> Diagnosis and treatment of lymphedema in patients with breast cancer

Definition

lymphedema is a debilitating condition, chronic and progressive, considered to be one of the più of the painful consequences of the treatment of breast cancer. The chronic lymphedema, untreated, has adverse effects on the qualityà of life, including the impairment of the freedomà motion, decreased strength, functional limitations and distortions of the body.

The overall incidence of lymphedema related to breast cancer varies from 15% to 45% with a range from 33% to 47% after axillary lymph node dissection (ALND) with radiation, and between 4% and 17% after biopsy (SLBN) with radiation (Fu, Ridner, and Armer, 2009; StoutGergich et al, 2008), sentinel lymph node.

ALND involves the removal of axillary lymph nodes and SLNB involves the removal of the first lymph node or nodes where cancer cells have più probability; to spread. The variability will be in the ranges of incidence is the result of a lack of consistent assessment and diagnostic criteria, which lead to the definition unclear and the prevalence of lymphedema clinically significant (McLaughlin et al., 2008; Ryan et al., 2012; Torres Lacomba et al., 2010). There is a needà of the standard criteria for the diagnosis, evaluation, and treatment of lymphedema in patients with breast cancer.

the identification of The risk factors of the patient is essential to minimize the risk of lymphedema early with progression to advanced stage (Stout et al., 2012).
secondary prevention, early diagnosis, referral, the timely initiation of treatment to control the progression of disease and a surveillance model of care compared with the current model of rehabilitation based on impairment, this allows for the early identification of impairments and early intervention. (Stout et al., 2012)

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Prevention of Lymphedema

oncology nurses must be informed of the potential risk factors for development of lymphedema, to identify patients at risk, provide guidelines and create precise references to the second of the cases (International Consensus, 2006). Early diagnosis and intervention are critical to optimize patient outcomes.

the Protocols of early intervention (for example compression garments as the initial management and long-term) have been shown to reduce the lymphedema in high-risk patients, reduce the volume of the affected limb and prevent the progression of lymphedema in advanced form for one year after the intervention. (International Consensus, 2006; StoutGergich et al., 2008)

Symptoms and diagnosis

the Role of oncology nurses in the assessment

The early identification and diagnosis of lymphedema are critical to preventing long-term consequences, including cu paresthesia, reduction of the possibilityà of motion, loss of strength, deformity, physical discomfort, recurrent infections, and wounds that do not scar (McLaughlin et al., 2008; NLN, 2011; Papadopoulou et al., 2012; StoutGergich et al., 2008; Torres Lacomba et al., 2010).

The early identification is difficult becauseé the observable signs of lymphedema are generally absent in the early stages, oncology nurses should perform in-depth evaluations of the skin to control dryness, pigmentation, fragilityà, redness or pallor, cyanosis, heat, or cold, dermatitis, cellulitis, infections, scars, hyperkeratosis, wounds, ulcers, and deep folds. (International Consensus, 2006; Papadopoulou et al., 2012; Ryan et al.,2012).

Measurements and symptom evaluation are needed to determine clinically lymphoedema (McLaughlin et al., 2008). The mismatch usually occurs between the subjective measures and objective lymphedema), becauseé the patients notice rarely the smallest change in volume of the limb (McLaughlin et al., 2008). To allow for the early detection of lymphedema a comprehensive approach structured and the ongoing evaluation carried out by the same nurses are fundamental to the International Consensus, 2006;. Torres Lacomba et al, 2010). The evaluation of the operating the initial può to prevent errors in the diagnosis of lymphedema becauseé allows for documentation of lymphedema pre-existing, a normal variation in inter-limb. (Stout et al., 2012).

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oncology nurses must be aware of the potential risk factors for the development of lymphedema, to identify patients at risk, provide information and create references to the second of the cases (International Consensus, 2006). the early diagnosis and intervention are essential to optimize patient outcomes. Protocols for early intervention have been shown to prevent lymphedema in high-risk patients, reduce the volume of the affected limb and to prevent progression to lymphoedema più advanced (International Consensus, 2006; StoutGergich et al., 2008).

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