Edema and Dehydration
Edema:
1.Broad Classification:
- Fluids and electrolytes
2.Definition:
- Edema is a problem of fluid distribution that results in fluid accumulation. The pathophysiological process that leads to edema occurs as a result of loss of plasma proteins, or decreased capillary oncotic pressure, or increased capillary hydrostatic pressure, or lymph obstruction or a combination of factors. (Huether, et al)
- Edema is the excessive accumulation of fluid within the interstitial spaces. (Huether, et al, pg 101)
- Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, it's most commonly noticed in your hands, arms, feet, ankles and legs. (
3. Incidence/Prevalence:
- Incidence:Could not find credible statistics
- Prevalence: Approximately 1 in 62 or 1.60% or 4.4 million people in USA (
4. Risk Factors:
* The following diseases and conditions can increase the risk of developing edema:
- Congestive heart failure
- Cirrhosis
- Kidney disease
- Nephrotic syndrome
- Chronic venous insufficiency (CVI)
- Deep vein thrombosis
- Lymphedema
* Due to the fluid needed by the fetus and placenta, a pregnant woman's body retains more sodium and water than usual, increasing the risk of edema.
* Taking some medications — such as drugs that open blood vessels (vasodilators), calcium channel blockers (calcium antagonists), nonsteroidal anti-inflammatory drugs (NSAIDs), estrogens and certain diabetes medications called thiazolidinediones — can increase your risk of edema.
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5. Signs/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
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Pulmonary edema includes:
* Shortness of breath
* Difficulty breathing
* Chest pain
6. Pathophysiology - describe cellular and systemic components and include genomics
* Hydrostatic pressure increases as a result of venous obstruction or salt and water retention. Venous obstruction causes hydrostatic pressure to increase behind the obstruction pushing fluid from the capillaries into the interstitial spaces. Thrombophlebitis (inflammation of the veins), hepatic obstruction, tight clotting around the extremities, and prolonged standing are common causes of venous obstruction.
* CHF and renal failure are associated with salt and water retention, which cause plasma volume overload, increased capillary hydrostatic pressure and edema
* Lost or diminished plasma albumin production (liver disease or protein malnutrition) contributes to decreased plasma oncotic pressure. Plasma proteins are lost in glomerular diseases of the kidney, serous drainage from open wounds, hemorrhage, burns, and cirrhosis of the liver. The decreased oncotic attraction of fluid within the capillary causes filtered capillary fluid to remain in the interstitial space, resulting in edema.
* Capillaries become more permeable with inflammation and immune responses, especially with trauma (burns, crushing injuries, neoplastic disease, and allergic reactions). Proteins escape from the vascular space and produce edema through decreased capillary oncotic pressure and interstitial fluid protein accumulation.
(Huether, et al Pg. 101-102)
7. Medical Diagnoses & Diagnostic tests:
* A doctor will perform a physical exam and ask you questions about your medical history. If your doctor suspects an underlying condition as the cause of your edema, he or she may recommend certain tests to help identify the cause. Tests might include:
- A urine test (urinalysis)
- Blood tests
- Measuring or estimating the pressure in certain blood vessels, such as in your jugular vein
- A chest X-ray
8. Therapy - describe common therapies
* Treating edema usually involves:
-Treating the underlying cause of edema
-Taking medication to increase your kidneys' output of water and sodium (diuretics), including thiazide diuretics, furosemide (Lasix) or spironolactone (Aldactone)
-Limiting salt in your diet to decrease fluid retention, as recommended by your doctor
*In some cases, diuretics may not be appropriate to treat edema, such as in some people who have chronic venous insufficiency or in most pregnant women.
* Non- pharmacotherapies:
-Movement
-Elevation
-Massage
-Compression
-Reduce salt intake
-Avoid temperature extremes.
9. Nursing Diagnoses:
-Excess fluid volume r/t excessive fluid intake, cardiac dysfunction, renal dysfunction, loss of plasma proteins
- Ineffective health maintenance r/t deficient knowledge regarding treatment of edema
- Risk for impaired skin integrity: Risk factors: impaired circulation, fragility of skin.
10. Summary and Nursing Implications:
- Monitor location and extent of the edema because if edema spreads, it could lead to heart or renal failure.
- Monitor patient’s daily weight for sudden increases because an increase could signify fluid retention.
- Monitor intake and output because it is very important for patients with fluid volume overload to not off balance intake vs. output.
- Monitor serum and urine osmolality, serum sodium, BUN/Creatinine ratio, and hematocrit for abnormalities because these measures will be altered with increased fluid volume.
Dehydration:
1.Broad Classification: Fluids and electrolytes
2.Definition:
* Dehydration describes water deficit but also is commonly used to indicate both sodium and water loss.
* Dehydration occurs when you lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions.
- Common causes of dehydration include intense diarrhea, vomiting, fever or excessive sweating. Inadequate intake of water during hot weather or exercise also may cause dehydration. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk.
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3. Incidence/Prevalence:
No credible sources. Numbers varied drastically
4. Risk Factors - describe common risk factors related to disease
-Infants and children: Worldwide, dehydration caused by diarrhea is a leading cause of death in children. Infants and children are especially vulnerable because of their relatively small body weights and high turnover of water and electrolytes.
-Older adults: As you age, you become more susceptible to dehydration for several reasons: Your body's ability to conserve water is reduced, your thirst sense becomes less acute and you're less able to respond to changes in temperature.
-People with chronic illnesses
-Endurance athletes
-People living at high altitudes
5. Signs/symptoms:
- Symptoms of dehydration include thirst, dry skin, dry mucous membranes, elevated temperature, weight loss, concentrated urine, tachycardia, weak pulses, postural hypotension among other things.
- Mild to moderate dehydration is likely to cause:
Dry, sticky mouth
Sleepiness or tiredness — children are likely to be less active than usual
Thirst
Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens
Few or no tears when crying
Muscle weakness
Headache
Dizziness or lightheadedness
-Severe dehydration, a medical emergency, can cause:
Extreme thirst
Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
Very dry mouth, skin and mucous membranes
Lack of sweating
Little or no urination — any urine that is produced will be dark yellow or amber
Sunken eyes
Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
In infants, sunken fontanels — the soft spots on the top of a baby's head
Low blood pressure
Rapid heartbeat
Fever
In the most serious cases, delirium or unconsciousness
-Thirst isn't always a reliable gauge of the body's need for water, especially in children and older adults. A better barometer is the color of your urine: Clear or light-colored urine means you're well hydrated, whereas a dark yellow or amber color usually signals dehydration.
6. Pathophysiology:
Dehydration results from increased fluid loss, decreased fluid intake, or both.
The most common source of increased fluid loss is the GI tract from vomiting, diarrhea, or both (eg, gastroenteritis). Other sources are renal (eg, diabetic ketoacidosis), cutaneous (eg, excessive sweating, burns), and 3rd-space losses (eg, into the intestinal lumen in bowel obstruction). All types of lost fluid contain electrolytes in varying concentrations, so fluid loss is always accompanied by electrolyte loss.
Decreased fluid intake is common during serious illness of any kind and is particularly problematic when the child is vomiting and during hot weather.
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7. Medical Diagnoses & Diagnostic tests - describe common tests used to diagnose disease
-A doctor can often diagnose dehydration on the basis of physical signs and symptoms such as little or no urination, sunken eyes, and skin that lacks its normal elasticity and resilience when pinched. If you're dehydrated, you're also likely to have low blood pressure, especially when moving from a prone to a standing position, a faster than normal heart rate and reduced blood flow to your extremities.
-To help confirm the diagnosis and pinpoint the degree of dehydration, you may have other tests, such as:
Blood tests: These may be used to check your electrolytes, especially sodium and potassium; to look for signs of concentrated blood; and to evaluate how well your kidneys are working.
Urinalysis: The color and clarity of your urine, the presence of carbon compounds (ketones) and your urine's specific gravity — that is, the mass of the urine as compared with equal amounts of distilled water — all help show whether you're dehydrated and to what degree. A high specific gravity, for example, indicates significant dehydration.
-If it's not obvious why you're dehydrated, your doctor may order additional tests to check for diabetes and for liver or kidney problems
8. Therapy
* Treating dehydration in sick children -Use an oral rehydration solution
-Continue to breast-feed
- Avoid certain foods and drinks: The best liquid for a sick child is an oral rehydration solution — plain water doesn't provide essential electrolytes, and although sports drinks replenish electrolytes, they replace those lost through sweating, not through diarrhea or vomiting. Avoid giving your child salty broths, milk — especially boiled milk — sodas, fruit juices or gelatins, which don't relieve dehydration and which may make symptoms worse.
* Treating dehydration in sick adults
Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can improve their condition by drinking more water. Water is best because other liquids, such as fruit juices, carbonated beverages or coffee, can make diarrhea worse.
* Treating dehydration in athletes of all ages
For exercise-related dehydration, cool water is your best bet. Sports drinks containing electrolytes and a carbohydrate solution also may be helpful. There's no need for salt tablets — too much salt can lead to hypernatremic dehydration, a condition in which your body not only is short of water but also carries an excess of sodium.
* Treating severe dehydration
Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously) rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do.
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9. Nursing Diagnoses:
- Deficient fluid volume r/t active fluid volume loss
- Ineffective health maintenance r/t deficient knowledge regarding treatment and prevention of dehydration.
- Impaired oral mucous membrane r/t decreased salivation, fluid deficit.
10. Summary and Nursing Implications:
- Watch for signs of hypovolemia, including thirst, restlessness, headaches, and inability to concentrate.
- Explain measures that can be taken to treat or prevent fluid volume loss
- Follow doctor’s orders on how to re-hydrate the patient.
- Monitor pulse, respirations, and blood pressure (every 15 minutes-1 hour for an unstable client, and every 4 hours for a stable client)
-Note skin elasticity and tugor.
-Monitor fluid intake and output.