Lymphedemia Flashcards
What is Lymphedemia
A chronic disorder characterized by an abnormal accumulation of lymph fluid in the tissues of an extremity or other body part.
Accumulation of lymph fluid is most often due to a mechanical insufficiency of the lymphatic system. In other words, the available lymphatic components are not functioning sufficiently to manage the load of lymph fluid that is present in the system.
Accumulation of lymph fluid is most often due to:
A mechanical insufficiency of the lymphatic system
What are the 2 types of lymphedemia
- Primary
- Secondary
Primary Lymphedemia- Cause
- Caused by a condition that is either congenital or hereditary. Complications to the developing fetus can be a factor as well.
- In PL, lymph vessel or lymph node development is impaired. Although a variety of dysplasias may present themselves, hypoplasia is the most common cause of problems. With hypoplasia there are fewer lymphatics present and they are smaller than normal.
Two of the more common types of primary lymphedema are Milroy’s disease and Meige’s syndrome.
What is the most common cause of problem with primary lymphedema?
HYPOPLASIA
Although a variety of dysplasias may present themselves, hypoplasia is the most common cause of problems. With hypoplasia there are fewer lymphatics present and they are smaller than normal.
Secondary Lymphedema- cause
Caused by the result of some known insult to the lymphatic system.
- Lymph capillaries, vessels, and/or nodes have been removed, blocked, fibrosed, damaged, or necrosed and have become insufficient to manage the lymph load that has accumulated in the involved body part.
Secondary lymphedema is more common than primary
Common causes:
Surgery, Radiation therapy. Trauma, Filariasis, benign or malignant tumor growth, Iatrogenic alterations, Infection, Chronic venous insufficiency, Self-induced or artificial lymphedema
What is CDT?
- Complete Decongestive Therapy
- Comprised of initial reductive phase (phase 1) followed by an ongoing individualized maintenence phase (phase 11)
- The primary goals of CDT are to: RI2DE2
- Reduce subdermal fibrosis
- Inc. Lumph drinage from congested areas
- Improve the skin condition
- Decrease edema
- Enhance pt. functional status
- Enable the pt to adhere to an idependent self care program
What are some common causes of Secondary Lymphedema? FI2RS2T- BC
(9)
- Filariasis
- Iatrogenic alterations
- Infection
- Radiation therapy.
- Surgery
- Self-induced or artificial lymphedema
- Trauma
- Benign or malignant tumor growth
- Chronic venous insufficiency
Which type of lymphedema is more prevalent, Primary or secondary?
Secondary lymphedema is more common
Components of CDT- REEMS
(6)
- Remedial exercise
- Education in LE self-management
- Elastic compression garments
- Manual Lymph drainage (MLD)
- Multi-layer, short stretch compression bandaging
- Skin and nail care
With lymphedema pts what would be the focus of pt treatment ?
- Infection prevention
- Infection is one of the trigger factors for lymphedema
Manual Lymph Drainage
- MLD is specialized manual effleurage technique which is believed to stimulate superficial lymph vessel
- MLD may be direct lymph flow out of congested areas and into functional lymph node basins
- It is a very ight gentle movement
True/ false- you use distal to proximal movements to remove lymph?
False- you need to move proximal to distal- pushing lymph to the nodes that are functioning rather than to the dysfunctional ones
Compression bandaging
- Short stretch bandages have limited extensibility under tension, in contrast to Ace bandages
- Multiple layers of bandages must be applied with low to moderaate tension using more layers in the distal, relative to the proximal positions of the affected limb
- Pressure within the short stretch bandages is low when the pt is inactive, resting posture…Muscle contractions increase the interstitial working pressure as muscles expand within the limited volume of the semi-rigid bandages. Cycling between low resting and high working pressures creates an internal pump that encourages movement of congested lymph along the distal to proximal gradient created by bandaging.
True / False- Following treatment (phase 1) CDT patients should be fitted with a compression garment
True
What are some early signs of Lymphedema?
- Feeling of tightness in the arm
- Pain, aching, or heaviness in the arm
- Swelling and redness of the arm
- Less movement/flexibility in the arm, Hand, wrist
- Rings, bracelets or sleeves do not fit
True or false- Aggressive palpation is important to remove the lymph out of the system/ affected limb
False- aggressive palpation can aggravate lymph nodes
True or false- short stretch bandages are only used for lymphedema pts
False- also used for pts with vascular issues as well
What are the typical signs and symptoms of lymphedema? (PG 29-30) SHILLINGS- F
- Swelling
- Heaviness of limb
- Increased susceptibility to infection
- Lymphatic cysts or fistulas, lymphorrhea, papillomas, hyperkeratinosis
- Loss of mobility
- Impaired wound healing
- Numbness and/or tingling
- Great discomfort (often described as pain)Sensation of pressure or tightness of skin or limb
- Fibrotic changes to the skin and underlying connective tissues
What does the term “limb at risk” mean?
It serves as a reference for the extremity closest to the lymph vessel disruption. Any part of the body supplied by the lymphatic system and subsequently disrupted can be at risk.
Some points to know about the “limb at risk”
- Precautions must be observed by everyone who is at risk in order to prevent as many cases as possible. D/t the unique variations in lymphatic anatomy for each individual, the damage and subsequent tissue changes that led to signs and symptoms may take months to years to appear clinically.
- Those who have already developed lymphedema should use the same list of precautions to control or avoid exacerbations of their symptoms as those who are at risk.
- The parts of the body at risk for developing lymphedema will most often be those surrounding and distal to lymph vessel disruption.
- The body part most often affected by lymphedema are the extremities d/t disruption of axillary or inguinal lymph nodes and /or vessels.
- When a person is given a list of precautions or guidelines for care of an extremity, the same instructions can be applied to any other body part at risk, such as the head, neck, trunk, abdomen, or genital regions.
Risk factors of Lymphedema- AOI
- Age- the older a person is when the lymphatic system insult occurs, the more likely they are to develop lymphedema. This is explained by the slowing of all circulation systems, and the less efficient uptake of all fluids due to aging.
- Obesity- slower circulation will lead to the biosynthesis of fat, while faster circulation will lead to lipolysis. Dr. Jeane A. Peterek states, “we already knew that infection and obesity contribute to the onset of lymphedema, but we were surprised to learn that weight gain following a cancer diagnosis is an especially high risk factor.”
- Infection- onset or exacerbation of lymphedema may be provoked by a local inflammatory response that may occur with infection.
True / False- weight gain following a cancer diagnosis is an especially high risk factor.”
True
Initiating factors of lymphedema
The stimulus or trigger that causes the initial onset of the symptoms of lymphedema will be different for each person.
- Local or systemic events that cause Hyperemia to the tissues of the involved limb(s): examples include- hot packs to the involved limb, hot tubs, summer weather, handling hot food directly, aggressive massage, overuse of the involved limb, soft tissue sprains, and/or strains. (Hyperemia- excess blood to tissue)
- Changes in pressure: examples include airplane travel, which involves pressure changes that allow interstitial fluid to pool in the dependent extremities while the vasomotor activity of the lymphangion is at a low level (the individual is at rest during the flight). Scuba diving is another example External applications of tight clothes, aggressive massage, and long periods of sleeping.
- Insult to skin integrity: infection is a risk factor, examples of triggers include pet scratches, gardening related injuries, insect bites, contusions, injections, or IV cannulation.
- Changes in weight and body fluid volumes: pregnancy, weight gain, chronic venous insufficiency, related complications from other health problems, and certain meds.
- Medications
What is hyperemia?
Excess blood to tissue
What are some prevention strategies for lymphedemia?
Website: http://www.gbmc.org/18stepstoprevention
- Skin Care- avoid trauma/injury to reduce infection risk
- Activity/lifestyle- maintain optimal weight
- Avoid Limb Constriction
- Compression Garments
- Extremes of Temperatures
- Additional Practices Specific to LE Lymphedema- avoid prolonged standing, sitting or crossing legs
How should pitting in edema be interpreted?
- Pitting occurs when pressure is applied to a specific spot with the examiner’s finger and an indentation remains. The implication is that the onset of swelling is more recent and, by some examiners’ estimates, less serious.
- A nonpitting response occurs when pressure applied to a specific spot does not leave a noticeable indentation. The implication is that swelling is significant, more advanced fibrotic changes have occurred subcutaneously, and fluid cannot be displaced with mere pressure.
What is CDT
Complete Decongestive Therapy
