Saturday, August 19, 2017
   
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Edema-The different types

Edema seems to be common among trach patients.

If you notice you have edema go to your doctor. This information is not intended for you to self treat.

Here is a run down on the different types of edemas:

Pulmonary edema is a complication of a myocardial infarction (heart attack), cardiac dysfunction, mitral or aortic valve disease, exposure to high altitude (rare), or other disorders. Fluid overload is a common cause in infants.

Fluid backs up into the veins of the lungs. Increased pressure in these veins forces fluid out of the vein and into the air spaces (alveoli). This interferes with the exchange of oxygen and carbon dioxide in the alveoli.

Some of the signs:

-shortness of breath, severe difficult breathing

-feeling of "air hunger" or "drowning"

-"grunting" sounds with breathing rales

-wheezing

-cough

-pale skin

-breathing, absent temporarily

Signs and tests:

-Listening to the chest with a stethoscope (auscultation) may show crackles in the lungs or abnormal heart sounds.
-A chest X-ray may show fluid in the lung space.
-Occasionally, a chest CT scan or chest MRI scan may be performed in addition to a chest X-ray.

Treatment:

This is a medical emergency!
Do not delay treatment. Hospitalization and immediate treatment are required.

Oxygen is given, by a mask or through a tube in the windpipe (endotracheal tube) using mechanical ventilation.

Medications they might give you include diuretics such as furosemide to remove fluid, morphine to relieve congestion and anxiety, and other medications to treat the underlying cardiac disorder.

Pulmonary edema is a life-threatening condition. It is often curable with treatment and control of the underlying disorder.

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Pitting edema; dependent edema; generalized swelling; edema; anasarca

Definition:

Excessive build-up of fluid in the tissues, or an increase in tissue mass.
Swelling can occur throughout the body (generalized swelling) or swelling can be limited to a specific part of the body.

-ankle, feet, and leg swelling

-angioedema

-swollen gums

-swollen glands

-facial swelling

-swelling in the abdomen

-breast enlargement

-scrotal swelling

-joint swelling

Remember--Slight edema of the legs commonly occurs in warm summer months.

Generalized swelling or massive edema (also called anasarca) is a common sign in severely ill people. While slight edema may be difficult to detect, especially in an overweight person, massive edema is very obvious.

Quick test to see if Pitting or nonpitting:

Edema may be pitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, an indentation is left that fills slowly) or nonpitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, no indentation is left in the skin).

-too much salt or sodium

-burns

-sunburn

-too little albumin in the blood (hypoalbuminemia)

-malnutrition

-pregnancy

-drugs

-androgenic and anabolic steroids

-antihypertensives

-corticosteroids such as prednisone (causes sodium retention)

-estrogens

-anti-inflammatory drugs (see NSAIDs)

-intravenous saline administration or tube feedings

-nephrotic syndrome

-acute glomerulonephritis

Note: There may be other causes of swelling. This list is not all inclusive.

Home care: Follow prescribed therapy to treat the underlying cause of the edema. Discuss with your health care provider the options to prevent skin breakdown (for chronic edema).

Maintain everyday activities. Walk rather than stand. Stand or lie rather than sit. When lying down, keep limbs above the heart level, if possible, to facilitate drainage. Do not do this if shortness of breath results.

Massage swollen areas regularly, particularly if edema has formed around the hip, buttocks, or back.

Reduced sodium (salt) in the diet may be recommended. Diagnostic tests that may be needed:

-albumin levels measured

-ECG

-echocardiography

-serum electrolyte tests

-urinalysis

-X-rays

Treatment may include fluid and sodium restriction, diuretics, digoxin, and (rarely) intravenous albumin administration. In some cases corticosteroids such as prednisone or immunosuppressive medications may be given.

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Swelling of the ankle, feet, or leg; peripheral edema; ankle swelling; foot swelling; leg swelling; edema, peripheral

Definition: Abnormal build-up of fluids in ankle and leg tissues. See also swelling,overall.

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in the lower legs.

When squeezed, the fluid will move out of the affected area and may leave a deep impression for a few moments.

Swelling of the legs is many times related to systemic causes (for example, heart failure, renal failure, or liver failure).

-long airplane flights or automobile rides

-menstrual periods (for some women)

-sunburn

-generalized allergy

-prolonged standing

-injury or trauma to the ankle or foot

-venous insufficiency (varicose veins)

-pregnancy (mild to severe swelling)

-insect bite or sting

-starvation or malnutrition

-medications

-estrogens and progestin oral contraceptives

-blood pressure-lowering drugs

-testosterone

There may be other causes of ankle, feet, and leg swelling. This list is not all inclusive.

Things that might help:

-Elevate the legs above the heart while lying down.

-Avoid sitting or standing without moving for prolonged periods of time.

-Avoid putting anything directly under the knees when lying down and don't wear constricting clothing or garters on the upper legs.

-Exercising the legs causes the fluid to work back into the veins and lymphatic channels so that the swelling goes down.

-The pressure applied by elastic bandages or support stockings can help reduce ankle swelling.

Diagnostic tests that may be performed include:

-blood tests such as a CBC or blood chemistry (Chem-20)

-ECG

-chest X-ray or extremity X-ray

They may start you on diuretics (fluid pills). These are effective in reducing the swelling but have some side effects.
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CHF; congestive heart failure

A disorder in which the heart loses its ability to pump blood efficiently, thereby failing to meet the demands of the body.

Causes, incidence, and risk factors: Heart failure may affect either the right side, left side, or both sides of the heart. As pumping action is lost, blood may back up into other areas of the body, including the liver, gastrointestinal tract, and extremities (right-sided heart failure), or the lungs (left-sided heart failure).

Structural or functional causes of heart failure include -high blood pressure

-(hypertension), heart valve disease, congenital heart diseases, cardiomyopathy, heart tumor, and other heart diseases.

-anemia

-irregular heartbeats (arrhythmias)

-hyperthyroidism

-kidney disease

Heart failure occurs in approximately 10 out of 100 people, and becomes more prevalent with advancing age.

Symptoms:

-sensation of feeling the heart beat (palpitations)

-pulse may feel irregular or rapid

-weight gain (unintentional)

-swelling of feet and ankles

-swelling of the abdomen

-pronounced neck veins

-loss of appetite, indigestion

-nausea and vomiting

-shortness of breath, especially with activity

-difficulty sleeping

-shortness of breath which occurs after lying down for a while

-fatigue, weakness, faintness

-decreased alertness or concentration

-skin discoloration, bluish (cyanosis) or yellow (jaundice)

-decreased urine production (oliguria)

-need to urinate at night (nocturia)

-infants may sweat during feeds (or other exertion)

Enlargement of the heart or decreased heart functioning may be seen on:

-a echocardiogram

-a coronary angiography

-a chest X-ray

-a chest CT scan

-a nuclear heart scans (MUGA, RNV)

-An ECG may show arrhythmias.

-A urinalysis may indicate kidney failure as a cause of the disorder, or as a consequence of left heart failure.

-Multiple blood studies may be performed, including CBC, blood chemistry, and other studies to determine the exact cause of heart failure.

Heart failure requires monitoring of the condition by the health care provider. Hospitalization may be required if symptoms are severe or unstable; difficulty breathing occurs at rest or with minimal activity; or there is failure to respond to initial treatment.

 

 

 

 

 

 

 

 

 

 

 

 

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