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ACOLS > Phases and Components of CDT > Flashcards

Phases and Components of CDT Flashcards

1
Q

Phase II - Components

A
  • Also known as the self-management, or improvement phase
  • Involved extremity may have reached a normal size if treatment started early Stage 1
  • Lymphostatic fibrosis will still be present if CDT started in late Stage 1 or Stage II
  • Fibrotic tissue can take several months to resolve.
  • The patient must assume responsibility for managing, improving, and maintaining the results achieved in phase I.
  • Daily care is vital - skin care, compression garments, bandages at night, MLD, exercises
  • Self-management is a lifelong process
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2
Q

Phase I - Components

A
  • Known as the Intensive Phase
  • Daily treatment, patient needs to be aware
  • Consists of skin care, manual lymph drainage (MLD), compression therapy using short-stretch bandages and padding material, as well as decongestive exercises.
  • Duration Upper Extremity 2-3 weeks
  • Duration Lower Extremity 2-4 weeks
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3
Q

Goal of Lymphedema Management in Phase I

A

To decongest the affected limb or area by re-route lymph flow around blocked sites.

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4
Q

Goal of Lymphedema Management in Phase II.

A
  • Self-Management
  • Improve and maintain Phase I results
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5
Q

What are the 4 components of CDT?

A
  • Manual Lymph Drainage
  • Skin Care
  • Compression
  • Decongestive Exercise
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6
Q

What are the principles behind MLD strokes on the Lymph System?

A
  • Designed to stretch the walls of the superficial lymph vessels which stimulates an increase in activity.
  • Re-route the lymph flow around blocked areas to more centrally located lymph vessels.
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7
Q

What are the effects of Manual Lymph Drainage? (5)

A


* Increases lymph production
* Increase in the contraction frequency of lymph collectors
* Reverse of lymph flow
* Increase in the local sympathetic response
* Increase in the general parasympathetic effect

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8
Q

How does MLD increase venous return?

A
  • MLD creates a suction effect on the distal lymph collectors
  • Superficial - directional stretch of working phase
  • Deep - deeper techniques of abdominal strokes
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9
Q

How Does MLD Increase Lymph Production?

A

Stretch on the anchoring filaments of lymph capillaries stimulates the intake of lymphatic loads into the lymphatic system.

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10
Q

How does MLD Increase Lymphangiomotoricity?

A

Increase in the contraction frequency of lymph collectors by mild stimuli of the smooth musculature located in the wall of lymph collectors.

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11
Q

How does MLD reverse Lymph Flow?

A

Moves lymph fluid in superficial lymph vessels opposite to its natural flow patterns. Lymph fluid is re-routed around blocked areas via collateral lymph collectors, anastomoses, or tissue channels

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12
Q

Why do many patients find MLD “soothing” or provides pain relief?

A

MLD decreases the sympathetic mode and promotes the parasympathetic response.
- accelerates drainage of nociceptive substance from tissues.

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13
Q

What considerations are there in MLD of the trunk?

A
  • ## Even if no apparent involvement treat the trunk for at least 1 day.
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14
Q

When and where does Trunk Lymphedema appear?

A
  • Breast Cancer/reconstructive surgeries 80%
  • appears as fullness over shoulder blades or upper back
  • fullness across the waistline on right side
  • extra rolls of fat along the side of the trunk
  • located in the affected breast/chest wall, clavicle scar lines.
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15
Q

Where are healthy lymph nodes/vessels located in relation to the damaged areas?

A

Adjacent

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16
Q

How is MLD in the extremity treatment carried out?..

A

In segments starting at the proximal aspect prior to the more distal aspects.

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17
Q

How is the lymph fluid re-routed during MLD in the upper extremity?

A

Towards
- the Cervical Lymph nodes
- axillary lymph nodes on the contralateral side
- inguinal nodes on the same side

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18
Q

How is the lymph fluid re-routed during MLD in the lower extremity?

A

Towards
- the deep lymphatic pathways in the abd area
- axillary lymph nodes on the same side
- inguinal nodes on the contralateral side

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19
Q

What is the term for a superficial skin infection of the dermis and upper subcutaneous layer? Presents with a well-defined edge.

A

Erysipelas

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20
Q

What two microorganisms are the primary cause of Cellulitis?

A

Group A Streptococcus
Staphlococcus

21
Q

Why are those with Lymphedema more susceptible to infections of the skin/nails?

A
  • protein-rich fluid serves as an ideal breeding ground
  • increased diffusion distance hinders a timely response of defense cells in the affected area
  • thick scaly skin increases the risk of cracks and fissures
22
Q

What are the considerations in effective skincare?

A
  • daily
  • with donning/doffing compression
  • low pH lotion (pH 5.0-5.5)
  • no fragrances
  • hypoallergenic
23
Q

What considerations in treating limbs with fungal infections?

A
  • only start working once medications are started
  • can work proximal area
  • avoid touching the affected area/use gloves
  • nail fungus: do NOT cut cuticles
24
Q

Why is compression therapy an integral part of CDT?

A

Maintains the decongestive effect achieved during the MLD session. Without compression therapy successful treatment of lymphedema would be impossible.

25
Q

What is the Law of LaPlace?

A

If the radius of a cylinder increases, the tension also needs to increase to achieve the same pressure.

26
Q

Compression Principles for CDT.

A
  • purpose is to create a cylinder shape of the limb
  • if consistent compression (from distal to proximal) a natural gradient will occur (means a change in tension is required)
    Necessary in order to prevent tourniquet effect
  • higher pressure distally
  • lower pressure proximally
27
Q

Why is padding necessary in compression therapy?

A
  • Swollen extremities generally lose their cone shape, making it necessary to use foam/padding to “construct” a cylinder.
  • Concave areas (behind ankles)
  • use between lobes
28
Q

Steps when applying compression in Phase 1.

A

1) Skin Care (cleanse, lotion)
2) Gauze bandages applied to fingers, toes without padding.
3) Cotton stockinet is applied to absorb swear
4) Short-stretch bandages with various widths and applied in layers.

29
Q

What type of pressure (work vs resting) is found with Short-Stretch Banadages?

A

HIGH working pressure
LOW resting pressure

30
Q

What type of pressure (work vs resting) is found with Long-Stretch “Ace” Banadages?

A

LOW working pressure
HIGH resting pressure
Creates tourniquet effects while resting

31
Q

What type of pressure is defined as the counter-pressure with the bandage sets against the muscles working underneath?

A

Working Pressure

32
Q

What type of pressure is defined as the pressure the bandage exerts on the tissue while resting?

A

Resting Pressure

33
Q

When using Short-Stretch Bandages what type of method is used?

A
  • multiple bandages
  • spiral wrap
  • “Herringbone” pattern
34
Q

Compression Wrap Therapy Scheduling Considerations?

A
  • Start on Monday to allow for the establishment of routine and teaching of self-application (weekends)
  • Patients need to cover wrapped limb when showering
  • Must remain on until removed by the therapist
  • Measurements once a week
35
Q

Compression Garment Considerations.

A
  • Pantyhose Style - must cover lower quadrants if groin involvement
  • Bandaging at night for fibrous tissue
  • Gradient compression from distal to proximal is necessary
36
Q

Exceptions in Compression Garments

A
  • padding may be required
  • Compression < CC II in upper extremities to be considered in arthritic hands, not able to don, paralyzed extremity, age
  • Compression > CC II in upper extremities with larger extremities, highly repetitive activities, very active patients, age (young)
  • overlap to achieve the desired amount of compression
37
Q

Compression Levels and Classes.

A

CC I - 20-30 mm/Hg
CC II - 30-40 mm/Hg
CC III - 40-50 mm/Hg
CC IV - >60 mm/Hg

38
Q

At what compression is used for most upper extremities?

A

CC II 30-40mm/Hg

39
Q

At what compression is used for most lower extremities?

A

CC III 40-50mm/Hg

40
Q

What are the considerations regarding ready-made compression wraps?

A
  • can replace bandaging at night
  • quick application
  • compression wraps are always superior
41
Q

What are the effects of compression?

A
  • reduce filtration
  • increase reabsorption
  • improves the efficiency of joint and muscle pump
  • prevent re-accumulation of lymph fluid
    *break-down of scar tissue and treat fibrosis
42
Q

Compression increases pressure, how does this affect filtration and reabsorption?

A

Filtration - reduced
Reabsorption - increased
*Improves exchange of fluids between the blood capillaries and the tissues.

43
Q

What is the Importance of Exercise in CDT?

A


* To improve lymph circulation
* To improve/increase venous return
* To optimize joint and muscle pump
* To increase lymphangiomotoricity
* Deep (diaphragmatic) breathing increases the volume of fluid returned via thoracic duct to the venous angle

44
Q

What type of Exercise is used in CDT?

A
  • 10-15min; 1-2 times a day
  • 3-4 light to moderate exercises
  • allow for a steady state for a period of time without extreme fatigue
  • should be able to engage in light conversation
45
Q

Why is maintaining compression important during exercise program?

A

With compression, exercise can increase the uptake of fluid into the initial lymphatics, improve the pumping action of the lymph collectors, and limit filtration.

46
Q

Example of Upper Extremity Exercise program?

A
  • Pump fist (digit flexion and extension)
  • Wrist flexion and extension
  • Elbow flexion and extension
  • Appropriate shoulder ROM
47
Q

Example of Lower Extremity Exercise program.

A
  • Walking x 10 minutes
  • Supine to perform…
  • Abdominal breathing
  • Ankle pumps
  • Knee flexion/extension
  • Hip ab/adduction
  • Abdominal breathing (again)
48
Q

Special considerations with CDT exercise therapy with breast cancer patients?

A
  • weight lifting shown to at the least not increase lymphedema and perhaps even have a role in prevention.
  • Lebed Method - exercise/movement program
49
Q

What are some of the reasons CDT fails in Phase I?

A
  • Lack of compliance
  • Improper treatment (MLD only)
  • Malignant lymphedema
  • Artificial lymphedema (self- induced)
  • Associated condition(s)
  • Severity of symptoms

ACOLS (7 decks)

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