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Lymphedema

Lymphedema. By Christina Hankins PT, CLT, CWS. Objective. Identify form and function of circulatory and lymph systems Describe various factors that affect the movement of fluid Describe difference between edema and lymphedema Describe stages of lymphedema Describe types of lymphedema

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Lymphedema

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  1. Lymphedema By Christina Hankins PT, CLT, CWS

  2. Objective • Identify form and function of circulatory and lymph systems • Describe various factors that affect the movement of fluid • Describe difference between edema and lymphedema • Describe stages of lymphedema • Describe types of lymphedema • Describe lymphedema treatment • Describe Referral process

  3. Anatomy of circulatory system • 3 structural elements • Heart • Blood cells- • RBC, WBC, platelets • Plasma – water, salts, proteins, vitamins, minerals, hormones, dissolved gases, toxins, medications, and fats • Blood vessels • Arteries, veins, and blood capillaries

  4. Anatomy of Lymphatic system • 3 structural components • Lymph vessels • Trunks, collectors, precollectors, and lymph capillaries • Lymphatic tissues • Lymph nodes (600-700), spleen, and thymus • Lymph fluid • Proteins, WBC, Medications, toxins, fats, water, bacteria

  5. Lymph capillaries > Collectors> Nodes>Lymph Vessels>Venous angle • Originate close to BC • Closed tubes in the interstitial spaces of sub endothelial layers of the skin • Larger than BC • More permeable • Anchoring filaments that connect to skin • Flat endothelial cells, arranged in a single layer, overlap

  6. Lymph Collectors • Are larger vessels than LC • Valves that contract • Propel lymph into lymph nodes

  7. What does the Lymph system Do? • Basically a scavenger system that removes proteins, excess fluid, debris, and other matter from the interstitial spaces….

  8. Factors affect fluid movement • Diffusion • Osmosis/osmotic pressure • Colloid osmosis/ colloid osmotic pressure • Filtration and reabsorption

  9. Physiology of lymphatic system • Passive edema protection • Pressures ^ in BC> pressure ^ in interstitial fluid> ^ reabsorption rate • Active edema protection • Safety factor: • Increase permeability of Lymph Capillaries • Increase contraction frequency of Lymph collectors

  10. Edema or Lymphedema? • Dynamic insufficiency • Lymphatic load > Transport capacity of an intact functioninglymph system • CHF, CVI (stage I or II), immobility, hypoproteineima, pregnancy • Edema is a swelling caused by the accumulation of abnormally large amounts of fluid in the intercellular spaces of the body • Treat with • Elevation • Compression • Exercise

  11. Lymphedema • Mechanical insufficency • Reduction of transport capacity due to damage of insufficient lymph system • Surgery, radiation, chronic inflammation, paralysis, Primary lymphedema • Lymphedema is high protein edema • To treat • CDT- Complex decongestive therapy

  12. Lymphedema or Edema? • Combined insufficiency • Lymph transport is compromised • Compounded with a sx or trauma

  13. Stages of Lymphedema • Stage 0 • Transport capacity is subnormal yet sufficient • Stage I • Pitting edema that recedes over night, 0 skin changes • Stage II • Fibrosis, cellulitis, pitting difficult to induce, wounds • Stage III • Fibrosis, papillomas, cysts, fistuals, hyperkeratosis, recurrent cellulitis, wounds

  14. Types of Lymphedema • Primary • Born with insufficient or compromised lymph system • Secondary • Due to know insult • Cancer, surgery, venolymphedema, obesity induced lymphedema, CHF induced

  15. CDT in Home Health • 4-6 weeks, although treatment set up upon individual need • Ensure pt is a good candidate • Education Disease process • Bandage • Ther Ex • MLD • Garments • Pumps

  16. CDT Benefits • Individual comprehensive treatment with focus on education to work towards independence with maintenence program • Incorporate function • Can fit into shoes • Ambulates much easier with smaller legs • Decreased risk of infection • Heal wounds

  17. Home Health Benefits • Great support staff • SN, PT, OT, MSW, Aides • In home assessment • Readily available to caregivers

  18. Refer to Home Health • Physical therapy to Eval and treat (Bilateral LE) lymphedema • Send prescription to Home Health • Phone • Fax • Demographics

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