day seven: lympthedema Flashcards
(85 cards)
1
Q
lymph nodes are known as
A
“filtering stations”
2
Q
lymph nodes fx:
A
produce WBC, regulate proteins in lymph
3
Q
lymph vessels fx:
A
intrinsic contractions 6-10 x / minutes
4
Q
list all the anatomy parts of the lymphatic systems :
A
- lymph nodes
- lymph vessles
- thymus gland
- spleen
- tonsils
- peyer’s patches
5
Q
four things in a lymp vessel:
A
capillaries
pre-collectors
collectors
trunks
6
Q
mechanisms of transportation inside the lymp system:
A
instrinic contraction respiration arterial / venous pulsation skeletal movement new lymph (creates pressure)
7
Q
lymph fluid consists of
A
PROTEINS: water Cells waste products foreign substances fat
8
Q
bodys move how much lymph a day?
A
2.-2.5 L
9
Q
fluid moves through what/
A
pressure gradients
10
Q
filtration =
A
resorption + lymph flow
11
Q
lymphatic load abb
A
LL
12
Q
lymphatic load def:
A
how much water proteins, cells, etc
13
Q
lymph time volume abb
A
LTV
14
Q
lymph time volume def:
A
amplitude and frequency fo intrinsic contractions
15
Q
transport capacity abb
A
Tc
16
Q
transport capacity def:
A
MAX LTV
10x LL in intact system
17
Q
functional reserve abb
A
FR
18
Q
functional reserve def:
A
difference between TC & LL
19
Q
normal lymph ratio:
A
LL < TC
20
Q
dynamic insufficiency:
A
overloaded lymphatic system:
- venous insuffiency, cardiac edema DVT
21
Q
mechanical insufficiency:
A
lympathic system damaged
- surgery trauma, radiation , etc
- lymphedema always includes mechanical insufficiency
22
Q
lymphedema always includes what insufficiency?
A
mechanical
23
Q
combined insufficiency:
A
damaged systems and overload
- obesity
CVI
- lipedema
24
Q
lymphedema def:
A
an abnormal collection of protein rich fluid in the interstitium which causes chronic inflammation and reactive fibrosis of the affected tissues
- the lymph load exceeds the total capacity of the system
25
lymphedema prognosis:
there is no cure
| - early detection and management and patient ability to self manage yield a good prognosis
26
if left untreated lymphedema will end in
elephantiasis
27
primary lymphedema:
mechanical insufficiency of the lymphatic system
- malformation of lymphatic vessles
- congenital or heredity
28
secondary lymphedema
known cause of lymph
| ie: surgery radiation trauma
29
early s/s of lymphedema:
```
limb feels heavy
skin feels tight
limb is achy (not painful)
clothing or jewelry is tight
can't see wrinkles in skin
```
30
stages of lymphedema:
latency
stage 1
stage 2
stage 3
31
latency stage:
no visible/ palpable edema subjective complaints possible
32
stage 1:
reversible (elevation, pitting edema often present increased limb girth and heaviness no fibrosis
33
stage 2
consistent swelling - does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult
34
stage 3:
lymphocytic elephantiasis, non pitting, fibrosis and sclerosis, skin changes (hyperkeratosis0
35
lichenification will be
leathery and hard
36
peau d'orange texture
skin will look like orange pulps because the CSF is leaking out of inflamed hair follicles enlarging them and giving them an orange tint
37
an infection is a
MEDICAL EMERGENCY
38
medications for lymphedema
no evidence of any medication that aids in treating lymph
39
surgeries for lymphedema
no surgeries currently can cure lymphedema
can get a lymph node transplant
debulking or liposuction
40
venography will rule out
venous problems
41
lymposcintigraphy is
a nuclear imaging method, tissue injection is transported by lymphatic system and allows assessment of superficial and deep lymphatics, no damage to lymph vessels
42
stemmers sign:
looks at thickening of skin on the dorsal hand / foot
| inability to pinch skin in these areas
43
CDT is
complete decongestive therapy
44
MLD is
manual lymphatic drainage
45
CDT involves:
```
MLD
compression bandaging
exercise
skin care
self care and risk reduction / education
```
46
effects of CDT:
decrease swelling by ore than 50%
increase lymph drainage from congested areas
improve skin conditions
improve patients function, quality of life
reduce risk of infection
47
two phases of CDT are:
reductive phase
| maintenance phase
48
reductives phase is
daily 5x/week treatments until fluid reduction has plateaued
49
bandages stay on how long in reductive phase?
all the time until you are back for the next appointment
50
maintenance phase
self management program
51
replacements of compression garments in the maintence phase happens
every 4-6 months
52
diaphragmatic breathing:
encourage deep breathing to allow diaphragm move and stimulate lymph nodes in abdomen
53
MLD fx
increases the movement of lymph/ interstitial fluid, including proteins
54
MLD improves:
lymph transport capacity, lymph vessel contractility
55
stretching of the skin affects the
superficial lymph vessels
56
pressure phase promotes:
fluid movement in a desired direction
57
relaxation phase causes
a vacuum due to the distention of the tissue and leads to refilling of the lymph vessels
58
MLD sequencing:
clear proximal regions and nodes
move segmentally
always stretch from distal to proximal
59
compression bandaging improves
efficiency of muscle pump
60
compression bandaging prevents
re-accumulation of evacuated fluid
61
compression bandaging facilitates
softening of fibrotic tissue
62
compression bandaging def:
non-stretch cotton tubular layer on skin to wick moisture away and protect skin
63
short stretch is
low elastic bandages provide low resting pressure (allows lymphatics to fill) and high working pressure (improves muscle pump)
64
where do you start with compression bandaging?
distal
65
when do you start distal?
with compression bandaging
66
where do you start with MLD
proximal - trunk
67
when do you start proximal?
MLD
68
where do you add the most layering for compression bandaging
distally
69
what does increase compression distally do?
creates a graduated pressure in the limb
70
remedial exercise should start with what though
diaphragmatic breathing
71
when do you want to do remedial exercise
when limb reduction is a goal
72
remedial exercise def:
active repetitive, non resistive motion; clear proximal then work distal to proximal (ROM / flexibility)
73
you should do exercise with
compression
74
pay attention to feelings of _______ with exercise
heaviness, increased swelling
75
what two types of exercises are beneficial to lymph
resistance
| aerobic
76
with exercise you should always
start slow and be cautious
77
what should you do with a sign of infection
CALL PHYSICAN OR TO THE ER
78
prevention of increase lymph include:
```
pt education
skin care
exercise
maintain proper weight/ nutrition
- avoid anti-inflammatory / DRINK WATER
```
79
compression garments are designed to
MAINTAIN limb size, not reduce it
80
when should you not wear a compression garment
at night
81
class 1 compression grade:
20-30 mm HG
82
class 1 is
beginning pressure arms
83
class 2:
30-40 mm Hg
84
class 2 is
ideal pressure legs
85
class 3
40-50 mm Hg
