1

Strength in Small Acts

Evidence Based Paper: Safety, Mobility, Hygiene

NRS 111 Nursing Skills
Carly J. Blue
Jan 17, 2021
 2

The term lymphoedema refers to the swelling of the limbs, typically the legs, as excess

lymphatic fluid builds up within the body and settles in the extremities. If unable to rejoin with the

circulation, quite a few unpleasant and undesirable side effects are likely to occur. In addition to the

physical swelling, a feeling of heaviness, aching/discomfort, and a restriction of movement can

coincide with it. The sooner this fluid can rejoin circulation, the better, and it can be done with one

simple process that people do each and every day; movement. Movement in this process is

absolutely essential, not too difficult, right? For much of the population, that statement would be

correct, however the populace who is most affected by lymphoedema is the elderly community.

Movement and activity in the senior community can be dangerous and is often more difficult to

safely perform. In the article, Engaging with patients to make exercise and movement more

meaningful: a case report, written by Dr. Portia Wilson, describes a case in which a community

lymphoedema therapist was able to help a gentleman in his 60s to incorporate exercise into his

care routine in a very creative and inspiring way.

This study demonstrates that by setting small, achievable, and enjoyable goals can be

implemented in the everyday life of the affected patient, the symptoms of lymphoedema can be

drastically reduced, if not removed entirely. In this case study, Dr. Wilson is able to implement

creative and innovative outlets in her patient’s life to improve his daily living. The first application

that Wilson makes refers to a simple way of sitting in his recliner. She suggests that instead of

sitting straight upright, where the lymph nodes are compressed and fail to properly circulate the

lymph in his body, that he instead recline the chair back, so the nodes are less compressed and are

able to somewhat function while his body is at rest. The second suggestion Wilson gave to her

patient involves a daily love shared between him and his wife; a hot cup of tea. Wilson told him that

when he walks to the kitchen to heat the water, to hold onto the sink for support, and march in

place in the time it takes for the water to boil (Wilson). This is a safe way to incorporate more

movement into a normal mundane everyday task.

 3

Other examples that Wilson suggested included wiggling of the client’s toes, flexing his feet,

and moving his ankles in circles every time a commercial comes onto the TV between breaks in a

show. The final and most integrated suggestion involves a beloved hobby of the gentleman’s past;

playing the organ. He played at several local churches during the weekly service before the

lymphoedema took hold too severely for him to continue. Now, with adequate healthcare, proper

skin hygiene, compression therapy, and massage coupled with the new exercise regiment, his

previous pastime could be revived. “The possibility of taking his scooter to a small local village

church to practice the organ was discussed, which ideally should lead to him walking the very short

distance” (Wilson). The walking would be ideal for his calf muscles to get an excellent opportunity

to exercise in a longer stretch, as well as bring several wonderful benefits that go beyond the

physical. Returning to a hobby he loved doing has the ability to improve upon mental and spiritual

health, as well as bring him back to the community he loved playing for. It is so much more than a

simple walk to town, it is the power to rejoin with friends and family through worship and the

universal language of music.

For patients in which the lower leg is the primary location of lymph buildup, using the

muscles in the legs, specifically the calf muscle, can help the return of blood and lymph. “The calf

muscle is often considered the second heart because it plays a role within the circulatory system

that is similar to the heart. One pump of the heart exerts enough power to send blood throughout

the body, reaching the lower extremities in just seconds. That oxygen-rich blood flows through

arteries and capillaries to reach every cell of the body, providing oxygen and nourishment” (Garcia).

One of the best methods to strengthen and utilize the body’s calf muscle is simply by walking.

Another great technique in this case study, specific to the gentleman at hand, is by using the foot

pedals on the console of an organ. By using the legs to push the pedals to down, achieving the

deeper bass tones, he is using the same motion as he would be when walking. This is why the old
 4

hobby of Wilson’s patient that is incorporated into his care routine provides so many substantial

benefits.

In the nursing practice, the importance of assessing the patient as a whole cannot be

overstated. Someone’s history and who they are is more than just their diagnosis. Of course, it is

still a very important part of how the care plan gets implemented into daily life, but it does not

define who they are. In addition, if a care plan is not crafted to fit the individual’s needs in his or her

current lifestyle it is much more unlikely that they will follow the plan. This case study

demonstrates that Wilson cares about her patient as a person and is able to implement a strategy

that will improve upon his daily life. The trifecta of mobility, safety, and skin hygiene all work

together to improve the quality of life of this wonderful gentleman.

 5

References

Garcia, A. Why Is the Calf Muscle Considered the Second Heart? (2018). HealthTide. Retrieved from

https://healthtide.com/calf-muscle-considered-second-heart/

Lymphedema. (2017, December). Mayo Clinic. Retrieved from

https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-

20374682

Maher JP, Dunton GF. Within-day time-varying associations between motivation and movement-

related behaviours in older adults. Psychol Sport Exercise. (2020). Retrieved from

https://doi.org/10.1016/j.psychsport.2019.04.012

Watts, T. Four cornerstones of lymphoedema care. Nurse Residential Care. (2018)

Retrieved from https://doi.org/10.12968/nrec.2018.20.7.310

Wilson, P. Engaging with patients to make exercise and movement more meaningful: a case report.

(2020). Clinical Focus, S28–S31. Retrieved from

https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2020.25.Sup10.S28