WOCN program
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| true or false: chronic lymphedema is not reversible and requires a lifetime management | true
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| what are the most common causes of secondary lymphedem | obstruction of lymphatic drainage system- cancer therapy (RT, node dissection) trauma, venous reconstruction, obesity, infection, malignancy
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| explain the difference between lymphedema and lipedema | lymphedema-unilateral, lipedema bilateral
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| what is the Stemmer sign? | inablilty to pinch skin into a fold on dorsal aspect below second metatarsal
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| identify areas for effective management of lymphededa | manual lymphatic drainage(therapeutic massage is what book says, not current guidelines) skin care compression
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| effective compression bandagin requires ___mmHg pressure | 40-60
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| what is the gold standard for lymphedema treatment | complete decongestive therapy (CDT)
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| list components of CDT | Manual lymphatic drainage (MLD) compression, therapeutic exercises, skin care, pt education
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| what are absolute contraindications to CDT | thrombosis, uncompensated heart failure
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| what are "use CDT with caution" conditions | arterial insufficiency, HTN, asthma, decreased sensation (DM, paralysis)
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| adjuvant therapies to CDT | pneumatic compression, compression strapping devices, kinesis tape, low level laser therapy
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| what are the features of lipedema | bilateral, spares hands or feet, doesn't respond to elevation, non pitting, may have hyperkeratinosis or papillomatosis
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| risk factors for lymphedema | longstanding CVI, cancer treatment (RT, surgery) obesity, infection, severe trauma, circulatory reconstruction, burns
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| what is primary lymphedema | congenital (dx within first year of life) Milroy disease, Meige disease (lymph. praecox) Lymph. Tarda (>35y/o)
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| what is mechanical insufficiency | low volume, is a result of altered function of lymph system
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| what is dynamic insufficiency | high volume, lymph load exceeds transport capacity (CHF hypoproteinemia CVI, dependency)
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| what is combined insufficiency | hemodynamic insufficiency AND lymphovenous (caused by CVI)
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| describe latent stage of lymphedema | no clinical signs, limb may feel heavy or tight
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| describe stage I of lymphedema | edema is observable, resolves with elevation, may be pitting, tissue soft negative or borderline Stemmers sign
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| describe stage II of lymphedema | edema is pitting and/or nonpitting, doesn't decrease whit elevation decreased ROM, +stemmers sign, fibrosis present, hyperkeratinosis, papillomatosis may be present
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| describe stage III of lymphedema | fibrosis, no pitting, disfigurement/elephantiasis, subcutaneous hypertrophy, ongoing infections likely
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| what labs may be pertinent | serum albumin, UA to assess for other causes of edema (renal/hepatic) lymph fluid protein level
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| what are the treatment goals | limb size reduction and preservation, alleviate sx's, prevent infection, improve limb function, ROM, improve QOL
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| Explain lipedema | Occurs in Women during or after puberty, nonpitting, tender to palpating, bruising common, always bilateral, ends at ankles, skin changes uncommon
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Created by:
Beth Perry
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