Oedema

• What is an Oedema look like on a patient?

  Swelling in the patients legs
• What’s an oedema? How does it occur? Hint-fluid and pressure

  Fluid shifts from plasma to interstitial fluid.

  It is an abnormal accumulation of fluid in the interstitial space, it occurs if the venous hydrostatic pressure rises, plasma on optic pressure decreases or interstitial oncotic pressure rises. It can also develop if an obstruction of lymphatic outflow decreased removal of interstitial fluid.
• List the 7 causes of an oedema?

  1)Extracellular fluid volume excess caused by addition or retention of saline aka saline overload

  2)Leaky capillary bed

  3)Obstruction to lymph flow

  4)Plasma oncotic pressure decreases

  5)Interstitial oncotic pressure rises

  6)Increase in intravascular hydrostatic pressure/if venous hydrostatic pressure rises

  7)Associated with cardiac, hepatic or renal failure and venous insufficiency

  remember: fluid distribution is governed by hydrostatic and colloid oncotic pressure

  
• What type of oedema is usually temporary and can resolve without treatment e.g. soft tissue injury and thrombophlebitis?

  Localised oedema
• what type of oedema affects all tissues e.g. heart failure which will need an intervention?

  Generalised oedema
• what type of oedema signs is fluid accumulation in lung tissue causing impaired gas exchange and pulmonary function?

  Pulmonary oedema
• localised soft tissue swelling – fluid accumulates in the interstitial space – affected by gravity e.g., immobility, obesity, pregnancy, long-term steroid therapy, conditions resulting in fluid retention and venous stasis, WHAT TYPE OF OEDEMA IS THIS?

  Peripheral oedema
• explain what a peripheral oedema is?

  – localised soft tissue swelling – fluid accumulates in the interstitial space – affected by gravity e.g., immobility, obesity, pregnancy, long-term steroid therapy, conditions resulting in fluid retention and venous stasis
• what are the steps to assessing an peripheral oedema?

  Location?

  Is it localized or generalized?

  past surgeries,medical history and medications?

  How long has the patient had the oedema?

  nutrition,intake output

  Cause?

  How does this affect the patient?

  -Need subjective and objective data
• How do you grade an oedema? describe the four steps and its aim?

  Grading of edema is typically done on a scale from 1+ to 4+ based on the depth and duration of the indentation when pressure is applied to the swollen area.

  Scale to see whether its pitting or non-pitting:

  1+ slight pitting/2mm, disappears rapidly

  2+ deeper pit/4mm, disappears in 10-15sec

  3+ deep pit/6mm, may last under 1 minute, extremity appears swollen

  4+ very deep pit/8mm, lasts 2-5 min, extremity grossly distorted
• effects of an oedema and impact on different locations?

  -gravity, so keep in prone position and have legs elevated

  •Tissue more susceptible to injury as linked to damage to skin cells

  •Poor supply of nutrients and oxygen to support healthy tissue

  •leg ulceration, may have ulcer for more than 5 years
• what nursing interventions are used for treating an oedema?

  • Manage underlying cause

  • position patient to reduce positional fluid collection and aid drainage e.g., elevation

  • recording measurements of pitting oedema

  • monitoring fluid balance

  • daily weigh

  • administering diuretics if prescribed

  • careful washing and patting dry

  • protecting affected tissue from pressure injury and trauma
• What is an oedema?

  oedema is the abnormal accumulation of fluid in the body, mainly water, in the intersitial space. it is a condition associated with fluid distribution and does not indicate fluid excess.
• What is a localized oedema?

  the accumulation of fluid may be localised as in thrombophlebitis or generalised as in heart failure, affecting all tissues. localised oedema is normally temporary and resolves without intervention.
• what’s can cause an oedema?

  -heart failure

  -excessive IV fluids containing sodium which will attract water

  -obesity resulting in increased fluid pressure and salt retention

  -drugs such as calcium antagonists (e.g. verapamil and nifedipine) and prolonged steroid therapy

  -renal conditions such as nephrotic syndrome

  -venous stasis resulting from immobility

  -varicose veins

  -liver cirrhosis causing hypoalbuminaemia, albumin is important as responsible for exerting on oncotic pressure in capillaries
• whats a pulmonary oedema? What causes it?

  a condition caused by the accumulation of fluid in the lungs, causing impaired gas exchange and pulmonary function.

  pulmonary oedema can result from:

  -congestive heart failure

  -fluid overload as a result of renal failure

  -myocardial infarction with left ventricular failure

  -chest injury

  -upper airway obstruction

  -severe chest infection
• What is a peripheral oedema?

  is a condition where there is localised soft tissue swelling from fluid accumulation in the interistial space. -Occurs in parts of the body affected by gravity; the lower limbs in a mobile patient or around the sacral region in a patient who is immobile and on bed rest.

  peripheral oedema can result from:

  -immobility

  -obesity

  -heart failure

  -pregnancy as a result of fluid retention and venous stasis

  -liver diseases such as cirrhosis of the liver

  -prolonged steroid therapy
• signs and symptoms of pulmonary oedema?

  dyspnoea or orthopnoea

  -wheezing

  -tachycardia and tachyapnoea

  -hypotension

  -cardiogenic shock

  -sweating

  -pallor or cyanosis

  -nausea

  -anxiety

  -dry or productive cough (if productive, pink frothy sputum)
• explain how to take a history from a patient with a pulmonary oedema and why its important?

  pulmonary oedemas can result in mild to severe dyspnoea; therefore, when obtaining a history from the patient in order to make a diagnosis, this must be considered. the healthcare professional should ask questions that are necessary and framed in such a way that the patient need only nod or shake their head. after a detailed hisotry has been undertaken from the primary source (the patient) or secondary soucres( other healthcare professionals; the patients partner, family or friends),
• Explain the investigations for pulmonary oedema?

  the following investigations may be required with patients consent and understanding:

  -chest x-ray

  -blood gas analysis

  -estimation of cardiac enzymes

  -liver fucntion tests

  -estimation of urea and electrolytes

  -electrocardiograph
• Explain management and care of pulmonary oedema?

  -psycological and physical support for patient and family

  -nurse call bell

  -tissues and sputum pot and trash bin

  -upright postion

  -humidified oxygen by facemask to improve oxygenation

  -medication e.g.diuretics like furosemide and caution with diamoprhine

  -monitor fluid balance , may need catheter to monitor output

  -Strict fluid restriction due to excess fluid causing oedema

  -monitor vital signs

  -assist with daily living
• What is a pitting oedema, how does it present?

  pitting oedema is a more serious type of oedema than non-pitting oedema. the area of skin, such as around the ankles, remains indented ( a pit forms) when lightly pressed. peripheral oedema does not appear or become visible until the body has retained up to 3L of fluid. if, for example, a patient retains 5.5L of fluid, this is equivalent to 5.5 kg of weight; hence, a way of determining

  if the patient is retaining fluid is to record daily weight, along with meticulous fluid balance monitoring.
• what is involved in the care of those with peripheral oedema?

  clearly explaining the condtion to the patient and if appropriate, their family

  -assessing skin condition following local policy

  -carefully washing and patting dry (not rubbing)

  -monitoring fluid balance

  -daily weight measurement

  -administering prescribed diuretics (e.g. furosemide)

  -elevating the patients oedematous ankles when they are sitting out of bed to aid drainage of the pooled fluid

  -helping with actiivties of daily living that the patient is unable to carry out independently.
• What type of condition can cause an oedema?


  remeber: any condition that causes retention of sodium and water increases blood volume=increases blood hydrostatic pressure which leads to a fluid shift=oedema
• Third spacing oedema?


  When the capillary or interstitial pressure changes fluid can shift from one compartment to another, therefore albumin will cause fluid to return to the vascular compartment tissue/interstitial spaces which cause a decrease in the protein level=thrid spacing oedema
• movement of plasma to interstitial fluid movement/oedema can be caused by?

  -Increased venous hydrostatic pressure means fluid can’t get from the intersitial space into the capillary this can occur from varicose veins, fluid overload, liver failure, heart failure

  -also can be caused by decreased plasma oncotic pressure meaning fluid can’t be drawn back into the capillary due to e.g.low protein , renal problems or malnutrition

  -increased intersitial oncotic pressure means capillary walls become damaged and proteins accumulate this is evident in e.g. trauma, burns, inflammation
• what to do when looking after a patient with an oedema?

  -important to look into their health history, medications, past surges and issues

  -physical examination

  -nutritional assessment, look into their sodium intake

  -look at their intake and output

  -activity/exercise

  -cognitive/neurological function

  Objective data:

  -look at mucous membrane

  -take vital signs, O2 sats

  -weigh, looks at total body fluid not just output 1litre body fluid=1 kg

  -skin turgor

  -lab values and blood test results especially white blood cells for infection=inflammation