Edema and Lymphedema

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Questions and Answers

What is included in the assessment of sensation during a neurologic assessment?

Localization and reflexes only

Hot/cold, sharp/dull, localization, and light touch (correct)

Skin texture and hair growth

Muscle strength and range of motion

What is a characteristic of turgor in chronic edema?

Painless

Mild warmth

Soft and pitting

Hard (correct)

Why is it important to take a pre-treatment photograph of affected and unaffected body parts?

To document the condition for future reference (correct)

To monitor hair growth patterns

To assess range of motion

To track changes in skin texture

What is the purpose of circumferential measurements in lymphedema assessment?

To compare the affected and unaffected sides of the limb Signup and view all the answers

What is a contraindication for manual lymphatic drainage?

Acute cellulite Signup and view all the answers

What is the primary goal of manual lymphatic drainage?

To reduce lymphedema and promote drainage Signup and view all the answers

What is the gold standard for measuring the volume of the whole limb in lymphedema assessment?

Water displacement method Signup and view all the answers

What is the purpose of compression therapy in the management of lymphedema?

To create a soft and natural pumping mechanism to activate lymphatic drainage Signup and view all the answers

During range of motion assessment, what should be noted?

Any limitations due to pre-existing conditions Signup and view all the answers

What is an important aspect of tissue quality assessment?

Checking for muscle wasting and changes in skin patterns Signup and view all the answers

What is assessed during tissue quality assessment?

The color, temperature, wounds, rashes, and texture changes Signup and view all the answers

What may skew circumferential measurements?

A 10-pound weight gain or loss Signup and view all the answers

What is a characteristic of venous edema?

Slowly progressive and achy pain Signup and view all the answers

What is the ideal frequency and duration of manual lymphatic drainage?

The duration and frequency vary depending on lymphedema volume Signup and view all the answers

What is the purpose of assessing the unaffected side of the limb in lymphedema assessment?

To compare the affected and unaffected sides of the limb Signup and view all the answers

What is a characteristic of lymphatic edema?

Mild warmth and usually painless Signup and view all the answers

What is the primary function of the lymphatic system in relation to edema?

To remove excess proteins that have escaped from blood vessels Signup and view all the answers

What is the main characteristic of localized edema?

It tends to be limited to one area of the body Signup and view all the answers

What is the result of increased permeability of the capillary walls?

Edema Signup and view all the answers

What type of edema is associated with chronic illnesses, such as kidney failure and liver disease?

Generalized edema Signup and view all the answers

What is the term for the accumulation of thick proteins in the interstitial space, which returns to its pre-pit state within 30 seconds?

Pitting edema Signup and view all the answers

What is the consequence of a compromised lymphatic system?

Increased susceptibility to infection Signup and view all the answers

What is the main difference between lymphatic edema and venous edema?

Cause of edema Signup and view all the answers

What is the term for the process by which the lymphatic system removes waste and toxins from the body?

Phagocytosis Signup and view all the answers

Study Notes

Edema

Edema is a local or generalized condition where body tissues contain an excessive amount of tissue fluid.
Etiology:
- Increased permeability of capillary walls
- Increased capillary pressure due to venous obstruction or heart failure
- Lymphatic obstruction
- Disturbances in renal functioning
- Chemical substances such as bacterial toxins, venoms, caustic substances, histamine

Pathophysiology

Two types: Lymphatic and Venous
Lymphatic: Plasma proteins in the tissues stagnate and a mechanical insufficiency of lymph drainage
Venous: Increased capillary pressure and venous obstruction

Types of Edema

Localized:
- Caused by venous or lymphatic obstruction
- Increased vascular permeability
- Limited to one area of the body
- May be bilateral
- May result from trauma, infection, or obstruction
Generalized:
- Systemic process occurring with chronic illnesses
- Congestive heart failure
- Kidney failure
- Liver disease
- Apparent in both lower extremities (LE), groin, and abdomen
- May exhibit whole-body edema through retention of both sodium and water

Lymphatic System

Removes excess proteins that have escaped from blood vessels, returning it to the blood
Removes waste excreted from body tissue
Fluid contains phagocytes and lymphocytes that trap and destroy invading cells

Lymphatic Considerations

Without phagocytosis and lymphocytes, the individual is susceptible to infection
The immune system is compromised
Extreme vulnerability to disease

Characteristics of Lymphedema

Pitting edema:
- Due to accumulation of thick proteins in interstitial space
- Returns to pre-pit within 30 seconds
Turgor:
- Tone of edematous tissue
- Hard = more chronic
- Hard turgor contributes to loss of ROM, loss of function, sensory impairment, and pain

Assessment

Circumferential measurements:
- Must be taken at designated landmarks
- Marked and measured at 4-cm intervals
- Taken at the same time of day
- With the same tool
- By the same person
- Compare affected and unaffected sides
Water displacement method:
- Gold standard for measuring edema
- Mainly used in research
- Measures the amount of water displaced from a container when the limb or part of the limb is submerged
- Provides information on the volume of the whole limb, including the hand or foot
Range of motion and muscle testing:
- Assess baseline function of involved limb
- Note limitations due to pre-existing conditions or excessive weight or edema of body part
Assess tissue quality:
- Check for color, temperature, wounds, rashes, and texture changes
- Palpate for sensitive areas, changed muscle bulk, tissue resistance, and temperature changes
Neurologic assessment:
- Assess sensation including hot/cold, sharp/dull, localization, light touch, and reflexes
Look for:
- Muscle wasting
- Changes in hair growth
- Patterns of skin
- Skin texture
Photograph:
- Take a pre-treatment photograph of affected and unaffected body parts

Conditions that may Skew Circumferential Measurements

Use of a diuretic
10-pound weight gain or loss
Additional medical problems
Change in treatment regimen

Physical Therapy Management of Lymphedema

Manual lymphatic drainage:
- Therapeutic technique used to reduce edema and symptoms
- Accelerates lymphatic drainage
- Consists of hand motions on the skin and subcutaneous tissue
- Applied pressure is very soft
- Applied motions are slow
- Every maneuver is applied from distal to proximal
- Stimulates internal contraction of lymphatic channels
- Provides drainage of obstructed lymph fluid from local lymph nodes
Compression therapy:
- Pressure to the area on the lymph ducts, activates the muscles below lymph ducts
- Creates a soft and natural pumping mechanism
- Includes compression bandaging, compression dressing, static graduated compression tools, and pneumatic compression tools

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Description

Identify the signs and symptoms of edema, including venous and lymphatic edema, and understand the effects of turgor on ROM, function, and sensation.