health care workers can use the tools of radiology including chest x-ray, electrocardiogram, echocardiogram, computed tomography, ultrasound, or venography contrast. Laboratory tools for the diagnosis of edema include functionalityà renal, functionalityà liver, thyroid function, and D-dimer (NLN, 2011; Tretbar et al., 2007).
the objective of The management of lymphoedema is that of delaying the progression, and offering relief from the symptoms, prevent complications, maintain the integrityà of the skin, reduce infections, maintain the compliance of the patient with self-management and maintain the qualityà of life (NLN, 2011; Ryan et al., 2012). Management and treatment needs to be customized for each patient.
Therapy decongestiva complete
La terapia decongestiva completa è riconosciuta come lo standard di cura (International Consensus, 2006; Lymphedema, 2009; NLN, 2011; Oncology Nursing Society [ONS], 2014; Papadopoulou et al., 2012; Ridner et al., 2012; Ryan et al., 2012; Stout et al., 2012; StoutGergich et al., 2008).
This therapy includes education on skin care, infection prevention and treatment; and può help perform the manual lymphatic drainage (a massage technique that increases the activitiesà of the lymph centers normal to move the fluid from the area congested); it is recommended the use of compression bandage for ciò concerning the clothes; specific exercises; and the daily treatment on a one-to-one for 3/8 weeks. (International Consensus, 2006; NLN, 2011; ONS, 2014; Stout et al., 2012).
We recommend two phases of treatment. The phase of intensive treatment consists of interventions with therapy decongestiva complete (NLN, 2011; Papadopoulou et al., 2012). Patients are moved to the maintenance phase of treatment when no changes occur in the volume of the limb. (Papadopoulou et al., 2012) (see table 1)
An interdisciplinary approach for the management of lymphedema and its treatment is necessary to provide treatment for the tumor of high qualityà. Depending on the diagnosis, a patient with breast cancer può benefit from several disciplines including surgery, medical oncology, radiation oncology, physical therapy, nutrition, pain management and psychology (StoutGergich et al., 2008).
A thorough evaluation and examination are required to start the adequate references in a timely manner (Papadopoulou et al., 2012; Tretbar et al., 2007). Physical therapists or trained professionals in the management of lymphedema perform a functional evaluation that includes range of motion, the abilityà to apply or remove clothing or bandages for compression, the abilityà to challenge or to carry out the activities; of daily life and the use of the garrisons. (International Consensus, 2006).
Therapists verified employment and perform the manual lymphatic drainage, massage on the scars, stretching exercises, exercises for the shoulders and activity; functional (Torres Lacomba et al., 2010).
The therapists at the lymphedema also take routine measurements to monitor the response to treatment and progression, formulate recommendations with regard to the exercises to the patients for the use of compression devices provide instructions and assist patients in the maintenance of the daily duties. (Papadopoulou et al., 2012).
The nutritionist carries out an assessment of body weight, from nutritional advice and recommendations, and può to plan the program of loss of weight with a target body mass of less than 25 (International Consensus, 2006; Papadopoulou et al., 2012).
The experts in pain management and palliatives are useful to determine the cause, nature, frequency, timing, seriousnessà and the inpatto of pain on the qualityà of life (International Consensus, 2006; Torres Lacomba et al., 2010). After the screening, a psychologist evaluates the signs of depression, social isolation, concerns, sessualità, anxiety, reduced self-esteem, the distorted picture of the body and the concerns of the report (for example, sexual, family, social) (International Consensus, 2006; Papadopoulou et al., 2012).
The psychologists also evaluate the understanding of the disease by the patient and help in the creation of expectations of treatment (International Consensus, 2006; Papadopoulou et al., 2012). Is performed an assessment of the qualityà of life to formulate recommendations for self-management and to teach the abilityà to deal with and manage their situation. (International Consensus, 2006; Papadopoulou et al., 2012; Ryan et al., 2012).
Patient education for preventing and managing lymphedema
Currently, there are no strategies which show that the lymphedema can be prevented or treated; therefore, education of the patient, initial and ongoing, is essential to managing International Consensus, 2006; McLaughlin et al., 2008; NLN, 2011; ONS, 2014; Ridner et al., 2012; Ryan et al., 2012).
patients who receive the education practiced più risk behaviours, reported fewer symptoms of lymphedema and have improved their behaviours. (Ryan et al., 2012).
The education preoperative includes an individual discussion about the incidence and pathogenesis of lymphedema (Papadopoulou et al., 2012). Patients should also receive printed material of the lymphatic system, to understand the sources of lymphedema, verbalize the identification of risk factors and discussing interventions to prevent lymphoedema (Torres Lacomba et al., 2010).
education, post-operative should include a plan of action individualized to minimize the risk and facilitate the lymphatic drainage, also should include the use of compression garments (Papadopoulou et al., 2012). Patients should be educated on the early signs and symptoms of lymphedema, including clothing or jewelry that become più close; pain; feeling of heaviness; a sense of oppression and fullness, or rigidityà; swelling observable (International Consensus, 2006; Lymphedema, 2009; Taylor et al., 2006).
patients should also be educated on the behaviors precautions to reduce the risk of development of lymphedema (see figure 4). Patient education is important to monitor the first signs and symptoms of side effects like pain, the immobilità, the weakness (Stout et al., 2012). The strengthening of these interventions is important in every encounter with the patient to promote adherence to the treatment plan and maximize the results.
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