M8: 3 Flashcards
Accumulation of fluid with lymphedema is usually due to
Mechanical insufficiency of the lymphatic system
Primary lymphedema caused by
Congenital or hereditary condition
Secondary lymphedema caused by
Some insult to the lymphatic system
- surgery
- radiation therapy
- trauma
- worm infestation
- tumor growth
- iatrogenic
- infection
- chronic venous insufficiency
Common s/s of lymphedema
- HEAVINESS
- swelling
- n/t
- pressure or tightness of skin
- susceptibility to infection
- fibrosis
- lymphatic cysts/fistulas
- impaired wound healing
Etc etc etc
What is the limb at risk
Extremity closest to the lymph vessel disruption
Risk factors for secondary lymphedema
- age
- obesity
- infection
Initiation factors for lymphedema
stimulus that causes varies
- pressure changes
- skin integrity insult
- BW change
- fluid volume change
Prevention strategies for lymphedema
- avoid trauma/injury to reduce infection risk
- exercise regularly
- avoid constriction
- compression garments
- avoid temp extremes
What does “pitting” edema imply?
ACUTE
Fluid is still able to move
What does “non-pitting” imply?
CHRONIC
Fluid is now dense and less likely to move
CDT =
Complete Decongestive Therapy
2 phases of CDT
- Treatment
2. Self-management
When is edema clinically detectable?
Only once interstitial tissue volume reaches 30% above normal
Edema: 1+
Barely detectable
Edema: 2+
- Slight indentation visible when skin is depressed
- indentation remains after depression
Edema: 3+
A deeper fingerprint returns to normal in 5-30 seconds
Edema: 4+
Extremity may be 1.5 - 2x normal size
What is involved in the tx phase of lymphedema management?
- meticulous skin care
- manual lymphatic drainage
- lymphedema bandaging
- exercise in bandaging
- compression garment (at end of phase I)
What is involved with phase II lymphedema mgmt?
- compression garment during day
- lymphedema bandaging at night
- exercise in garment or bandaging
- meticulous skin care
- MLD as needed
How is MLD different from massage?
- light and specific
- requires specialized education to be delivered accurately
MLD: duration of tx
30-60 mins, depending on
- limb size
- severity of sx
- amt of fibrosis
Short stretch bandaging: strong support during
Muscle contraction
Short stretch bandaging: during rest
Don’t constrict during rest
How long are short-stretch bandages to be worn?
23 hrs per day during tx phase
How should pts exercise during the tx phase for lymphedema?
maintain or increase activity level while wearing the bandages
What exercise precautions should be taken for a lymphedema pt?
- minimize DOMS
- smooth, rhythmic exercise with light resistance
- depends on fitness level, age, overall health
- avoid anything that might decrease transport capacity of lymph vessels
When do you fit a pt with compression garments?
When involved limb has reached normal or near normal size
