick
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50
Q

2* Effects of Lymphedema: Cellulitis

KNOW THIS ONE!!!!!!

Tx:

A
  • Antibx therapy
  • *NOTE: Pts w/ chronic lymphedema often provided Rx for antibx, and are instructed to begin tx immediately upon suspicion of cellulitis, and call PCP immediately!
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51
Q

Evaluation of Pt w/ Lymphedema

Hx of Present Illness

52
Q

Evaluation of Pt w/ Lymphedema

PMH

53
Q

Evaluation of Pt w/ Lymphedema

Social Hx and PLOF

54
Q

Evaluation of Pt w/ Lymphedema

Examination

A

NOTE: NO sharp/dull→ do not want to risk breaking skin*****

Functional status→ Transfers-ESP sit-to-stand**

see pics

55
Q

Evaluation of Pt w/ Lymphedema

Examination

Integumentary*** KNOW IT!!!

A
  • Tissue texture:
    • Soft/firm/spongy/fibrotic
  • Tissue appearance:
    • Dry/Weeping/Thin/Shiny
    • Discoloration/Hemosiderin staining/reddening/cyanotic
  • Presence abnorm tissue:
    • Hyperkeratosis/papillomas/cysts
  • Infx’s:
    • Cellulitis/fungal
  • Presence open wounds:
    • Venous/Arterial
  • Redundant tissue:
    • Must remember to examine beneath/in-bw skin folds****
56
Q

Pitting Edema Scale

Characteristics to look @:

A
  • Some based on depth of indentation following fingertip pressure
  • Some based on length of time indentation remains following fingertip pressure
57
Q

Staging of Lymphedema

___________ are the most distinguishing criteria for Staging lymphedema

A

Tissue changes***

NOTE: volume of limb DOES NOT determine stage

58
Q

Staging of Lymphedema

Helps to what?

A

Classify progression of dis. process

59
Q

Staging of Lymphedema

Applies only to 2 areas: _____ and _____

A

Arms and Legs

60
Q

Staging Lymphedema

Stage #s

A
  • Stage 0→ Latent Lymphedema
  • Stage 1
  • Stage 2
  • Stage 3
61
Q

Stages of Lymphedema

From Patho book

ALL FIRST

A
  • Stage 0 (Latent or Pre-Clinical Lymphedema)
    • Lymph transport capacity reduced; no clinical edema present
  • Stage I→ Spontaneously Reversible
    • Accumulation of pro-rich, pitting edema
    • reversible w/ elevation; area affected may be norm size upon waking in morn.
    • Incs w/ activity, heat, humidity
  • Stage II→ Spontaneously Irreversible
    • Accumulation of pro-rich NONpitting edema w/ connective scar tissue
    • Irreversible; does NOT resolve overnight; inc’ly more difficult to pit
    • Clinical fibrosis present
    • Skin changes present in severe stage II
  • Stage III (Lymphatic Elephantiasis)
    • Accumulation pro-rich edema w/ sig inc in connective and scar tissue
    • Severe NONpitting fibrotic edema
    • Atrophic changes (hardening of dermal tissue, skin folds, skin papillomas, hyperkeratosis)
62
Q

Staging Lymphadema

Stage 0 (Latent Lymphedema)

A

LTC (lymph transport capacity) reduced; no clinical edema present

63
Q

Staging Lymphedema

Stage I

A
  • Accumulation pro-rich, pitting edema
  • Reversible w/ elevation; area affected may be norm size upon waking up in morning
  • INCs w/ activity, heat, humidity
64
Q

Staging Lymphedema

Stage II (now nonpitting)

A
  • Accumulation of pro-rich, NONpitting edema w/ connective scar tissue
  • Irreversible; does NOT resolve overnight; inc’ly MORE diff to pit
  • Clinical fibrosis present
  • Skin changes present in severe stage II
65
Q

Staging Lymphedema

Stage 3 (Lymphostatic Elephantiasis) (more scarring now)

A
  • Accumulation of pro-rich edema w/ sig. inc connective and scar tissue
  • Severe nonpitting fibrotic edema
  • Atrophic changes→ hardening of dermal tissue, skin folds, skin papillomas, hyperkeratosis)
66
Q

Stemmer Sign typ appears in Stage ______

67
Q

The Stemmer Sign

Typ Stage II (nonpitting edema now)

A

Try to lift skin on dorsum of fingers/toes

  • (+) Sign: skin can NOT be lifted, or only lifted w/ difficulty compared to uninvolved side
    • Indicates presence of Lymphedema
  • (-) Sign: skin CAN be lifted w/out diff.
    • Does NOT R/O lymphedema***
68
Q

Stages of Lymphedema

Simonds Chart from lecture***

69
Q

Stages of Lymphedema

*Simonds Chart

Stage 0 (Latent or Pre-Clinical Edema)

A
  • Indicates @ risk for dev. lymphedema
  • LTC reduced, but still capable of managing lymph load
  • NO edema present
  • Bioimpedance MAY detect presence of edema
  • May remain in stage 0 indef, or progress
  • Goal→ Risk reduction
70
Q

Stages of Lymphedema

*Simonds Chart

Stage 1 (Spontaneously Reversible)

A
  • Swelling→ visible, pitting; pro-rich fluid
  • Elevation w/ reverse edema (temporary)
  • Swelling may go away overnight
  • Swelling returns w/ limb in dep. pos.
  • Tissue soft and NO fibrotic changes
71
Q

Stages of Lymphedema

*Simonds Chart

Stage II (Spontaneously Irreversible)

A
  • Fibrosis present
  • Pitting more diff.
  • Stemmer Sign is (+)
  • Vol. of swelling is INCd
72
Q

Stages of Lymphedema

*Simonds Chart

Stage III (Lymphostatic Elephantiasis)

A
  • Giant fibrotic changes***, incd fibrosis
  • Thickened, INelastic skin
  • NO PITTING
  • Add. skin changes→ hyperkeratosis, papilloma, cysts, skin folds deepen
  • Incd chance recurrent infx
73
Q

Measures of Edema→ Circumferential Measures

A

Measure in cm, along length of extremity (every 5-10cm)

Involved vs Uninvolved

74
Q

Measures of Edema

Volumetric/Water Displacement

A
  • Place known vol. of water in receptacle
  • Submerge body part/segment
  • Meaure water displacement.
75
Q

Bioimpedance Analysis (BIA)

A

Non-invasive

  • Measures body comp based on electrical conductive props of diff body tissues
  • Can detect inc fluid lvls in body part BEFORE visible or measurable
  • early detection of lymphedema
76
Q

Measures of Edema- Bioelectric Impedance (Bioimpedance)

A
  • Determines electrical impedance, or opposition to flow of electric current thru body tissues which can then be used to calc measure of ECF in limb being assessed
  • Current flows more quickly thru fluid
    • More liquid→ faster current travels***
77
Q

Imagining for Lymphedema

A

Lymphoscintigraphy

78
Q

Measures of Edema- Perometry (Optoelectronic Volumetry)

A

Assess size and composition of limb

  • Placed into vertically or horizontally oriented frame
  • Limb volume, %diff bw selected measurements, contour, cross-sectional area displayed
79
Q

Measures of Edema-

Photography

A

Correlate w/ measurements

Self-explanatory→ take pics

CONSENT****

80
Q

Treatment for Lymphedema=_______

A

CDT (Complete Decongestive Therapy)

81
Q

Treatment for Lymphedema

CDT

4 Components:

A
  1. Skin Care
  2. Manual Lymph Drainage (MLD)
  3. Compression (Bandaging and/or garments)
  4. Exercise***
82
Q

Lymphedema

Tx Concepts and Approaches

2 Notes:

A
  1. ANY lymphedema tx tech. can be used for other types of edema

BUT….

  1. Tx techs for other types of edema ARE NOT RECOMMENDED for use w/ lymphedema***
83
Q

Complete Decongestive Therapy (CDT)

2 Phases of Care

A
  • Phase 1→ Decongestion
  • Phase 2→ Maintenance

See pics for components of ea.

84
Q

Complete Decongestive Therapy CDT

Phase 1: Decongestion

GOALS:

A
  1. Vol. reduction by mob’ing lymph fluid
  2. Improve tissue texture
  3. Improve ROM and functional ability
  4. Pt edu→ skin care, risk reduction, bandaging, exercise

NOTE: proceed to phase 2 when max. dec in vol./ bennies achieved

85
Q

Complete Decongestive Therapy CDT

Phase 2: Maintenance

GOALS:

A
  • Maint. of phase 1 achievements
    • Compression garments, Self-MLD
  • Further reduction volume
  • Further improve. tissue texture
  • Pt edu→ all aspects of self care
86
Q

Complete Decongestive Therapy

Precautions

A
  • Malignancy
    • may be indicated if palliative
  • Cardiac Hx & HTN
    • avoid MLD to neck
  • Bronchial asthma
    • MLD may induce asthma attack
  • Acute DVT
    • avoid affected limb until therapeutic. anticoag’d
  • Pregnancy/Dysmenorrhea→ CANNOT undergo CDT*
  • Hyperthyoid
    • avoid neck
  • Abdom sx/inflammatory cond’s of GI/Abdom Aortic Aneurysm
    • avoid abdomen
87
Q

Complete Decongestive Therapy (CDT)

Contraindications (DO NOT DO)

A
  • Cardiac edema
  • Cellulitis (until tx’d)
  • Atherosclerosis
    • avoid MLD to neck
  • Renal failure
    • need phys. clear.
  • Arterial Insuff.
88
Q

CDT→ Skin Care

KEEP SKIN:

A

Clean, dry, moisturized, intact*

CDT can be performed in presence of wounds/skin probs as long as tx’d and monitored*

89
Q

CDT→ Manual Lymph Drainage (MLD)

What IS it?

A
  • Lt, manual massage w/ specific strokes to stim. lymph vessels and/or tissue
  • Firm/specialized/standard tech’s in areas of fibrosis
90
Q

MLD

Effects of MLD

A
  • INC in lymph production
    • does not mean inc in edema, means more fluid taken up from tissue into lymph system*
  • INC in lymphangiomotoricity
    • inc lymph transport into Central venous system
  • Reverse or divert lymph flow
    • circumvent lymph away from and around dmg’d vessels
  • INC venous return
  • Diuretic effect*
    • inc need to urinate
  • Analgesia
    • transport of noxious subs. AWAY from tissue***
91
Q

MLD

Summary…

A

MLD INCs uptake and transport of….lymph loads and becomes primary route for LG mc’s to exit involved tissue. Compression alone does NOT stim lymphatic system. Special techs used in MLD INC interstitial fluid uptake into lymph cap. network. This filling force along w/ stretch stim of skin traction raises intravascular pressure and peristalsis of lymph collectors, trunks, and ducts. Ultimately, lymph fluid empties into blood circulation causing area for more absorption along continuum.

92
Q

CDT→ Compression

Broken into subtopics

Goal/Obtained by use of:

A
  • Goal:
    • Facilitate and/or maintain Vol. reduction of the body part
    • Prevent re-accumulation of fluid
  • Compression obtained by using:
    • Short stretch bandage
    • Compression garments
    • Compression pumps
93
Q

CDT→ Compression

Broken into subtopics

Physical Effects:

A
  • INCd pressure in tissue, INCd pressure on lymph/blood vessels
  • DECd cap. filtration
  • INCd venous and lymph return
  • INCd effect of muscle pump action during exercise/activity
  • Helps break up and soften fibrosis in tissue
  • Support for tissues that have lost elasticity
94
Q

CDT→ Compression

Broken into subtopics

Correct Application:

A
  • Apply MORE bandage layers DISTALLY vs proximally*
  • Pressure→ > DISTALLY vs proximally*
  • Assists fluid mvmt→ DISTAL to proximal direction*
  • Prevents re-accumulation of fluid in extremity*****
95
Q

CDT→ Compression

Broken into subtopics

External Support of involved limb (via compression) ALWAYS necessary due to:

A
  • Loss of elasticity in skin as result of perm. dmg from edema
  • Perm dmg to lymph vessels
  • Likelihood of lymphedema reoccurrence
96
Q

Compression Pressures

Ex’s

A
  • MUST be GREATEST Distally and gradually DEC proximally
  • Incorrect== complications
97
Q

Compression Bandages

2 MAIN Types:

A

Short Stretch vs. Long Stretch

98
Q

Compression Bandages:

Short Stretch

A

Used for management of lymphedema

99
Q

Compression Bandages:

Long Stretch

A

NOT used for mgmt of Lymphedema

100
Q

Working and Resting Pressures of Compression Bandages

A
  • Working→ amt pressure exerted by bandage on the tissue while mm’s and joints Actively moving*
  • Resting→ amt pressure exerted by bandage on tissue when mm’s and joints are @ Rest
101
Q

Long vs. Short Stretch Compression Bandages

Which should you try FIRST????

A

SHORT-STRETCH!!!

102
Q

Long vs. Short Stretch Compression Bandages

Long Stretch + Ex’s

A

Ex. ACE bandage

  • Elasticity→ provided by weaving latex OR elastic fibers thru bandage
  • Have a LOW working pressure
    • mm contracts→ bandage stretch
  • Have HIGH resting pressure
  • NOT suitable for lymphedema mgmt***
103
Q

Long vs. Short Stretch Compression Bandages

Short-Stretch

*TRY FIRST!!!

A
  • Elasticity→ occurs as result of cotton weaving method
  • Provide HIGH Working pressure
    • mm contracts→ bandage does NOT stretch much to accommodate
  • Very LOW Resting pressure
    • risk dmg to tissue and vessels LOW
  • Suitable for use w/ lymphedema mgmt****
104
Q

Bandaging Technique and Materials

GOALS:

A
  • Create proper pressure gradient
  • Insure pt can remain functional while wearing bandage
  • Bandage must be comfortable
  • Bandage must be durable in order to remain in place bw PT sessions***

See pics for Compression Bandaging Ex’s ***

105
Q

Transitioning to Compression Garments

A
  • Once reduction in limb has been achieved→ bandaging DIScontinued and Garments ordered
    • bandaging may continue when not wearing garments, or during exacerbation
  • Most likely worn t/o life
  • Prophylactically to prevent edema e.g. when on airplane

Must be fitted properly!!!

106
Q

Compression Garments:

Things to Consider:

A
  • Compression lvl needed (mmHg)
  • Day/Night time
  • Style, Custom vs ready to wear
  • Flat knit vs circular
  • Pts ability to don/doff indep.
  • Function when wearing
  • Cosmesis, cost, compliance*
107
Q

Compression Garments:

Daytime

A
  • Need to: be more cosmetically acceptable, allow full ROM and activity, fit underneath clothes
108
Q

Compression Garments

Nighttime

A
  • Alleviates→ need for compressions @ night
  • Bulky
  • Night time so do not need to be comsetic. pleasing or fit under clothes
109
Q

Compression Garmnents

Ready to Wear:

A

Several sizes/lengths, fit best on proportional and reg. shaped limbs, less $$$, quicker to obtain

110
Q

Compression Garments

Custom Made

A

Best for irregularly shaped limbs, PRECISE measurements needed*, more $$$, easier to don/doff

111
Q

Compression Garments

2 types:

A
  1. Flat Knit
  2. Circular Knit
112
Q

Ex’s of Variety of UE Compression Garments

A

Arm sleeve, Glove, Gauntlet

113
Q

Ex’s of a Variety of LE Compression Garments

A

Sock, Foot, Knee high, Thigh high, Leggings, Bike shorts, Pantyhose

114
Q

Compression Garments

Function, Cosmesis, Compliance, Cost

A
  • Function: pt should be able to maint. highest functional lvl
  • Cosmesis: If not cosmetically acceptable, won’t wear (think back to P&O!!!!)
  • Compliance: Essential for mgmt
    • cosmesis, ease don/doff, comfort, functional ability while wear
  • Cost: Prices vary
115
Q

Compression Pumps

AKA: Pneumatic compression, Mech. Compression, and/or Intermittent Pneumatic Compression

A
  • Utilizes sleeves that fills w/ air to predetermined amt pressure
  • NEWER→ mult. chambers inflate sequentially (distal→proximal) ==> “milking” type of compression
  • ***Mechanical intermittent compression remains controversial
    • lymph may leave distal extremity but pool in prox. segments
116
Q

Exercise and Lymphedema***

In general…

A
  • Exercise is key component in Tx of Lymphedema!!!
    • Regain: Strength, endurance, ROM
    • Facilitates: Fluid uptake while wearing compression bandage by INC working pressure of bandage, Wt reduction in overWt./Obese pts
    • Improves mood, outlet for socialization***
117
Q

Exercise and Lymphedema***

During Intensive phase of lymphedema mgmt:

A

Ex’s generally remedial in nature during this phase

118
Q

Exercise and Lymphedema***

Can progress to Resistive Exercises*

A

Undertaken gradually in order to prevent worsening of lymphedema

119
Q

Exercise and Lymphedema***

Aerobic exercise + Types

A

Helps to reduce edema by INCing flow of lymph***

  • Swimming/Water walking
    • INCd pressure exerted by water
    • avoid if skin not intact*
  • Yoga
    • flexibility inc, facilitates: deep breathing, postural alignment
  • Pilates
    • Core strength
  • Return to PLOF is goal for most active pts***
    • Self-monitor for improvement/worsening= KEY*
120
Q

POC→ CDT

Ideally vs Realistically

A
  • Ideally, pts should be seen for CDT 5x/week
    • compression bandaging worn 24hr/d
    • compression bandage removed daily
      • wash/hang dry
    • skin washed daily bw wrapping*
  • Realistically, pts are seen for CDT 2-3x/wk
    • compression bandaging worn 24hr/d
    • compression bandaging removed just before next tx session or during tx session
    • Skin washed bw bandaging
121
Q

POC-CDT

Delineate time frames and Tx Plan

Example Cont’d…

A
  • Pt will be seen 3x/wk for 4wks
  • MLD to RLE towards R. axilla and L inguinal lymph nodes
  • Skin care*
  • Compression bandaging→ R. toes, foot, leg, and thigh using gray foam in add. to short-stretch bandage
  • TherEx, gait training, stair training
  • Assess. for compression garments when volume red. achieved
  • Pt Edu→ skin care, risk reduction, self-MLD, self-bandaging, HEP, use and care of compression garments
  • Drivers training program prn
122
Q

Lymph Caps are _______ in diameter vs blood caps

123
Q

Both lymph caps AND blood caps carry ______ and ______

A

RBCs; WBCs

124
Q

Which Stage of lymphedema?

Elevation of the edematous limb will alleviate or resolve swelling in Stage____

125
Q

Malignancy is NOT a contraindication of CDT

T/F???

A

TRUE!!!

Malignancy is NOT a contraindication of CDT

126
Q

Reverse or Direct Lymph flow is an effect of _______

Medcon Rehab IV (18 decks)

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