Pta 210 Lymphedema

Front 1

Lymphedema is

Back 1

an accumulation of protein-rich fluid in the interstitial tissue, resulting in swelling in one or more extremity: the trunk, head and neck, or genital area. . It is a chronic and progressive disease resulting from an impairment to the lyphatic system.

Front 2

types of Lymphedema 1°

Back 2

Due to an inherited abnomnlity in the lymphatic systems (Milroy's disease, Meige's disease, lymphedema praecox or tarda)

' May be present at birth or develop at puberty. Most frequently involves the lower extremities.

Front 3

Lymphedema secondary

Back 3

Acquied as a result of damage to the lymphatic system from surgery, radiation filariasis, cancer, trauma, infection or chronic venous insufficiency.

Front 4

stages of Lymphedema

Back 4

0: no visible or palpable edema

possible subjective complaints

1: spontaneous and reversible pitting edema, should reduce with elevation

may be noticeable protein rich fluid accumulation

2: spontaneous and irreversible, skin becomes hard and fibrotic, edema does not reduce with elevation

3: lymphostatic elephantiasis, non-pitting limb becomes large and fiberoptic with skin changes called papilloma and hyperkeratosis

Front 5

The Lymphatic Organs:

Back 5

Lymph nodes, spleen, thymus, tonsils, Peyer's patches and lymph vessels.

Front 6

Lymph nodes:

Back 6

Filter lymphatic fluid of pathogens (bacterial, viruses and cellular waste). Houses lymphocytes, which are responsible for our immune responses Regulates the concentration of protein in the lymph, allowing excess water to be reabsorbed into the blood capillaries.

of the 600-700 lymph nodes in the body, the majority are found in? the abdomen.

Other areas rich in lymph nodes include the head and neck, the groin and axilla.

Front 7

Spleen:

Back 7

Largest lymphatic organ. Filters blood of damaged cells, release lymphocytes to destroy pathogens and dead cells in the blood.

Front 8

Thymus:

Back 8

Main organ of the lymphatic system. Produces T-lymphocytes which are responsible for our immune response.

Front 9

Tensile:

Back 9

Located in the back of the throat and nasal cavity. They protect the digestive tract and lungs from infection.

Front 10

Peyer's Patches:

Back 10

A bundle of lymphatic tissue in the gut that contains B cells that attack pathogens that enter the body via the intestinal tract.

Front 11

lymphatic vessels

Back 11

p4

Front 12

lymphatic malfunction

Back 12

Lymphatic Load: The amount of substances that have to be removed from the interstitium by the lymphatic system. This includes protein, bacteria, dead cells, fats and water.

Mechanical Insufficiency: When the valves fail, the lymphangion doesn't contract, or there is trauma, surgery, or radiation that causes the lymphatic system to be incompetent to carry the lymphatic load.

Front 13

diagnosis of lymphedema

Back 13

▪Subjective report or swelling and heaviness

▪ Medical history and physical exam most important

▪Inspection and palpation noting trophic changes, scars, location of swelling, temperature, "Stemmer " sign fibrosis, papillomas or ulcers.

▪Circumferential measurements, bio-impedence, perometry and water displacement

▪Diagnostic tests including lymphangiography, lymphoscintigraphy, MRI and venous doppler/ULTRASOUND.

Front 14

Lymphedema RX

Back 14

▪Complete Decangestive Therapy (CDT) remains the gold standard af care

▪Compression pump is an adjunct to CDT, but should not stand alone:

▪Surgery

Front 15

Complete Decongestive Therapy

Back 15

Phase 1- (Intensive phase) performed by a Certified Lymphedema 'Therapist (CLT)

Manual Lymph Drainage .

Compression Bandaging .

Skin and nail care

Remedial Exercise

Phase 2-Maintenance Phase (self management) .Self manual ph drainage .Compression gamients by day with or without bandaging or a night time gamlent . Remedial exercises . Skin care . Follow up visits with CLT

Front 16

Manual Lymphatic Drainage

Back 16

Gentle strokes to redirect the flow of lymph away from blocked or damaged areas to an area of healthy lymphatic vessels, (know where to send)

. Stimulates the lymphangions to contract more frequently to move a greater volume of lymph fluid.

. Promotes relaxation and may have an analgesic effect.

Front 17

contraindicators for MLD

Back 17

Untreated acute infections . Must have 48 hours of antibiotics and MD permission to resume treatment I

. Undiagnosed malignancies or recurrence Of cancer

. Recent or uncontrolled congestive heart failure

. Recent pulmonary edema

. Acute renal failure

. Acute DVT

. Arterial disease

Front 18

compression bandaging

Back 18

foam can help skin

ace bandage not to be used

Front 19

skin and nail care

Back 19

Skin inspection before bandaging and after bandages are removed.

. Use a low PH moisturizing lotion like Eucerin:

. Don't cut cuticles

. ' Know signs of infection-redness, wamith, fever, achiness and flu like symptoms.

.Avoid injury, insect bites and burns to affected limb,

Front 20

remidial exercise

Back 20

Performed with the bandages or compression garment on.

. Active, slow and rhythmic.

. Include diaphragmatic breathing pre and post exercise to stimulate the thoracic duct and increase volume of lymph transported.

. Increase muscle and joint pump.

. Increase versus and lymphatic return.

Front 21

exercise purpose

Back 21

p11

Front 22

goals of CDT

Back 22

volume reduction

. Improve or preserve tissue texture

. Restore mobility and ROM

. Infection prevention

' Improve cosmesis

' Improve quality of life

Front 23

risk reduction practices

Back 23

KNOW THE SIGNS AND SYMPTOMS OF INFECTION . Contact healthcare provider immediately . Cleanse area and apply topical antibiotics

AVOID INJURY OR TRAUMA . Use sunscreen and insect repellent . Avoid punctures such as injections or blood draws, if possible . Wear gloves when gardening, washing dishes, or working with sharp objects

LIMB CONSTRICTION . Avoid blood pressure on at risk limb if possible . Assure proper fit of compression gamlents . Avoid nothing or jewelry that's too tight

AVOID EXTREME TEMPERATURES . Extreme cold can cause rebound swelling and chapping of skin

AVOID PROLONGED INACTIVITY

. Change position frequently . Participate in aerobic activity to improve circulatory and lymphatic flow

MAINTAIN A HEALTHY BODY WEIGHT . Obesity is known to increase the risk of lymphedema BMI greater than 25 is at risk

Front 24

edema

Back 24

An abnormal increase in the amount interstitial fluid it may be diffuse throughout the area or localized to the injury site

Front 25

tape measure

vs

volumeter

Back 25

▪The volumeter looks at total volume, but it does not account for individual areas of excessive edema relative to the diffuse edema

▪ The volumeter does not enable the clinician to document precisely where the edema is located, simply that there is edema.

▪ The volumeter is not practical to use for the assessment of an entire extremity

▪ The volumeter can be a useful & time-efficient tool for the foot and ankle, wrist, or hand.

Front 26

volumetric critical factors

Back 26

▪The time of day for subsequent measurements should be the same as the initial time of measurement ▪The same temperature of water should be used for each measurement (tepid or lukewarm) ▪The unit of measurement must remain constant (ounces or milliliters af water) ▪The patient must immerse the body part to a standard depth

▪ Same amount of water to start with