Unit 7 Lymphatic System – Flashcards
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2/Unit Objectives: List therapies used in physical therapy intervention for the treatment of lymphedema
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2/Unit Objectives: Cite common medical and surgical management options for lymphedema
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2/Unit Objectives: List etiologies, risk factors and clinical manifestations (signs and symptoms) of lymphedema
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2/Unit Objectives: Describe lymphedema
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2/Unit Objectives: Explain briefly the anatomy and physiology of the lymphatic system
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2/Unit Objectives: Discuss the impact of diseases of the lymphatic system on rehabilitation
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3/Review of Concepts: Define Anthropometric measurements.
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The measurement of the size and proportions of the human body by measuring, recording, and analyzing specific dimensions of the body, such as height and weight; skin-fold thickness; and bodily circumference at the waist, hip, chest and extremities.
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3/Review of Concepts: When are Anthropometric measurements made?
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Used when abnormalities are noted during the observation and palpation phase of assessment
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3/Review of Concepts: Provide examples of Anthropometric measurements made?(3)
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1 - Volumetric - Swollen finger, toes, hands, feet. 2 - Palpation - Edema and temperature 3 - Girth - Swollen limbs
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4/A&P of Lymphatic System: What does the lymphatic system do?
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Collects the remaining 10% of interstitial fluid remaining after extracellular fluid is resorbed by veins.
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4/A&P of Lymphatic System: For what reason does this interstitial remain uncollected by the venous system?
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Filled with many proteins too big for the venous system. The healthy lymph system can handle the collection of them.
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4/A&P of Lymphatic System: What is the approximate volume collected daily
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About 2 liters/day
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5/Anatomy of Lymphatic Vessels: What is the path of flow in the lymphatic system?
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Initial lymphatic vessels > collecting vessels > lymphatic ducts/trunks > subclavian veins > heart
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5/Anatomy of Lymphatic Vessels: What is the direction of fluid movement?
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Fluid moves from periphery to central circulation
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5/Anatomy of Lymphatic Vessels: What scientific principle drives the lymph system?
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Pressure-driven system (principles of osmosis)
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5/Anatomy of Lymphatic Vessels: Describe the spontaneous contraction of lymphatic vessels
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Uses extrinsic pumping mechanisms the result of skeletal muscles actions, arteriol pulses, respiration, and mechanical message.
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6/Regional Lymphatic System: What is a lymphatome?
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A map of the body's lymph draining territories, which are bordered and separated by watershed areas. These are interconnected both superficially and deep.
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7/Anatomy of Lymphatic System: Describe the thoracic duct
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leading from the cisterna chyli to discharge into the left sublcavian vein in the neck. Responsible for most of the trunk, LE, LUE, and left side of neck and head.
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7/Anatomy of Lymphatic System: Describe the right lymphatic duct
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carries far less lymph than the thoracic duct, draining mainly the right arm and head, the heart and lungs, and the anterior chest wall.
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8/Lymphatic System Functions: What is the primary purpose of the lymphatic system?
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Maintain fluid balance in tissues
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8/Lymphatic System Functions: What other system does it work and closely resemble?
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Works with the venous system
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8/Lymphatic System Functions: What are some of the functions of the lymphatic system?(3)
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1 - Fight infection. 2 - Assist in the removal of cellular debris. 3 - Removal of waste products from extracellular spaces1 -
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9/Disorders of the Lymphatic System: What is Lymphangitis?
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Lymphangitis - inflammation of a lymphatic vessel
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9/Disorders of the Lymphatic System: What is Lymphadenitis
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Lymphadenitis - inflammation of lymph node(s)
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9/Disorders of the Lymphatic System: What is Lymphadenopathy?
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Lymphadenopathy - enlargement of lymph node(s) not necessarily due to infection of lymph node, but more likely due to fighting other infection.
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9/Disorders of the Lymphatic System: What is Lymphedema?
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Lymphedema - increased lymph in soft tissues
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9/Disorders of the Lymphatic System: How many stages to Lymphedema? How are they identified?
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4 - Stage 0, Stage I, Stage II & Stage III
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9/Disorders of the Lymphatic System: Describe Stage 0 of Lymphedema
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Lymph transport capacity is reduced, no clinical edema is present.
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9/Disorders of the Lymphatic System: Describe Stage I of Lymphedema
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Accumulation of protein-rich, pitting edema. Reversible with elevation, affected areas normal size on waking in the morning. Increases with activity, heat and humidity.
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9/Disorders of the Lymphatic System: Describe Stage II of Lymphedema
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Accumulation of protein-rich, nonpitting edema wth connective scar tissue. Irreversible, does not resolve overnight; increasingly more difficult to pit. Clinical fibrosis is present. Skin changes present in severe Stage II.
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9/Disorders of the Lymphatic System: Describe Stage III of Lymphedema
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Accumulation of protein-rich edema with significant increase in connective and scar tissue. Severe nonpitting fibrotic edema. Atrophic changes (hardening of dermal tissue, skin folds, skin papillomas, and hyperkeratosis)
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10/Lymphedema: What is edema?
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Edema - accumulation of excessive fluid within the interstitial tissues or within body cavities
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10/Lymphedema: What is lymphedema?
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Lymphedema - swelling of soft tissues that results from the accumulation of protein-rich fluid in the extracellular spaces. Lymph transport capacity is inadequate. Therefore there is a decrease in absorption and an ncrease in lymphatic load
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11/Lymphedema: What is primary lymphedema?
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Due to trauma, hereditary or idiopathic state
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11/Lymphedema: What is secondary lymphedema?
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Due to removal of lymph nodes
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12/Pitting Edema Scale: What is pitting edema?
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Pitting edema = presence of indentations in the skin when pressure is applied
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12/Pitting Edema Scale: What are the scores for pitting edema?
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1+, 2+, 3+, & 4+
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12/Pitting Edema Scale: Describe the 1+ score for pitting edema.
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Indentation barely detactable
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12/Pitting Edema Scale: Describe the 2+ score for pitting edema.
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Slight indentationvisible when skin is depressed, returns to normal in 15 seconds
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12/Pitting Edema Scale: Describe the 3+ score for pitting edema.
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Deeper indentation occurs when pressed and returns to normal within 30 seconds
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12/Pitting Edema Scale: Describe the 4+ score for pitting edema.
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Indentation lasts for more than 30 seconds
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13/Lymphedema - Sequelae: Define Sequelae
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Complications
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13/Lymphedema - Sequelae: Functional limitations & disability in Lymphedema are the result of?
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1 - Increased limb girth and weight - alteration of gait pattern. 2 - Discomfort 3 - Neuromuscular deficits. 4 - Integumentary complications
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13/Lymphedema - Sequelae: What is the discomfort the result?
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Pain from extra tissue/weight
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13/Lymphedema - Sequelae: What is trophic?
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thickening of the skin
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14/Lymphedema - Etiology: Lymphedema common in populations such as? (5)
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1 - Post-mastectomy (especially LN removal). 2 - Lymph node dissection. 3 - Reconstructive surgeries 4 - Radiation treatments. 5 - Structural or functional impairment of lymphatic system
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15/Medical Management: What was the philosophy of the 90's for cancer?
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Treat cancer first, then lymphedema
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15/Medical Management: What is the history of medications for lymphedema?
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Diuretics - for edema (Na driven), not lymphedema... could actually worsen problem. The future is proteolytic drugs - those that break down proteins to smaller molecules that can more easily be re-absorded.
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15/Medical Management: What is the history of surgery?
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No clinically successful measures, Debulking, anastomoses of lymph vessels
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16/Considerations for the PTA: Describe healthy lymph nodes. When should the patient be referred to a physcian?
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Lymph nodes - should be non-palpable, soft. Palpable/hard lymph nodes - refer to physician
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16/Considerations for the PTA: The therapist should provide pt with S&S of lymphedema especially when? (2)
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Pt education: S&S of lymphedema. Especially with history of (h/o) radiation, mastectomy, etc.
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16/Considerations for the PTA: Why do girth measurements?
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Monitor changes in swelling
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16/Considerations for the PTA: Lymphedema may be lifelong issued, when?
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May be lifelong if patient has had lymphatic tissue removed
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16/Considerations for the PTA: What are the 3 categories for Lymphedema precautions
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3 categories: infection prevention, circulatory compromise, stress on impaired lymphatic system
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17/Considerations for the PTA: What are the considerations for a BP cuff with lymphedema patients?
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Do not place cuff above IV line or AV shunt; on involved side. If involved side can't be avoided, do not inflate cuff > average systolic pressure
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17/Considerations for the PTA: Why are lymphedema pts prone to infection?
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Prone to infection due to poor healing and poor skin integrity
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17/Considerations for the PTA: Properly fitting shoes, skin checks etc should be provided for lymphedema pts, why?
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They are prone to infection and rubbing etc could lead to it.
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17/Considerations for the PTA: Lymphedema certification for PTs & PTAs can be obtained where?
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Academy of Lymphatic Studies. Norton School of Lymphatic Therapy
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18/Comprehensive Lymphedema Management: What is Manual lymphatic drainage (MLD)?
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MLD (Manual Lymph Drainage) is a gentle, superficially applied manual treatment technique designed to improve the activity of intact lymph vessels by providing mild mechanical stretches on the wall of the lymph collectors. Requires the PT/PTA to obtain additional training.
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18/Comprehensive Lymphedema Management: List 3 apparatus to assist lymphedema patients.
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Compression bandaging/garments/pumps
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18/Comprehensive Lymphedema Management: What is the order for exercise for Lymphedema patients?
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Exercise - Specific order (trunk muscles, then limb girdle muscles, proximal to distal on limb, finish with trunk exercise & deep breathing to enhance flow of lymph through thoracic duct)
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18/Comprehensive Lymphedema Management: List 6 educaton points for lymphedema patients.
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Basic anatomy, skin/nail care, self-massage, self-bandaging, garment care, infection management
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18/Comprehensive Lymphedema Management: Lymphedema patients require what other non-tangible support?
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Psychological and emotional support
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19/Manual Lymphatic Drainage: How does MLD improve lymph vessel activity?
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Improves activity of intact lymph vessels by providing mild mechanical stretches on the wall of the lymph collectors
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19/Manual Lymphatic Drainage: What does massage mean? Why is it not appropriate to be used as a descriptor for MLD?
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Massage means to knead and MLD does not have kneading elements. Also, massage is applied to subfascial tissues and MLD is suprafascial
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19/Manual Lymphatic Drainage: Where are lymph collectors located on the body?
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lymph collectors are located in the dermal and subcutaneous regions (superficial to fascia)
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20/Complete Decongestive Physical Therapy: What is the first phase of complete Decongestive PT called? How long does it usually last?
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Intensive phase (BID for 4-6 weeks)
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20/Complete Decongestive Physical Therapy: What does the 1st phase of complete decongestive PT consist of? What happens toward the end of this phase?
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Meticulous skin care, MLD, bandaging, exercises with bandage on. Toward end of this phase, patient fitted for compression garment
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20/Complete Decongestive Physical Therapy: What is the 2nd phase of decongestive PT called?
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Self-management phase (started when edema is under control)
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20/Complete Decongestive Physical Therapy: What does the 2nd phase of complete decongestive PT consist of?
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Patient performs own skin care and MLD, applies own compression garment during the day and bandaging at night.
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20/Complete Decongestive Physical Therapy: T/F During 2nd phase of complete decongestive PT, a patient may still perform exercises with the bandage or the compression garment
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TRUE
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