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EDEMA

Accumulation of fluid in the tissue space is called edema


It occurs due to
Increased filtration
Decreased reabsorption
Impaired lymph drainage
CAUSES
Renal disorders like
Chronic renal failure
CGN
Nephritic syndrome
End stage renal disease
Cardiac causes like
Heart failure (CCF)
HTN
Liver disorders like
Cirrhosis of liver
Cerebral disorders like
Cerebral edema
Increased intracranial pressure due to intracranial hematoma
Hydrocephalus
Pulmonary disorders like
COPD
Pulmonary edema etc
Endocrinal disorders like
Hypothyroidism
Cushing syndrome
Hematological disorders like
Anemias
Skin disorders like
Burns
Others like
Acute laryngeal abstraction
Chronic wound

Lymphatic disorders ( lymph adenopathy, lymphatic obstruction,


lymphadenitis)
Drugs like
Corticosteroids
Rapid IV infusion
Manifestation
Signs
Skin changes, skin surface smooth and shiny
Bulging of the vascular structures or engorged vessels
On the palpitation of the area smooth and warm temperature,
tenderness
Symptoms
Weight gain, pleural effusion
Facial puffiness
Dyspnea, pericardial effusion
Leg pains ascities
Diagnosis
History collection
Physical examination
Examine the area for edema
Include
Sacrum
Scapular region
Ankle
Feet
Peri orbital region
Edema of the legs are assessed for pitting type and non pitting
type of edema
To asses peripheral edema press a finger into skin over the
client tibia, note the present and depth and persistent of any
resulting depression
Edema is often graded by using scale
Characteristic features of edema
Examiner must check the edema for
Presence or absent
Pitting or non pitting
Unilateral or bilateral
Dependent or non dependent
Grading of edema

Grade-0
no edema
Grade -1
a rarely detectable
depression accompanied by normal foot and leg contours
Grade-2
a deep depression less than
5 mm accompanied by normal foot and leg contours
Grade-3
a deep depression 5-10 mm
accompanied by foot and leg contours
Grade-4
Deeper depression more
than 1 cm accompanied by foot and leg swelling

Management
Goals:
To reduce edema
To maintain fluid and electrolyte balance
To prevent complications
Conservative management
Adequate rest and sleep
Limitation of movement or exercise
Psychological reassurance
Regular weight monitoring
Pharmacological therapy
Diuretics- lasix
Anti hypertensives to reduce the work load proper electrolyte
correction based on serum electrolyte levels
Nutritional therapy
Salt restricted diet with high calorie intake
Regular evaluation of cardio pulmonary function
Fluid restriction based on urinary output
Nursing diagnosis
Excess fluid volume related to increased intravascular fluid secondary to
disease process as evidenced by weight gain, pedal edema
Impaired skin integrity related to shift of the fluid into the interstitial
space, subcutaneous tissue secondary to disease condition as evidenced
by dry and scaly skin
Impaired physical mobility related to pedal edema