Test 3: Lymphedema Flashcards
Lymphatic vessels carry _________
____ with waste products
Interstitial fluid
Lymphatic vessels empty into lymph
nodes that act as _____
Filters
Once interstitial fluid enters the capillaries it becomes known as ____
Lymph
The lymph vessels collect ______
_____, which consists of protein,
water, fats, and wastes from cells.
Lymphatic fluid
The lymph vessels transport the fluid to the lymph nodes, where waste materials and foreign materials are filtered out from the fluid. The fluid is then returned to the \_\_\_\_\_\_.
Blood
When the lymphatic vessels are \_\_\_\_\_\_ or missing, the lymph fluid cannot move freely throughout the system. This causes an accumulation of fluid and results in abnormal \_\_\_\_\_\_
Impaired
__________ is the result of
this accumulation of lymphatic
fluid in the interstitial tissue
Lymphedema
Lymphedema can develop anytime there is an _______ in the lymphatic
system function
Impairment
What are the two types of lymphedema?
Primary or secondary
Difference in Lymphedema &
Edema:
Lymphedema happens when “Extra fluid builds up in your tissue when your
_________ ________ isn’t working well,
usually because your lymph nodes were
damaged or removed. It’s often a side effect of
cancer treatment and can show up years later.”
lymphatic system
Difference in Lymphedema &
Edema:
“Edema happens when your _____ _____
vessels _____ _______ into nearby tissues.
That extra fluid builds up, which makes the
tissue swell. It can happen almost anywhere in
the body.”
small blood vessels leak fluid into nearby tissues
Primary lymphedema◦
Due to ________ malformations in
the lymphatic system such as
defective valves or vessels.
Congenital
Which type of lymphedema is something “you are born with” or born with a predisposition to have
Primary
Secondary lymphedema
AKA “___________ Lymphedema”
It occurs ____birth
Acquired
After
Common causes of secondary lymphedema: \_\_\_\_\_\_\_ involving removal of lymph nodes and vessels (e.g., cancer surgery) \_\_\_\_\_\_\_\_ therapy \_\_\_\_\_\_\_\_ of lymph vessels and nodes following infections and trauma
Surgery
Radiation
Scarring
If lymph nodes are removed, radiated, or
damaged there is ______ a risk of developing
lymphedema
Always
T or F: patients are always at risk to develop lymphedema (even years later) after an insult to lymphatic system.
True
Symptoms of Lymphedema: A \_\_\_\_\_ sensation in the limb(s) Skin feeling “tight” or “heaviness” sensation \_\_\_\_\_\_\_\_ flexibility in the hand, wrist, or ankle
Full
Decreased flexibility
Symptoms of Lymphedema:
____ fitting into
clothing in one
specific area
Difficulty
Symptoms of Lymphedema:
Bra strap becoming tight or making deep \_\_\_\_\_\_\_\_ in the skin Persistent swelling which begins gradually or suddenly
Indentations
Symptoms of Lymphedema: \_\_\_\_\_\_ in the adjacent shoulder or hip due to the increasing weight of the swelling limb Ring/wristwatch/ bracelet tightness.
Aching
Important to advise “at-risk” patients… To seek \_\_\_\_\_\_ medical advice (and get at least one second opinion) if they notice any signs or symptoms of lymphedema
immediate
Stages of Lymphedema
Stage 1 -(spontaneously
reversible) “mild”
◦ Tissue is still at the ______ stage, which
means that when pressed by fingertips, the
area indents and holds the indentation. Usually,
upon waking in the morning, the limb(s) or
affected area is normal or almost normal size.
Pitting
Stage 2 (spontaneously irreversible) “moderate” ◦ The tissue now has a spongy consistency and is "non-pitting," meaning that when pressed by fingertips, the tissue bounces back without any indentation forming. ◦ \_\_\_\_\_\_ found in Stage 2 lymphedema marks the beginning of the hardening of the limbs and increasing size.
Fibrosis
Stages of Lymphedema Stage 3 (lymphostatic elephantiasis) “severe” ◦At this stage the swelling is \_\_\_\_\_\_\_\_\_ and usually the limb(s) is/are very large. A classic presentation of stage 3 lymphedema is the tissue is very hard (fibrotic)
Irreversible
Fibrosis occurs in stage __ lymphedema
2
In stage 3 lymphedema, tissue
changes and that’s where the name
__________ comes from due to
the appearance of the skin.
elephantiasis
When lymphedema remains untreated, protein-rich fluid continues to accumulate, and in this state, the swollen limb(s) becomes a perfect culture medium for \_\_\_\_\_\_. Chronic infections and skin/tissue \_\_\_\_\_\_\_\_\_\_\_ are often the result
Bacteria
Breakdown
Stemmer’s Sign- an OT evaluation tool • \_\_\_\_\_\_\_\_\_\_\_\_ sign - perform test by attempting to gently pinch and lift a thickened fold of skin at the base of the second toe or second finger
Stemmer’s
Stemmer’s Sign- an OT evaluation tool • \_\_\_\_\_\_\_\_ test result- present when the skin cannot be lifted. This is considered to be an indication of the presence of lymphedema.
Positive
* important to note that the absence of Stemmer sign does not rule out the possibility of lymphedema. It may be an \_\_\_\_\_\_\_ \_\_\_\_ of lymphedema .
Earlier stage
Lymphedema Treatment
GOLD STANDARD- ___________
◦
Complete/Complex Decongestive Therapy (CDT)?
What are the 4 components of Complete/Complex Decongestive Therapy (CDT)?
- Skin care
- Manual Lymphatic Drainage (MLD)
- Compression (multi-layer
bandaging, vaso-pneumatic pump) - Exercise (best results when
performing exercises with
compression on)
Contraindications for CDT
CHF Renal Failure Acute Infections Acute DVT Malignancies Acute Bronchitis or bronchial asthma
Multi-layer bandaging
Low stretch bandage is easier to tolerate over
many hours of wear and can be worn at rest
& during ____
exercise
Multi-layer bandaging
In Lymphedema use ________ stretch
bandages which have low resting
pressure
Low
Multi-layer bandaging
In Lymphedema use ________ stretch
bandages which have low resting
pressure
Short/low
Multi-layer bandaging \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ pressure- occurs when the force of the compression material is the strongest when the muscle is active and pushing against the bandage
Low resting
Multi-layer bandaging \_\_\_\_\_\_\_\_\_\_\_\_ pressure- occurs when force of the compression material is still strong when muscles are in a relaxed state. Examples: ACE bandages, coban, and medical compression garments
High resting
Manual Lymphatic Drainage
(MLD)
A _________________ where the
therapist uses light touch and through
skilled massage the therapist stimulates the
lymphatics and promotes transportation of
lymph in a direction it can be absorbed.
Manual therapy technique
Manual Lymphatic Drainage (MLD) To do this effectively, the therapist must have a good understanding of patients \_\_\_\_\_\_\_\_\_\_\_\_\_\_ to know which areas have lymphatic deficiencies so fluid can be re-routed in the direction of intact lymphatic pathways.
Medical history
Key principles of MLD
Touch is always _____
Skin is stretched, not stroked
The therapist works proximal to distal**
Light
Key principles of MLD There should be \_\_\_\_\_\_\_\_\_\_ of the skin MLD should never be painful The techniques/ hand movements used in MLD are repeated rhythmically
No reddening
Compression Garments are
Necessary
To ________ lymphedema occurring
or increasing
Prevent
Grades of Compression
Garments:
Level 1 – ______ mmHg
1-20
Grades of Compression
Garments
Level 2 – 30-____ mmHg
30-40
Grades of Compression
Garments
Level 3 – 40-____ mmHg
40-50
