Pathophysiology of Lymphedema

Pathophysiology of Lymphedema

Disease / Diagnosis:

Lymphedema

Associated Surgical Procedure:
(Complete Surgical Procedure Card)

None performed this admission
Detailed Pathophysiology of Disease:

(Swelling of tissues produced by an obstruction to the lymph flow in an extremity. Results in excessive accumulation of fluid in the interstitial space.)

Lymphedema can be classified as primary (congenital malformations) or secondary (acquired obstruction. Swelling in the extremities occurs due to an excessive increased amount of lymph fluid due to an obstruction of lymphatic system. The obstruction may be in both the lymph nodes and the lymphatic vessels. Eventually this will lead to subcutaneous tissue becoming fibrotic; this will impair vascular flow and oxygen transfer to the tissues.

Signs: What you can observe
(list all and then √ which apply to your pt.):

Swelling of part of your arm or leg or your entire arm or leg, including your fingers or toes
Recurring infections in your affected limb
Hardening and thickening of the skin on your arm or leg
Symptoms: What the patient has to tell you. Not observable by nurse. (list all and then √ which apply to your pt.):

 A feeling of heaviness or tightness in your arm or leg
 Restricted range of motion in your arm or leg
 Aching or discomfort in your arm or leg

Laboratory & Diagnostic Tests (√ which your pt. has had completed):

MRI
CT
Doppler Ultrasound
Lymphangiography
Lymphoscintigraphy

Associated Nursing Care:

Assess:

Assess extremity for edema and inflammation
Palpate edema to determine its quality (soft, firm, pitting, non-pitting)
Note any areas of abscess formation
Watch for signs of fever/chills
Do:

Advise patient to rest frequently with affected part elevated, each joint higher than preceding one.
Ensure patient cleans in crevices of skin to maintain skin integrity
Administer diuretics as ordered to control excess fluid
Recommend isometric exercises with extremity elevated
Suggest moderate sodium restriction

Teach:

Instruct patient on proper application of compression garments
Teach compliance with therapy
Teach patient to avoid trauma to affected extremity
Teach patient to use lotions free from perfumes, so they won’t irritate the skin
Teach to inspect feet and legs daily for skin breakdown

Reference(s) in APA Format:

Nettina, S. (2013). Lippincott manual of nursing practice (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. 686 - 687

Staff, Mayo Clinic. "Lymphedema: Tests and Diagnosis." Mayo Clinic. Mayo Foundation for Medical Education and Research, 15 Nov. 2011. Web. 03 Dec.