Edema

What is edema?

• Edema most commonly occurs in the feet and legs, where also is referred to asfrom peripheral •Edema is anitobservable swelling fluid edema. The swelling the result of the accumulation in certainisbody tissues. accumulation of excess fluid under the skin in the spaces within the tissues that are outside of the blood vessels. These spaces are known as interstitial spaces or compartments.

• The term anasarca refers to the severe, widespread accumulation of fluid in the various tissues and cavities of the body.

• Edema (American English), formerly known as dropsy or hydropsy, is the increase of interstitial fluid in any organ — swelling. Generally, the amount of interstitial fluid is determined by the balance of fluid homeostasis, and increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.

TYPES OF EDEMA

• Pitting edema can be demonstrated by applying pressure to, for example, the skin of a swollen leg, by depressing the skin with a finger. If the pressing causes an indentation in the skin that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Actually, any form of pressure, such as from the elastic part of socks, can induce the pitting of this edema.

• In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a radical mastectomy, or congenital lymphedema. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shins that occurs in some patients with hyperthyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.

Assessment of Edema

• The nurse palpates the edema, particularly if the area is taut, shiny skin noted. • Edematous areas are palpated for consistency, temperature, shape, tenderness, and mobility. • The nurse presses a finger firmly against the edematous area for 5 seconds to assess for pitting edema, that is, a residual indentation left by the finger’s pressure when the fluid is displaced from the underlying tissue.

• The depth of pitting is expressed in millimeters or centimeters. Because the variation in rating scales is more accurate for the nurse to state the depth of pitting rather than to rate it. • Areas examined by the nurse for edema include over the sacrum (especially in bed ridden clients), the feet, ankles.

Signs and symptoms

• Swelling or puffiness of the tissue under your skin (subcutaneous tissue) • Stretched or shiny skin • Skin that retains a dimple after being pressed for several seconds • Increased abdominal size (abdominal bloating)

Causes and symptoms

Many ordinary factors can upset the balance of fluid in the body to cause edema, including: • Immobility. The leg muscles normally contract and compress blood vessels to promote blood flow with walking or running. When these muscles are not used, blood can collect in the veins, making it difficult for fluid to move from tissues back into the vessels. • Heat. Warm temperatures cause the blood vessels to expand, making it easier for fluid to cross into surrounding tissues. High humidity also aggravates this situation.

• Medications. Certain drugs, such as steroids, hormone replacements, nonsteroidal anti-inflammatory drugs (NSAIDs), and some blood pressure medications may affect how fast fluid leaves blood vessels. • Intake of salty foods. The body needs a constant concentration of salt in its tissues. When excess salt is taken in, the body dilutes it by retaining fluid. • Menstruation and pregnancy. The changing levels of hormones affect the rate at which fluid enters and leaves the tissues.

Some medical conditions may also cause edema, including: • Heart failure. When the heart is unable to maintain adequate blood flow throughout the circulatory system, the excess fluid pressure within the blood vessels can cause shifts into the interstitial spaces. Left-sided heart failure can cause pulmonary edema, as fluid shifts into the lungs. The patient may develop rapid, shallow respirations, shortness of breath, and a cough. Rightsided heart failure can cause pitting edema, a swelling in the tissue under the skin of the lower legs and feet. Pressing this tissue with a finger tip leads to a noticeable momentary indentation.

• Kidney disease. The decrease in sodium and water excretion can result in fluid retention and overload. • Thyroid or liver disease. These conditions can change the concentration of protein in the blood, affecting fluid movement in and out of the tissues. In advanced liver disease, the liver is enlarged and fluid may build-up in the abdomen. • Malnutrition. Protein levels are decreased in the blood, and in an effort to maintain a balance of concentrations, fluid shifts out of the vessels and causes edema in tissue spaces.

Nursing Interventions

Treatment of edema is based on the cause. Simple steps to lessen fluid build-up may include: • Reducing sodium intake. A high sodium level causes or aggravates fluid retention. • Maintaining proper weight. Being overweight slows body fluid circulation and puts extra pressure on the veins. • Exercise. Regular exercise stimulates circulation. • Elevation of the legs. Placing the legs at least 12 in (30.5 cm) above the level of the heart for 10-15 minutes, three to four times a day, stimulates excess fluid re-entry into the circulatory system.

• Use of support stocking. Elastic stockings, available at most medical supply or drug stores, will compress the leg vessels, promoting circulation and decreasing pooling of fluid due to gravity. • Massage. Massaging the body part can help to stimulate the release of excess fluids, but should be avoided if the patient has blood clots in the veins. • Travel breaks. Sitting for long periods will increase swelling in the feet and ankles. Standing and/or walking at least every hour or two will help stimulate blood flow.

Dietary changes, in addition to cutting back the amount of sodium eaten, may also help reduce edema. Foods that worsen edema, such as alcohol, caffeine, sugar, dairy products, soy sauce, animal protein, chocolate, olives, and pickles, should be avoided. Diuretic herbs can also help relieve edema. One of the best herbs for this purpose is dandelion (Taraxacum mongolicum), since, in addition to its diuretic action, it is a rich source of potassium. (Diuretics flush potassium from the body and it must be replaced to avoid potassium deficiency.) Hydrotherapy using daily contrast applications of hot and cold (either compresses or immersion) may also be helpful.

Edema cannot be cured. The only way to treat edema is to treat the condition that is causing it. The following are some things you can do to keep the swelling down: • Put a pillow under your legs when you are lying down. • Wear support stockings, which you can buy at most drugstores. Support stockings put pressure on your legs and keep water from collecting in your legs and ankles. • Do not sit or stand for too long without moving. • Follow your doctor's orders about limiting how much salt you eat.

Your doctor might want you to take a medicine called a diuretic, which is also called a water pill. It is important to see your doctor if you have edema. If it is not treated, your skin may keep stretching, which can lead to other problems. Call your doctor right away if have edema and you start to have trouble breathing. If you are pregnant and you notice edema, call your doctor as soon as you can.

PHARMACOLOGICAL TREATMENT

KINDS OF DIURETICS: • Furosemide (Lasix) • Torsemide (Demedex) • Butethamide (Bumex)

Those three blocks the sodiumpotassium chloride transporter in the ascending loop of Henle.

Diuretics that can combine to other agents: 1.Thiazide type diuretics such as: •Hydrochlorthiazide (Hydrodiuril) •Metolazone (Zaroxolyn) Thiazide blocks the electroneutral sodium chloride transporter in the distal convoluted tubule.

Potassium-sparing diuretic: • • • •

Spironolactone (Aldactone) Triamterene (Dyrenium) Amiloride (Midamor) Acetazolamide (Diamox) - which counteracts the development of a high concentration of bicarbonate (too much alkali) in the blood

Not all patients with edema will require drug treatment; in some patients, sufficient sodium restriction (i.e., less than the amount excreted by the kidneys) and elevation of the lower extremities above the level of the left atrium are effective. However, diuretics are required in most patients in addition to nonpharmacologic treatments, especially continued restriction of salt.

The choice of diuretic, route of administration, and dosing regimen will vary based on the underlying disease, its severity, and the urgency of the problem.

HERBAL TREATMENT FOR EDEMA

Parsley, taken either as an infusion or eaten raw (but not if pregnant), or dandelion leaves, either drunk as a "coffee" or eaten in salad are both recommended. Cut down on salt, eat lots vegetables, salads, and fruit, and drink fruit juices. Aromatherapy Lavender is very helpful. Massage and Acupressure Both of these can be beneficial. Effleurage is the most effective massage technique.

What Is It? Edema is swelling of both legs from a buildup of extra fluid. Edema has many possible causes:

• Prolonged standing or sitting, especially in hot weather, can cause excess fluid to accumulate in the feet, ankles and lower legs. • Tiny valves inside the veins of the legs can become weakened, causing a common problem called venous insufficiency. This problem makes it more difficult for the veins to pump blood back to the heart, and leads to varicose veins and buildup of fluid.

• Severe chronic (long-term) lung diseases, including emphysema and chronic bronchitis, increase pressure in the blood vessels that lead from the heart to the lungs. This pressure backs up in the heart. The higher pressure causes swelling in the legs and feet. • Congestive heart failure, a condition in which the heart can no longer pump efficiently, causes fluid buildup in the lungs and other parts of the body. Swelling is often most visible in the feet and ankles.

• Pregnancy can cause edema in the legs as the uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs. Fluid retention during pregnancy also can be caused by a more serious condition called pre-eclampsia. • Low protein levels in the blood caused by malnutrition, kidney and liver disease can cause edema. The proteins help to hold salt and water inside the blood vessels so fluid does not leak out into the tissues. If a blood protein, called albumin, gets too low, fluid is retained and edema occurs, especially in the feet, ankles and lower legs.

Symptoms • Symptoms vary according to the type of edema and its location. In general, the skin above the swollen area will be stretched and shiny.

Prevention • The only way to prevent edema is to prevent the cause. • Smoking is the main cause of chronic lung disease. • Congestive heart failure most often is caused by coronary artery disease, high blood pressure or drinking too much alcohol

• To avoid leg swelling on long trips, stand up and walk around often • Ideally, you should get up once an hour • Exercise your feet and lower legs while sitting. This will help the veins move blood back toward the heart.

Treatment Treatment of edema focuses on correcting the cause of the fluid accumulation. A lowsalt diet usually helps. You also should avoid drinking too much fluid. If you are not short of breath, elevate your legs above the level of your heart to keep swelling down. Your doctor might suggest that you take a low dose of a diuretic (water pill).

For swollen ankles and feet caused by pregnancy, elevate your legs and avoid lying on your back to help improve blood flow and decrease swelling. If you have mild leg edema caused by venous insufficiency, elevate your legs periodically and wear support (compression) stockings. Sometimes surgery is needed to improve the flow of blood through the leg veins.

No matter what the cause of edema, any swollen area of the body should be protected from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns in areas that have edema take much longer to heal and are more likely to get infected.

When To Call A Professional Call your doctor immediately if you have pain, redness or heat in a swollen area, an open sore, shortness of breath or swelling of only one limb.