Treatment - Lymphedema Flashcards
Complete decongestive therapy
phase 1
phase 2
phase 1 —> CDT
5 components of daily tx
5 components of daily tx –> phase 1
manual lymphatic drainage (MLD)
compression bandaging
skin care
remedial exercises
pt education of self care management
phase 2 –> CDT
maintenance phase
maintenance phase
compression garments during the day
self-bandaging at night or use night time garment
meticulous skin care
daily remedial exercises
self MLD daily
types of compression garments
standard v. custom
class 1,2,3
stypes
standard compression garment
circular knit
risk of tourniquet
class 1,2,3
40-50 mmHg
tx goals
volume reduction
infection
improve
-skin integrity
-cosmesis
-psychosocial morbidity
-fxnal mobility and QOL
what is MLD
gentle manual therapy which improves activity of lymph vascular systems
increases re-absorption of protein rich fluid
what does MLD do
re-routes lymph flow around the blocked areas into more centrally located healthy lymph vessels
which drain into the venous system
what does MLD improve
lymph production
lymph circulation increasing the volume of lymph fluid transported
what does MLD help do
breakdown fibrotic areas
what does MLD promote
relaxation
analgesic effect
MLD has a
diuretic effect
increases urine output
what type of bandages do we use w/ compressive bandaging
short stretch bandages only
what does compression bandaging improve
efficiency of the muscle and joint pumps
what does compression bandaging increase
tissue pressure in the swollen limb
compression bandaging prevents
re-accumulation of evacuated lymph fluids
compression bandaging helps
break up deposits of accumulated scar tissue and connective tissue
how long do bandages stay in place
remain in place until next MLD session begins during phase 1 of tx
contraindication to compression bandaging
ABI < 0.7
how should exercise be performed
lower exertion
slow
rhythmic
what should exercise be performed w/
compression bandaging/garments on
purpose of exercise
increase muscle and joint pump efficiency
increase venous and lymphatic return
skin care
decreases risk of infection
keeps skin clean
always use lotions and soaps with low pH levels
general contraindications
acute infection of any kind
cardiac edema
malignant dz (relative)
renal dysfxn
acute DVT
arterial disorders/dz
acute CHF
HTN (relative)
why does tx fail
malignant lymphedema
morbid obesity
poor or absent homecare support
co-morbidities
lack of compliance
faulty dz
insufficient tx
insufficient tx
improper bandaging techniques or MLD techniques
deviation from proper CDT protocol
risk reduction practices
skin care
exercise
no deep tissue massage to affected quadrant
no heat to affected limb
never wear tight fitting clothes or jewelry
avoid extreme temps
avoid prolonged positioning
air flight
skin care
moisturize daily w/ non fragrance lotion
use soap w/ low alc base (Dove)
proper nail care
proper nail care
no pedicaure/manicures
there should be no
blood draws
injections
blood pressure to the affected limb
avoid… –> skin care
bug bites or sunburns
scratches or cuts
exercise –> RR practice
minimal restrictions w/ activity
minimal restrictions w/ activity
upper extremity pt
aquatic therapy
do not overstress affected limb
UE pt –> RR practices
should not lift more than 15 lbs
aquatic therapy –> RR practices
very beneficial for lymphedema pts
no heat to the affected limb
hot packs
moist heat
hot tobs
whirlpool
hot showers
avoid prolonged positioning –> RR practices
that would cause compression to affected lymph node groups
air flight –> RR practices
always wear compression sleeve/stocking
even if pt has no sxs, they are at risk then compression should be worn
wrapping
base layer
artiflex
wrap individual fingers
foam layer
bandage
artiflex
used to shape and padding
1-2 layers
foam layer
helps with conical shape
bandage
multiple layers
