M8: 3

Question 1

Accumulation of fluid with lymphedema is usually due to

Answer 1

Mechanical insufficiency of the lymphatic system

Question 2

Primary lymphedema caused by

Answer 2

Congenital or hereditary condition

Question 3

Secondary lymphedema caused by

Answer 3

Some insult to the lymphatic system

• surgery
• radiation therapy
• trauma
• worm infestation
• tumor growth
• iatrogenic
• infection
• chronic venous insufficiency

Question 4

Common s/s of lymphedema

Answer 4

• HEAVINESS
• swelling
• n/t
• pressure or tightness of skin
• susceptibility to infection
• fibrosis
• lymphatic cysts/fistulas
• impaired wound healing
  Etc etc etc

Question 5

What is the limb at risk

Answer 5

Extremity closest to the lymph vessel disruption

Question 6

Risk factors for secondary lymphedema

Answer 6

• age
• obesity
• infection

Question 7

Initiation factors for lymphedema

Answer 7

stimulus that causes varies

• pressure changes
• skin integrity insult
• BW change
• fluid volume change

Question 8

Prevention strategies for lymphedema

Answer 8

• avoid trauma/injury to reduce infection risk
• exercise regularly
• avoid constriction
• compression garments
• avoid temp extremes

Question 9

What does “pitting” edema imply?

Answer 9

ACUTE

Fluid is still able to move

Question 10

What does “non-pitting” imply?

Answer 10

CHRONIC

Fluid is now dense and less likely to move

Question 11

CDT =

Answer 11

Complete Decongestive Therapy

Question 12

2 phases of CDT

Answer 12

1. Treatment

2. Self-management

Question 13

When is edema clinically detectable?

Answer 13

Only once interstitial tissue volume reaches 30% above normal

Question 14

Edema: 1+

Answer 14

Barely detectable

Question 15

Edema: 2+

Answer 15

• Slight indentation visible when skin is depressed

- indentation remains after depression

Question 16

Edema: 3+

Answer 16

A deeper fingerprint returns to normal in 5-30 seconds

Question 17

Edema: 4+

Answer 17

Extremity may be 1.5 - 2x normal size

Question 18

What is involved in the tx phase of lymphedema management?

Answer 18

• meticulous skin care
• manual lymphatic drainage
• lymphedema bandaging
• exercise in bandaging
• compression garment (at end of phase I)

Question 19

What is involved with phase II lymphedema mgmt?

Answer 19

• compression garment during day
• lymphedema bandaging at night
• exercise in garment or bandaging
• meticulous skin care
• MLD as needed

Question 20

How is MLD different from massage?

Answer 20

• light and specific

- requires specialized education to be delivered accurately

Question 21

MLD: duration of tx

Answer 21

30-60 mins, depending on

• limb size
• severity of sx
• amt of fibrosis

Question 22

Short stretch bandaging: strong support during

Answer 22

Muscle contraction

Question 23

Short stretch bandaging: during rest

Answer 23

Don’t constrict during rest

Question 24

How long are short-stretch bandages to be worn?

Answer 24

23 hrs per day during tx phase

Question 25

How should pts exercise during the tx phase for lymphedema?

Answer 25

maintain or increase activity level while wearing the bandages

Question 26

What exercise precautions should be taken for a lymphedema pt?

Answer 26

- minimize DOMS - smooth, rhythmic exercise with light resistance - depends on fitness level, age, overall health - avoid anything that might decrease transport capacity of lymph vessels

Question 27

When do you fit a pt with compression garments?

Answer 27

When involved limb has reached normal or near normal size