STUDY - Technical - New Dacian's Medicine
Edema
(Classical / Allopathic Medicine)
A common sign in
severely ill patients, generalized edema is the excessive
accumulation of interstitial fluid throughout the body. Its
severity varies widely; slight edema may be difficult to
detect, especially if the patient is obese, whereas massive
edema is immediately apparent.
Generalized edema
may result from cardiac, renal, endocrine, or hepatic
disorders as well as from severe burns, malnutrition, or the
effects of certain drugs and treatments.
Facial edema
refers to either localized swelling - for example, around the
eyes - or more generalized facial swelling that may extend to
the neck. Occasionally painful, this sign may develop
gradually or abruptly. Sometimes it precedes the onset of
peripheral or generalized edema. Mild edema may be difficult
to detect; the patient or someone familiar with his appearance
may report it before it's noticed during the assessment.
Leg edema results
when excess interstitial fluid accumulates in one or both
legs. It may affect just the foot and ankle, or it may extend
to the thigh; it may be slight or dramatic and pitting or
nonpitting. It may result from a venous disorder, trauma, or a
bone or cardiac disorder that disturbs the normal fluid
balance.
ALERT:
If the patient has severe edema:
- promptly take his vital signs, and check for jugular vein distention and cyanotic lips
- auscultate the lungs and heart; be alert for signs of heart failure
- place him in Fowler's position, if appropriate, and administer oxygen and a diuretic, as ordered
- initiate emergency measures (if facial edema is present and affecting the patient's airway).
If the patient presents with generalized, facial, or leg edema, perform a focused assessment.
If the patient has severe edema:
- promptly take his vital signs, and check for jugular vein distention and cyanotic lips
- auscultate the lungs and heart; be alert for signs of heart failure
- place him in Fowler's position, if appropriate, and administer oxygen and a diuretic, as ordered
- initiate emergency measures (if facial edema is present and affecting the patient's airway).
If the patient presents with generalized, facial, or leg edema, perform a focused assessment.
HISTORY:
If the patient presents with generalized or leg edema, obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs as well as alcohol intake and recent I.V. therapy. Also, ask these questions:
When did the edema begin?
Does the edema move throughout the course of the day - for example, from the upper extremities to the lower extremities? Is it worse in the morning or at the end of the day or is it affected by position changes?
Is the edema accompanied by shortness of breath or pain in the arms or legs?
Have you gained weight? How much? Describe your diet and fluid intake.
Do you have previous cardiac, renal, hepatic, endocrine, or GI disorders?
If the patient has facial edema, also ask these questions:
Did the edema develop suddenly or gradually?
Do you have allergies? Have you been recently exposed to allergens?
Have you had recent facial trauma?
If the patient presents with generalized or leg edema, obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs as well as alcohol intake and recent I.V. therapy. Also, ask these questions:
When did the edema begin?
Does the edema move throughout the course of the day - for example, from the upper extremities to the lower extremities? Is it worse in the morning or at the end of the day or is it affected by position changes?
Is the edema accompanied by shortness of breath or pain in the arms or legs?
Have you gained weight? How much? Describe your diet and fluid intake.
Do you have previous cardiac, renal, hepatic, endocrine, or GI disorders?
If the patient has facial edema, also ask these questions:
Did the edema develop suddenly or gradually?
Do you have allergies? Have you been recently exposed to allergens?
Have you had recent facial trauma?
PHYSICAL
ASSESSMENT:
If the patient presents with generalized edema:
Compare the patient's arms and legs for symmetrical edema. Also, note ecchymoses and cyanosis. Assess the back, sacrum, and hips of the bedridden patient for dependent edema.
Palpate peripheral pulses, noting whether hands and feet feel cold. Perform a complete cardiac and respiratory assessment.
If the patient presents with facial edema:
Examine the oral cavity to evaluate dental hygiene, and look for signs of infection. Visualize the oropharynx, and look for soft-tissue swelling.
If the patient presents with leg edema:
Examine each leg for pitting edema. Palpate peripheral pulses to detect possible insufficiency. Observe leg color and look for unusual vein patterns.
Palpate each leg for warmth, tenderness, and cords, and gently squeeze the calf muscle against the tibia to check for deep pain. If leg edema is unilateral, dorsiflex the foot to look for Homans’ sign, which is indicated by calf pain.
Note skin thickening or ulceration in the edematous areas.
If the patient presents with generalized edema:
Compare the patient's arms and legs for symmetrical edema. Also, note ecchymoses and cyanosis. Assess the back, sacrum, and hips of the bedridden patient for dependent edema.
Palpate peripheral pulses, noting whether hands and feet feel cold. Perform a complete cardiac and respiratory assessment.
If the patient presents with facial edema:
Examine the oral cavity to evaluate dental hygiene, and look for signs of infection. Visualize the oropharynx, and look for soft-tissue swelling.
If the patient presents with leg edema:
Examine each leg for pitting edema. Palpate peripheral pulses to detect possible insufficiency. Observe leg color and look for unusual vein patterns.
Palpate each leg for warmth, tenderness, and cords, and gently squeeze the calf muscle against the tibia to check for deep pain. If leg edema is unilateral, dorsiflex the foot to look for Homans’ sign, which is indicated by calf pain.
Note skin thickening or ulceration in the edematous areas.
SPECIAL
CONSIDERATIONS:
If the patient has generalized edema, position him with his limbs above heart level to promote drainage. If he develops dyspnea, lower his limbs, elevate the head of the bed, and administer oxygen.
If the patient has generalized edema, position him with his limbs above heart level to promote drainage. If he develops dyspnea, lower his limbs, elevate the head of the bed, and administer oxygen.
PEDIATRIC
POINTERS:
Renal failure in children commonly causes generalized edema.
Periorbital edema is more common than peripheral edema in children with such disorders as heart failure and acute glomerulonephritis. Pertussis may also cause periorbital edema.
Uncommon in children, leg edema may result from osteomyelitis, leg trauma, or, rarely, heart failure.
Renal failure in children commonly causes generalized edema.
Periorbital edema is more common than peripheral edema in children with such disorders as heart failure and acute glomerulonephritis. Pertussis may also cause periorbital edema.
Uncommon in children, leg edema may result from osteomyelitis, leg trauma, or, rarely, heart failure.
AGING ISSUES:
An older patient is more likely to develop edema for several reasons, including decreased cardiac and renal function and, in some cases, poor nutritional status.
An older patient is more likely to develop edema for several reasons, including decreased cardiac and renal function and, in some cases, poor nutritional status.
PATIENT
COUNSELING:
Teach the patient with known heart failure or renal failure to recognize edema and to report it to his healthcare provider. Advise him to monitor his weight and report a gain of 2 lb (0.9 kg) in 1 day or 5 lb (2.3 kg) in 1 week.
Teach the patient with known heart failure or renal failure to recognize edema and to report it to his healthcare provider. Advise him to monitor his weight and report a gain of 2 lb (0.9 kg) in 1 day or 5 lb (2.3 kg) in 1 week.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)