Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint: Follow-up for lymphedema / New or worsening symptoms concerning lymphedema (specify)
History of Present Illness:
For follow-up visits, inquire about any changes in lymphedema symptoms since the last encounter (e.g., increased swelling, changes in skin texture, discomfort, difficulty using affected limb).
Describe the character, duration, and severity of new symptoms.
Briefly describe any recent events that may have worsened lymphedema (e.g., injury, infection, excessive activity).
Mention any changes in adherence to self-care practices (compression garments, elevation).
Past Medical History:
Include the date of lymphedema diagnosis and the underlying cause (primary, secondary – post-surgical, post-traumatic, post-inflammatory).
Mention the affected limb(s).
List any relevant past medical history, including:
History of cancer treatment (common cause of secondary lymphedema)
Underlying medical conditions that may contribute to lymphedema (e.g., obesity, venous insufficiency)
Medications:
List all current medications, including any diuretics used for lymphedema management.
Social History:
Inquire about occupation and activities that may impact lymphedema (e.g., prolonged standing, heavy lifting).
Family History:
Inquire about a family history of lymphedema (relevant for primary lymphedema).
Physical Exam:
Affected limb:
Measure limb circumferences at specific points for comparison with past measurements and assessment of swelling progression.
Assess for skin integrity (breaks, discoloration, signs of infection).
Evaluate for pitting edema (indentations remain after applying pressure).
Assess for joint mobility and range of motion limitations.
General observation: Assess for signs of infection (fever, chills, redness) in the affected limb.
Imaging Studies (if recent):
Lymphoscintigraphy: May be used to assess lymphatic drainage patterns and identify blockages.
Doppler ultrasound: May be used to evaluate blood flow and rule out venous insufficiency.
Assessment:
Lymphedema stage: Describe the current stage of lymphedema based on severity of swelling (pitting edema, fibrotic changes).
Skin integrity: Describe the condition of the skin on the affected limb.
Functional limitations: Briefly describe any limitations in using the affected limb due to lymphedema.
Response to treatment: Evaluate the patient’s response to ongoing lymphedema management (e.g., improvement in swelling, increased function).
Plan:
Treatment:
Reinforce the importance of self-care practices:
Compression garments: Proper application and use of compression garments is crucial for lymphedema management.
Manual lymphatic drainage (MLD): If indicated, continued MLD sessions by a trained therapist can help manage swelling.
Skin care: Moisturizing and maintaining skin integrity is essential to prevent infection.
Elevation: Regular elevation of the affected limb can help reduce swelling.
Exercise: Encourage regular exercise within limitations to improve circulation and overall health.
Consideration for additional interventions: Depending on the severity and response to conservative measures, other options may be discussed. Examples include:
Decongestive lymphatic therapy (DLT): A more intensive form of MLD with additional bandaging techniques.
Pneumatic compression pumps: Devices that use inflatable sleeves to promote lymphatic drainage.
Surgical intervention (rarely used): Liposuction or lymphovenous bypass surgery may be considered in specific cases.
Monitoring: Schedule regular follow-up visits to monitor lymphedema progression, skin integrity, and response to treatment.
Education:
Educate the patient about lymphedema, the importance of self-care practices, infection prevention strategies, and healthy lifestyle choices that can help manage the condition.
Follow-up:
Schedule follow-up visits based on the severity of lymphedema and the need for monitoring and adherence support.
Advise the patient to return sooner if they experience worsening symptoms, signs of infection, or have difficulty managing their lymphedema at home.