THE CLIENT WITH LYMPHEDEMA

lymphadenopathy - enlarged lymph nodes, may be localized or generalized. Localized enlarge lymph nodes rise from
inflammation, generalized enlarged lymph nodes are usually associated with disease or malignancy.
lymphangitis - inflammation of the lymph vessels draining an infected area of the body. Red streaks alone inflamed
vessels, pain, heat, and swelling.
lymphedema - primary or secondary resulting from inflammation, obstruction, or removal of lymphatic vessels;
extremity edema. Primary is uncommon. Secondary is an acquired condition, resulting from damage, obstruction or
removal of lymphatic vessels. Filariasis-infestation of filaria worm most common as well as bacterial lymphangitis,
obstruction by tumors, surgical and radiation therapy for breast cancer.

PATHOPHYSIOLOGY AND MANIFESTATIONS

obstruction of lymph drainage, prevents protein molecules from returning to circulation, increase in tissue osmotic
pressure, draws in additional fluid, causing edema. edema usually starts distal and works up the extremity. edema is
soft and pitting (venous disorders cause softer edema and skin hyperpigmentation). lymphedema is generally painless,
limb may feel heavy.

INTERDISCIPLINARY CARE

focus on relieving edema, preventing or treating infection

DIAGNOSIS

abdominal or pelvic us and ct scans, mri; lymphangiography-radioactive isotope; lymphoscintigraphy-mapping return

flow (injected distally)

TREATMENTS

meticulous skin and foot care to prevent infection. always wear shoes. careful cleansing and emollients to prevent
drying. exercise is encouraged and frequent periods of leg elevation. fob raised 15-20 degrees at night. ted hose
during the day or compression boots. antibiotics, diuretic therapy intermittently. surgery will create anastomoses.

NURSING CARE

focus on reducing edema, preventing tissue damage, promoting effective coping, disorder on body image and function

NURSING DIAGNOSIS AND INTERVENTIONS

IMPAIRED TISSUE INTEGRITY

frequent inspection of skin, report areas of pallor, redness or inflammation. breaks in skin increase risk for infection
(cellulitis) apply ted hose or compression boots - remove devices every 8 hours inspect skin; elevate extremities; use
preventative skin devices - egg create foam, sheepskin, pillows or padding; keep skin clean and dry; adhere to
therapeutic regimen.

EXCESS FLUID VOLUME

intermittent diuretic therapy, dietary sodium restriction; monitor I&O; during acute periods, asses daily, measure girth

DISTURBED BODY IMAGE

disproportionate size of extremity can affect body image; as disease progresses, maybe become more disfiguring;
mobility may be impaired; may develop and increasingly negative self perception. encourage discussions, accept the
client’s perception, encourage active participation in self care.

COMMUNITY BASED CARE

recommend exercise, foot and skin care, ted hose, prevent infection (wearing gloves) signs and symptoms to report to
heath worker, use precautions associated with any meds, na restricted diet.