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Lymphedema

As a nurse, you will encounter patients with various health conditions. Being the primary point of contact for patients and their families, you are also responsible for educating them regarding these conditions. The better your patients and their loved ones know about their health condition, the better the health outcomes can be. Lymphedema, or lymphatic dysfunction, is a chronic and often overlooked condition that many people have.

Lymphedema is a condition of the lymphatic system in which fluids have difficulty draining from tissues in the body. When the fluid does not drain properly, it can lead to inflammation and other symptoms. According to the Lymphatic Education & Research Network, up to 10 million people in the US suffer from lymphedema.

Learning more about lymphatic dysfunction is necessary to improve your ability to provide clinical care and better patient education.

In this Fast CE For Less guide, we will cover various aspects of lymphedema, from its symptoms to causes, treatments, and more.

What is Lymphedema?

Also commonly called lymphatic dysfunction, lymphedema is a chronic condition affecting millions of people. The lymphatic system is responsible for draining the excess fluid from the tissues, allowing the body to maintain proper fluid balance. These fluids have immune cells, waste products, and toxins that go to the lymph nodes. These nodes are responsible for filtering fluid and returning it to your bloodstream.

If the lymphatic system does not work properly, tissues can start to swell due to fluid buildup. While it typically happens in a person’s legs or arms, other body parts can also be affected by lymphedema. The condition is classified into four stages:

  • Latent Lymphedema (Stage 0): At this initial stage, no visible swelling is evident, although individuals might experience sensations of achiness or tightness in the affected area.
  • Mild Lymphedema (Stage 1): Swelling begins to appear and can fluctuate throughout the day. Pressing on the swollen area leaves an indentation, known as pitting edema. At this stage, the skin returns to normal when the swelling decreases.
  • Moderate Lymphedema (Stage 2): The swelling becomes more constant and does not subside overnight. The affected tissue feels spongy, and there may be inflammation along with a noticeable thickening of the skin.
  • Severe Lymphedema (Stage 3): The most advanced stage, characterized by persistent swelling, hardening of the tissue, and significant enlargement of the affected area. Skin changes become permanent, and there may be a loss of function in the limb.

Understanding these stages helps in diagnosing and managing the condition effectively.

What are the Common Symptoms of Lymphedema?

Lymphedema manifests through various symptoms that keep getting worse if left untreated. Here are the most common symptoms patients may report:

  • Swelling of part of an arm or leg, which may include fingers or toes: Often accompanying skin discoloration, blisters, leaking fluid from the skin, and other changes, it is the most noticeable sign.
  • A feeling of heaviness or tightness: Patients typically describe a sensation of fullness or fatigue in the affected limb.
  • Restricted range of motion: Swelling may impede the ability to move the affected limb freely.
  • Aching or discomfort: Mild to severe pain can occur in the affected areas.
  • Recurring infections: Impaired lymphatic function makes patients more susceptible to infections in the affected limbs.
  • Hardening and thickening of the skin (fibrosis): As the condition progresses, the skin texture changes, becoming thicker and less flexible.

As a nurse, it is important to understand these signs as the indicators of lymphedema. It can help you recommend seeing a specialist for proper diagnosis and treatments to manage the chronic condition.

What Parts of the Body Does Lymphedema Affect?

Lymphedema primarily affects the limbs, although it can occur in other parts of the body. Here’s how it typically presents:

  • Legs: Including the feet and toes.
  • Arms: Including the hands and fingers.

Besides the arms and the legs, lymphedema can affect tissues in the neck and the head.

What are the Causes of Lymphedema?

While there are four stages of lymphatic dysfunction, there are two types of it, depending on the cause:

Primary Lymphedema

A rare, inherited condition where lymph vessels are absent or abnormal from birth. A person is likely to have primary lymphedema if another family member also has the condition.

Secondary Lymphedema

This is more common, caused by external factors like surgery that removes lymph nodes, radiation therapy for cancer, infection, or injury that damages lymph nodes or vessels. Typically, surgeries involving removing cancerous breast tissue require removing lymph tissue from under the arm.

What are the Risk Factors of Lymphedema?

Several factors can increase the risk of developing lymphedema, including:

  • Family history: Genetics can play a significant role, especially in primary lymphedema.
  • Cancer treatments: Surgery or radiation therapy that affects the lymph nodes, particularly in breast, pelvic, or testicular cancers.
  • Infection: Severe cellulitis or other infections can impair lymphatic function.
  • Obesity: A higher body mass index (BMI) can strain the lymphatic system, increasing the risk of developing lymphedema.

By understanding the underlying causes and recognizing risk factors, nurses can better guide patients in managing or preventing this condition.

How to Diagnose Lymphedema

Diagnosing lymphedema involves several steps to identify and assess the severity of the condition accurately. Initially, a healthcare provider takes a detailed medical history, focusing on any past surgeries, treatments, or infections that could affect the lymphatic system. They will also conduct physical examinations to look for signs of swelling and skin changes. Healthcare providers may also order laboratory tests to help rule out other conditions with similar symptoms. For more precise diagnostics, they also use imaging tests like:

  • CT scans: These provide detailed images of the affected area and can show blockages or changes in the lymphatic system.
  • Lymphoscintigraphy: A special dye is injected and tracked through the lymph vessels to detect flow disruptions.

These tests are essential for healthcare providers to confirm the presence of lymphedema and to plan effective treatment strategies.

How to Treat Lymphedema

Because lymphedema is a chronic condition, it has no cure. The goal of treating lymphatic dysfunction is to reduce swelling as early as possible to allow the affected area to retain its function and range. There are palliative and surgical treatments for severe cases.

Palliative Treatments

Palliative treatments focus on managing symptoms and preventing progression:

  • Compression Garments: Wearing specially designed stockings or sleeves helps reduce swelling and supports lymph flow.
  • Manual Lymph Drainage (MLD): A specialized form of massage that encourages lymph to move out of the swollen area.
  • Exercise: Tailored exercises can help maintain mobility and encourage lymph drainage.
  • Skin Care: Good skin care reduces the risk of infections, which can worsen lymphedema.
  • Dietary Adjustments: Proper nutrition supports overall health and can help manage weight, reducing strain on the lymphatic system.

Surgical Treatments

For severe cases, surgical options may be considered to reduce the volume of the affected limb or improve lymphatic function:

  • Lymphatic Bypass Procedures: These involve redirecting lymph flow around blocked areas.
  • Lymph Node Transfer: Transplanting lymph nodes from one part of the body to another to improve lymphatic drainage.
  • Liposuction: Removing fatty tissue that can accumulate in chronic lymphedema.

Outlook, Quality of Life, and Life Expectancy 

The outlook for individuals with lymphedema varies, largely depending on the stage at diagnosis and the effectiveness of management strategies. While there is currently no cure for lymphedema, appropriate treatment can significantly enhance quality of life by reducing symptoms and preventing complications. Life expectancy is typically not affected directly by lymphedema itself, but the condition can impact daily functioning and overall well-being. Managing lymphedema effectively involves:

  • Consistent use of compression garments.
  • Regular participation in physical therapy.
  • Diligent skin care to prevent infections.

With proactive management, individuals can lead active and fulfilling lives despite some limitations.

Remember, lymphedema is an ongoing condition that requires constant care. It is important to recommend that your patients seek immediate care and consult specialists to begin managing the condition as early as possible.

If you have not completed your nursing continuing education requirements to renew your license and want to learn more about providing care for your patients, online nursing CEUs offered by Fast CE For Less can be of great help.

To access flexible and affordable nursing continuing education courses and state bundles, visit www.fastceforless.com.

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