Chapter 13 – Lymphatic System Assessment
Health Promotion and Disease Prevention: Considerations and Interventions
Health promotion is an important component of a healthy lymphatic system. To determine appropriate interventions, carefully consider all of the collected data, both subjective and objective. As part of subjective data collection, you should inquire about risk factors, social determinants, and other considerations.
Integrate this kind of inquiry throughout the assessment. You will ask many probing questions during the subjective assessment, but other questions will emerge based on your critical reflection of data collected during the subjective and objective assessment. These findings will inform your clinical judgement and help you develop appropriate health promotion interventions for each specific patient.
Preventing the Spread of Infection
The spread of infections can be prevented with simple techniques such as hand hygiene, staying home when sick, covering the mouth when coughing, wearing a mask, and receiving an annual influenza vaccine. You may need to assess the knowledge of the client and provide education about infection control. Also, with young children, you may need to assess the knowledge of parents/caregivers and educate them about infection control so that they can teach their children. Children learn about preventing the spread of infection by watching their parents/caregivers/siblings and practicing the techniques they use, so it is important to reinforce proper technique and infection prevention behaviours.
Probing questions might include:
- When do you perform hand hygiene?
- How do you perform hand hygiene?
- What do you do when you are sick?
Activity
Activity is another important part of assisting with effective lymph fluid transportation. For example, the pump action associated with muscle contraction helps aid in lymphatic drainage. Activity and exercise also help maintain a healthy body weight and prevent obesity.
It is often recommended that clients with lymphedema engage in gentle movement of limbs to help transport lymph fluid. Activities can include walking, swimming, and bike riding. Depending on the severity of lymphedema, clients may be assisted with range of motion exercises and referred to a physiotherapist or a registered massage therapist specializing in lymphedema.
Probing questions may include:
- Tell me about any activity/exercise you are involved in?
- How many times do you participate in exercise a week?
- How long each time?
- Do you have limitations related to activity/exercise?
- Do you have any concerns related to activity/exercise?
Healthy Eating
Healthy eating promotes healthy cell function, so it is important that clients have an appropriate level of water intake, nutrients, and vitamins. Healthy eating can also help maintain a healthy body weight; extra body weight can interfere with the lymphatic system’s ability to transport lymph fluid.
Probing questions may include:
- Tell me about your normal diet?
- What do you eat and drink each day?
- Do you have sufficient access to healthy food?
- Do you have sufficient funds to access healthy food?
Alcohol and Drug Use
Alcohol and drug use can affect the lymphatic system in many ways. For example, these activities can be associated with certain cancers, cause inflammation, and increase the risk for injury and infections. The most recent Canadian guidelines now suggest that there are health risks associated with any level of alcohol consumption, although negligible with two drinks or less weekly (Paradis et al., 2022). Alcohol is considered a carcinogen and linked to several types of cancers and can affect the arteries (Paradis et al., 2022).
Reflect on your own biases about alcohol and drugs. Use of these substances can be stigmatized, so self-reflection is crucial to help facilitate a non-judgmental approach to care.
Probing questions may include:
- Tell me about how much alcohol you consume in a day? If the client does not consume alcohol daily, you can assess consumption based on weekly, monthly, or none. If the client’s answer is affirmative, ask probing questions such as: How much (e.g., ounces a day)? What type of alcohol (e.g., red wine, beer)? For how long? Can you tell me the reasons?
- If you do not currently consume alcohol, have you ever? If affirmative, ask similar probing questions, including why the client quit.
Ask similar questions related to drug use.
Contextualizing Inclusivity
Consider a client’s socio-economic status during your assessment, particularly as it relates to healthy eating. For example, does the client have geographical access and sufficient funds for healthy foods such as fresh fruits and vegetables? If not, discuss alternatives with the client (e.g., frozen vegetables). Another issue is that discussions about weight can be triggering for some clients, especially those with moderate to severe lymphedema, which can affect body image. Always use a compassionate, open, and non-judgmental approach to assessment.
