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Health Promotion - Final > 3: Lymphedema > Flashcards

3: Lymphedema Flashcards

(54 cards)

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1
Q

What is the definition of lymphedema?

A
  • Chronic disease
  • Increased collection of lymphatic fluid causing swelling
  • Leads to skin and tissue changes
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2
Q

What are the two classifications of lymphedema?

A
  1. Primary/Genetic
  2. Acquired/Secondary
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3
Q

What are the six components of lymph?

A
  1. WBC
  2. Triglycerides
  3. Bacteria
  4. Cell debris
  5. Water
  6. Protein
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4
Q

What are typical symptoms of lymphedema?

A
  • Distal swelling
  • Proximal swelling
  • Decreased ROM
  • Skin discoloration
  • Pain and altered sensation
  • Limb heaviness
  • Difficulty fitting into clothes
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5
Q

What are the three subtypes of primary lymphedema?

A
  1. Congenital
  2. Lymphedema praecox
  3. Lymphedema tarda
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6
Q

Describe congenital primary lymphedema

A

Present at birth or recognized within two years

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7
Q

Describe lymphedema praecox

A

Occurs at puberty through the start of the third decade

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8
Q

Describe lymphedema tarda

A

Begins after age 35

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9
Q

What is the general cause of secondary lymphedema?

A

Injury or obstruction of the lymphatic system

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10
Q

What is the most common cause of secondary lymphedema worldwide?

A

Infection - wuchereria bancrofti

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11
Q

How does lymphedema develop from infection?

A

Parasitic infestation in the lymph nodes due to mosquito bites

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12
Q

What is the second most common cause of secondary lymphedema?

A

Malignancy or related treatments - breast cancer specifically

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13
Q

What is the incidence of primary lymphedema?

A

1/100,000

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14
Q

What is the incidence of secondary lymphedema in women with breast cancer?

A

20%

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15
Q

What % of people with head and neck cancer develop lymphedema?

A

90%

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16
Q

What % of women treated for gynecologic cancer develop lymphedema?

A

37%

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17
Q

What are important questions to include in you history related to lymphedema?

A
  • Duration of swelling
  • Distribution
  • Past infection
  • International travel
  • Cancer
  • Liver or cardiac dysfunction
  • Prior surgery
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18
Q

Describe how lymphedema presents in the initial stages?

A
  • Resembles general edema,
  • Pitting is present
  • Skin is soft
  • Elevation will resolve swelling
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19
Q

Describe how lymphedema begins to progress?

A
  • Pitting no longer visible
  • Skin hardening
  • No change with elevation
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20
Q

What are the 4 key lymphedema symptoms?

A
  1. Edema in extremity
  2. Hyperkeratosis
  3. Lymphangioma
  4. Lymphorrhea
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21
Q

What is hyperkeratosis?

A

Skin thickening and scaly presentation

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22
Q

What is lymphangioma?

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A

Small bumps and blisters on the skin

23
Q

What is lymphorrhea?

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A

Leakage of lymph fluid from skin

24
Q

What is Stemmer’s Sign?

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A

Inability to pinch a fold of skin at the second toe

25
When will Stemmer's Sign be present?
Develops after stage 1
26
What are the two components of a physical exam for lymphedema?
1. Size of limb 2. Imaging
27
What difference in limb size is considered to be mild or moderate?
< 20%
28
What difference in limb size is considered to be severe?
> 20%
29
What are the four types of diagnostic imaging for lymphedema?
1. Lymphscintigraphy 2. MRI 3. CT 4. Ultrasound
30
What are 6 treatment options for lymphedema?
1. Decongestive lymphedema therapy 2. Manual lymph drainage 3. Compression 4. Skincare 5. Exercise 6. Surgery
31
What is decongestive lymphedema therapy (DLT)?
Moderate to severe lymphedema to mobilize lymph and dissipate fibrosclerotic tissue
32
What is manual lymph drainage (MLD)?
Lymph massage to increase lymphatic flow
33
Describe compression to treat lymphedema?
- Assists with drainage
34
What are two risks of compression as a treatment for lymphedema?
- Skin irritation - Increased risk of infection
35
Why is skincare important in lymphedema management?
Secondary infection prevention
36
Why is exercise important for lymphedema treatment?
Promotes lymph drainage and protein absorption vis muscle contraction
37
What are the 4 stages of lymphedema?
0 = Latency Stage 1 = Spontaneous 2 = Spontaneously Irreversible 3 = Lymphostatic Elephantiasis
38
Describe Stage 0
At risk for lymphedema due to injury or lymph vessel but lack clinical signs of lymphedema
39
What patients are in Stage 0?
Pts with breast cancer who have undergone biopsy or radiation that
40
Why are patients in Stage 0 at risk for developing lymphedema?
Decreased lymph transport predisposing patient to lymphatic overload and resultant edema
41
How should you monitor pt's in Stage 0?
Volumetric measures repeated every 3 months for the first year - then twice a year for up to 5 years
42
What are interventions for Stage 0?
- Education - Self massage - Compression garments - Complete Decongestive Therapy
43
What exercises are Grade A recommendations for Stage 0?
- Progressive resistance training - Individualized aerobic exercise program - Monitor for exercise tolerance and adverse effects weekly
44
What are the three characteristics of Stage 1?
- Reversible - Pitting edema - Swelling is soft and will respond to elevation
45
What interventions are Grade A recommendations for Stage 1?
- Compression garment fitting - Exercise program - Education
46
What interventions are recommended for Stages 2 and 3?
- Manual drainage - Compression - K tape - Self care management - IPC - Laser
47
What are the characteristics of Stage 2?
- Tissue fibrosis/induration - No change with elevation - Skin and tissue thickening occurs as limb volume increases - Pitting may be present but difficult to assess due to fibrosis
48
What are the characteristics of Stage 3?
- Pitting edema - Fibrosis - Skin changes - Papillomas, infection, cellulitis, dry skin
49
Describe massage for lymphedema?
Start proximal and work distal
50
How should exercise be designed for lymphedema?
Proximal to distal exercises incorporating diaphragmatic breathing to improve volume reduction
51
Is yoga effective for limb volume reduction?
No, but it is safe
52
What is the prognosis for lymphedema?
- No cure - Treatment focused to lessen disease progression and prevent complications
53
What should be included in pt education?
- Self massage - Infection prevention - Exercise - Weight control - Compression
54
What two things are contraindicated with lymphedema?
1. Venipuncture in affected extremity 2. BP measures on affected extremity

Health Promotion - Final (4 decks)

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