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Osteopathic Skills--Lexie > Lymphatics OSCE > Flashcards

Flashcards in Lymphatics OSCE Deck (42)
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1

if the shape of a lymph node is irregular, what should you think?

-regular is round
-think cancer

2

color of skin observations

-should be unchanged from baseline
-red: infection
-pale: other

3

tenderness of lymph nodes

-regular: none
-large and tender: infection (fast process)
-large and non tender: lymphoma (slower process)

4

what is the regular consistency of lymph nodes?

-regular: spongy
-hard is not normal

5

Virchow's Node

-on left side, supraclavicular
-enlarged due to metastasis
-could mean intra-abdominal cancer because abdomen drains to deep visceral-->cisterns chyli-->thoracic duct-->Virchow

6

where is the superior and inferior inguinal LN?

-find ASIS and move medial and inferior
---inferior to femoral triangle

7

what is the significance in the epitrochlear inguinal LN?

-superior and posterior to medial humeral epicondyle
-if it is enlarged, could mean secondary syphilis

8

5 treatment zones of lymphatic OMT treatment

1. thoracic inlet down to thoracoabdominal diaphragm
2. abdominal diaphragm down to pelvic diaphragm
3. upper extremities
4. lower extremities
5. head and neck

9

goal of lymphatic OMT treatment

move lymph centrally

10

what to start with and end with in lymphatic OMT treatment?

-open thoracic inlet
-treat thoracic inlet again at end

11

thoracic inlet myofascial release

-purpose move lymph centrally
-position: drive the bus, pt supine with doc at head of table
-technique: index fingers on SC joint, angle rib 1, thumb on T1 transverse process
---press toward pt's feet and twist hands to feel ROM
---if restrict to one side, perform direct technique until feel tissue creep

12

pectoral traction treatment

-purpose: increasing negative pressure on thorax
-position: pt supine with doc at head of table
-technique: grasp inferior border of pec at anterior axilla
---arms extended, apply cephalic traction bilaterally
---pull when pt inhales and resist on exhale

13

doming diaphragm

-purpose: relax diaphragm so it can produce greater pressure gradients to promote lymph drainage back to venous circulation--improves diaphragm excursion/frees up diaphragmatic motion and thus improves ability to move lymph back centrally
-position: pt supine with doc at side of table facing cephalad
-technique: doc's hand on infracostal region, below thoracic cage (xiphoid process) with fingertips/thumbs pointing cephalad
---have pt take deep breath and press down on exhalation and resist on inhalation
---repeat 3-4 times on last time move thumbs cephalad under xiphoid

14

rib raise seated

-purpose: stimulates sympathetic chain ganglia, improved lymph flow
-position: pt seated with doc standing facing pt
-technique: pt cross arms and lean towards doc
---grasp posterior inferior rib angle lateral to transverse process
---apply anterolateral traction and pull cephalad toward doc
---continue up ribs

15

rib raise supine

-purpose: stimulates sympathetic chain ganglia, improved lymph flow
-position: pt supine with doc standing on side to treat
-technique: contact rib angles--start bottom to top
---flex fingers and apply traction by rocking backward

16

tapotement treatment

-purpose: loosen up lateral in lungs and get expulsion of it
-position: pt supine with doc at side of table
-technique:
---hacking--karate chop its ulnar side of hands
---cupping--cup hands
---slapping--palmar surface

17

thoracic pump

-purpose: affect pressure gradients, indicated for clearing thoracic dict region especially for COPD, URI, LRI, swollen upper extremities, enhance immune fcn
-repetitive
-position: pt supine with doc at head of table
-technique: place thenar eminence of each hand over respective pectoral muscle just inferior to clavicle on ribs 2-4
---apply rhythmic pumping at a rate of 110-120 times/min

18

vacuum version of thoracic pump

-purpose: affect pressure gradients, indicated for clearing thoracic dict region especially for COPD, URI, LRI, swollen upper extremities, enhance immune fcn
-position: pt supine with doc at head of table
-technique: place thenar eminence of each hand over respective pectoral muscle just inferior to clavicle on ribs 2-4
---as pt exhales, apply a compressive force downward and maintain end point in inhalation
---continue for 4-5 breaths
---at beginning of last inhalation, briskly remove hands to allow for rapid deep inhalation

19

abdominal pump treatment

-purpose: indirectly affects pressure gradients, indirectly massage thoracic duct at its origin in cisterna chyli
-position: pt supine with doc next to pt
-technique: palms on abdomen with fingers towards the pt's head and thumbs side by side
---pump in a rhythmic manner at 20-30 times per minute

20

sacral rocking

-purpose: relax muscles at lumbosacral joint
-position: pt prone with doc at side
-technique: heal of cephalad hand on sacral base with fingers pointing towards the coccyx, caudad hand on top
---exert a gentle pressure downward
---alternate direction following respiration

21

effleurage of zone 3

-purpose: aid in movement of lymph toward central core
-position: pt supine, doc at side, standing
---raise pt's arm up to allow gravity to assist in drainage
-technique: doc's other hand induces a stroking force directed distal to proximal on affected arm

22

petrissage of zone 3

-purpose: aid in movement of lymph toward central core
-position: pt supine, doc at side, standing
---raise pt's arm up to allow gravity to assist in drainage
-technique: doc induces a kneading/twisting force directed distal to proximal on affected arm utilizing both hands

23

effleurage of zone 4

-purpose: aid in movement of lymph toward central core
-position: pt supine, doc at side, standing
---raise pt's leg up to allow gravity to assist in drainage
-technique: doc's other hand induces a stroking force directed distal to proximal on affected arm

24

petrissage of zone 4

-purpose: aid in movement of lymph toward central core
-position: pt supine, doc at side, standing
---raise pt's leg up to allow gravity to assist in drainage
-technique: doc induces a kneading/twisting force directed distal to proximal on affected arm utilizing both hands

25

pedal pump

-purpose: motion/fluid wave in body passively moves fluid centrally by creating an oscillatory pump
-position: pt supine with doc at feet
-technique: contact plantar portion of feet, dorsiflex feet
---apply a cephalad force to induce repetitive force to khyperdorsiflex feet
---do at 100x/min

26

iliotibial band effleurage

-purpose: reduce lymphatic congestion to aid other treatments to the IT band
-position: pt is lateral recumbent with affected side up and doc facing pt
-technique: doc's cephalad hand contacts the pt's greater trochanter for stabilization
---make a C shape and contact IT band
---start 1/2 way down leg and move distal to proximal
---then, after freeing of some congestion, move just superior to knee and stroke distal to proximal

27

cervical stroking

-purpose: stretch muscle groups surrounding cervical vertebrae
-position: pt supine with doc at head of table
-technique: place hands along paravertebral muscles and slowly stroke in a caudal direction

28

anterior cervical traction

-purpose: stretch muscle groups surrounding cervical vertebrae
-position: pt supine with doc at head of table
-technique: locate anterior and posterior border of inferior portion of SCM muscle
---place thumb along anterior margin, the second through 5th digits on posterior margin
---gently lidt anteriorly and laterally until relaxation
---move superiorly to middle portion then again at most superior
---repeat up to 3 times

29

pre and post auricular

-purpose: move congested lymph in ear region, temporal scalp, and lateral eyelids
-position: pt seated with doc at front or behind pt
-technique: spread fingers around ear to contact
---apply a CW and CCW motion to auricular lymph nodes

30

mandibular drainage: galbreath technique

-purpose: direct pressure technique to move lymph for eustachian tube dysfunction, lymphatic congesting in ENT, or submandibular region
-position: pt supine and rotate head to doc, doc opposite side of tx
-technique: place cephalad hand on TMJ with fingertips and thenar eminence on rams
---apply a slow, repetitive downward traction on mandible from angle out (face raking)