Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)

March 8, 2022
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Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)

Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)

1. C-1: Compare and contrast Hodgkin and non-Hodgkin lymphomas based on pathophysiology, signs and symptoms, diagnosis, and treatments.
2. C-2: Explain why infections occur frequently in patients with lymphomas. Is this true for patients with other lymph disorders?
3. C-3: Describe the prognoses for a person with a stage I and stage IV Hodgkin lymphoma. Use rationale to explain your reasoning. How would you explain this to a patient/family?
4. C-4: Outline the conditions of Hodgkin’s lymphoma at each of the four stages as defined by the Ann Arbor staging system.
5. C-5: Describe the condition of lymphedema. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
6. C-6: Describe the condition of multiple myeloma. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
7. C-7: Describe the condition of Castleman disease. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)Posting to the Discussion Forum
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C-5: Describe the condition of lymphedema. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.

Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)Lymphedema is a chronic lymph disorder that occurs due to the build-up of increased lymphatic fluid in the tissue space with the lymphatic system failing to properly filter it through the body. This results in extreme swelling. It occurs due to a disruption in the normal occurrences that happen within the lymphatic system. It may occur at different stages of life congenital (birth), lymphedema praecox (puberty), and lymphedema tarda (occurs after age 35). Some other general causes are genetics, cancer, age, excess weight/obesity, filariasis (bacterial strain Wuchereria bancrofti), rheumatoid arthritis, parasites, malignancies, and injury to the lymphatic system (Sleigh, 2021). Primary lymphedema is rather rare (1 in 100,000) versus secondary lymphedema (1 in 1000) (Sleigh, 2021). There is no cure for lymphedema, but there are effective management techniques.

Signs: swelling of extremities, decreased ROM, recurring infections, thickening of the skin, clothes fitting tighter, dimpled skin, water retention

Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)Symptoms: heaviness/tightness and pain

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Some strategies to assist in returning to homeostasis consist of decongestive lymphedema therapy, compression stockings (to assist in the recirculation of the fluid), manual lymph drainage, exercise, skincare, surgery, and pain medications.

Citations
Sleigh, B. C. (2021, June 4). Lymphedema. NCBI. Retrieved September 27, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK537239/.
Describe the condition of lymphedema. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.
Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)Lymphedema is the swelling of the tissues in the extremities due to obstruction of the lymphatic vessels. To understand the pathophysiology of lymphedema, it is important to understand lymphatic circulation. As fluid leaves the blood system and into the interstitial space, the fluid is picked up by lymph capillaries, filtered by lymph nodes, and returned to the circulatory system (Hubert & VanMeter, 2018, p. 215). This system helps maintain a fluid balance in the body. If this system is obstructed or damaged in any way, lymph begins to accumulate initiating the swelling of the lymph tissue. The cause of lymphedema can be either congenital (primary) or from another disease or process such as cancer, cancer treatment, surgery, accidents, or chronic venous insufficiency (secondary) (Li et al., 2020).
The accumulation of the interstitial, or lymph, fluid creates swelling. In the first stages, swelling may be soft and the limb may begin to feel heavy. As the swelling progresses, the limb may become firm and tender. When the skin becomes hard and thick, it is known as skin fibrosis. The lymph fluid contains proteins predisposing this condition to infection, such as cellulitis (Hubert & VanMeter, 2018, p. 221).
Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)The key to treating lymphedema is trying to remove some of the fluid that has built up. Ways of trying to do this include exercising, compression stockings, manual lymphatic drainage, elevation of the affect limb, and diuretic therapy. A newer option for patients suffering with lymphedema is pneumatic compression devices (PCD), or Flexitouch. PCD’s are sleeves that are placed on the swollen extremity that inflate and deflate creating gentle pressure that pushes the lymphatic fluid to other parts of the body (Karaca et al., 2017). Surgery is also used for treatment to either remove the tissue or place a shunt to drain the fluid.
Reply 2 to Team C
Alexandra,
The video you displayed was very informative. In my future practice as an Advanced Practicing Registered Nurse (APRN), I may encounter patients with this condition. The Flexitouch system sleeves look like an essential treatment for symptoms of lymphedema. Knowing that lymphedema can be from a primary or secondary cause, one would think treatments would be different. However, treatments are the same depending on the severity of the condition.
Upon physical examination, I may observe edema or swelling that progresses over time and hardening of the skin, also known as fibrosis (CDC,2021). A patient may complain of symptoms are heaviness, tight skin, tenderness, and overall discomfort (Mayo Clinic,2021). Moreover, the Flexitouch system provides at-home pneumatic compression therapy for daily management and symptom relief in thirty-two minutes ( Rider et al., 2019).
Furthermore, the Flexitouch compression system has fifteen treatment options that will facilitate adequate drainage as it compresses the fluid from the unhealthy region back to the healthy areas. A study done by Rider et al. (2019) revealed that physical examination revealed a change in the number of swollen sites and swelling severity from baseline to treatment.
Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)Thank you for a great post and the opportunity to learn about lymphedema and treatment options such as the Flexitouch system that, as studies show, gives patients a better quality of life.
Best Regards,
Teresa H.

Week 5 Discussion 1: Question-Based Discussion—Team C (Lymph Disorders)Reference:
Center for Disease Control and Prevention (CDC). (2021). Cancer Survivors: Lymphedema https://www.cdc.gov/cancer/survivors/patients/lymphedema.htm
Mayo Clinic. (2021). Lymphedema: Symptoms and Causes https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682
Ridner, S., Dietrich, M., Deng, J., Ettema, S., & Murphy. B.(2019). Advanced pneumatic compression for treatment of lymphedema of the head and neck: a randomized wait-list controlled trial. Supportive Care in Cancer https://tactilemedical.com/wp-content/uploads/2020/12/Ridner2020_Article_AdvancedPneumaticCompressionFo.pdf
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