Nursing care plans for edema plus interventions with examples 1

Nursing Care Plans for Edema Plus Interventions with Examples

Introduction

Edema is swelling that occurs when too much fluid is trapped in the body’s tissues, particularly the skin. There are different causes and types of edema. For example, pulmonary edema affects the lungs, while pedal edema causes swelling in the feet. Edema usually starts slowly, but the onset can be sudden. It is a common condition, but it can also signify a serious condition.

This blog post discusses nursing care plans for edema together with the diagnosis, causes, symptoms and interventions with elaborate examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Edema

Edema, or water retention, causes swelling in the affected part of the body.

Edema refers to swelling and puffiness in different areas of the body. It most often occurs in the skin, especially in the hands, arms, ankles, legs, and feet. However, it can also affect the muscles, bowel, lungs, eyes, and brain.

Edema mainly occurs in older adults and pregnant people, but anyone can experience it.

Symptoms of Edema

Symptoms depend on the underlying cause, but swelling, tightness, and pain are common.

A person with edema may also notice:

  1. Swollen, stretched, and shiny skin
  2. Skin that retains a dimple after a few seconds of pressure
  3. Puffiness of the ankles, face, or eyes
  4. Aching body parts and stiff joints
  5. Weight gain or weight loss
  6. Decreased urine production
  7. Fuller hand and neck veins
  8. Visual anomalies

Symptoms can also depend on the type of edema a person has and which part of the body it affects.

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Nursing care plans for edema plus interventions with examples 2

Treatment of Edema

Treatment will also depend on the cause of edema.

Diuretics medication. They help get rid of excess fluid by increasing the rate of urine production by the kidneys. Different types work in different ways.

A doctor will recommend a specific treatment plan for macular edema, pulmonary edema, and other types of edema.

A person with edema could also try wearing compression garments and doing specific exercises to help.

Prevention of Edema

Wearing compression stockings can help reduce the swelling and discomfort associated with edema.

Some self-care techniques can help reduce or prevent edema. These include:

  1. Reducing salt intake
  2. Losing weight, if appropriate
  3. Getting regular exercise
  4. Raising the legs when possible to improve circulation
  5. Wearing support stockings, which are available to purchase online
  6. Not sitting or standing still for too long
  7. Getting up and walking about regularly when travelling
  8. Avoiding extremes of temperature, such as hot baths, showers, and saunas
  9. Dressing warmly in cold weather
  10. A masseuse or physical therapist may help remove the fluid by stroking firmly in the direction of the heart.

Oxygen may be useful for treating some types of edema. For example, an individual with cardiogenic pulmonary edema may need additional oxygen if they have difficulty taking in enough. Oxygen delivered through the nose may improve poor vision associated with diabetic macular edema, according to older research from 2004.

Types of Edema

There are many types of edema. Each one can indicate a range of further health conditions. Types include:

Peripheral Edema

This affects the feet, ankles, legs, hands, and arms. Symptoms include swelling, puffiness, and difficulty moving certain parts of the body.

Pulmonary Edema

This occurs when excess fluid collects in the lungs, making breathing difficult. This can result from congestive heart failure or acute lung injury. It is a serious condition, and it can be a medical emergency, leading to respiratory failure and death.

Cerebral Edema

This occurs in the brain. It can happen for a range of reasons, many of which are potentially life-threatening. Symptoms include:

  • Headache
  • Neck pain or stiffness
  • Whole or partial vision loss
  • Changes in consciousness or mental state
  • Nausea
  • Vomiting
  • Dizziness

Macular Edema

This is a serious complication of diabetic retinopathy. Swelling occurs in the macula, which is the part of the eye that enables detailed, central vision. The person may notice changes to their central vision and how they see colours.

Pitting Edema

With this type, which can occur in peripheral edema, pressure applied to the skin leaves an indent or pit in the skin.

Periorbital Edema

 This refers to inflammation and puffiness around the eye or eyes. The puffiness is due to fluid buildup and is usually temporary.

Note: Edema can occur in other locations as well, but those mentioned above are the most common. Edema can indicate one of many serious health conditions. A person needs to check with a doctor if they are concerned about any kind of swelling.

Causes of Edema

Nursing care plans for edema plus interventions with examples 3
Nursing Care Plans for Edema Plus Interventions with Examples 6

Edema can result from circulatory problems, infection, tissue death, malnutrition, total body fluid overload, and electrolyte problems.

There are many other possible causes of edema, including:

Heart failure

If one or both of the heart’s lower chambers cannot pump blood properly, blood can accumulate in the limbs, causing edema.

Kidney disease or kidney damage

The body of a person with a kidney disorder may not be able to eliminate enough fluid and sodium from the blood. This puts pressure on the blood vessels, which causes some of the liquid to leak out. Swelling can occur around the legs and eyes.

Damage to the glomeruli, which are the capillaries in the kidneys that filter waste and excess fluids from the blood, can result in nephrotic syndrome. One symptom of this is a low level of protein albumin in the blood. This can lead to edema.

Liver disease

Cirrhosis affects liver function. It can lead to changes in the secretion of hormones and fluid-regulating chemicals and reduced protein production. This causes fluid to leak out of the blood vessels into the surrounding tissue.

Cirrhosis also increases pressure within the portal vein, which is the large vein that carries blood from the intestines, spleen, and pancreas to the liver. Edema can occur in the legs and abdominal cavity.

Certain medications

Certain medications can also increase the risk of edema.

These include:

  • Vasodilators, which are drugs that open blood vessels
  • Calcium channel blockers
  • Nonsteroidal anti-inflammatory drugs
  • Estrogens
  • Some chemotherapy drugs
  • Some diabetes drugs, such as thiazolidinediones

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Pregnancy

During pregnancy, the body releases hormones that encourage fluid retention and the body to retain more sodium and water than usual. The face, hands, lower limbs, and feet may swell.

When a person is resting in a reclined position during pregnancy, the enlarged uterus can press on a vein known as the inferior vena cava. This can obstruct the femoral veins, leading to edema.

During pregnancy, the blood clots more easily. This can increase the risk of deep vein thrombosis (DVT), which is another potential cause of edema.

Eclampsia, which results from pregnancy-induced hypertension, or high blood pressure, can also cause edema.

Dietary factors

A number of dietary factors can also affect the risk of edema, such as:

  1. Consuming too much salt (in people who are susceptible to developing edema)
  2. Malnutrition, wherein edema can result from low protein levels in the blood.
  3. A low intake of vitamin b 1, b 6, and b5

Diabetes

Some complications of diabetes include:

  1. Cardiovascular disease
  2. Acute renal failure
  3. Acute liver failure
  4. Protein-losing enteropathy is an intestinal condition that causes protein loss.
  5. These complications, and certain medications for diabetes, can result in edema.
  6. Diabetic macular edema is the swelling of the retina in diabetes.

Conditions affecting the brain

Some causes of swelling in the brain include:

  • Head injuries: A blow to the head may result in an accumulation of fluids in the brain.
  • Stroke: A major stroke can result in brain swelling.
  • Brain tumours: A brain tumour will accumulate water around itself, especially as it builds new blood vessels.

Allergies

Some foods and insect bites may cause edema of the face or skin in people who have allergies or sensitivities to them. Severe swelling can be a symptom of anaphylaxis.

Swelling in the throat can close a person’s airway, so they cannot breathe. This is a medical emergency.

Problems with the extremities

Some extremity-related causes of edema include:

A blood clot: Any blockage, such as a clot in a vein, can prevent the blood from flowing. As pressure increases in the vein, fluids start to leak into the surrounding tissue, causing edema.

Varicose veins: These usually occur because valves become damaged. Pressure increases in the veins, and they start to bulge. The pressure also increases the risk of fluids leaking into the surrounding tissue.

A cyst, growth, or tumour: Any lump can cause edema if it presses against a lymph duct or vein. As pressure builds up, fluids can leak into the surrounding tissue.

Lymphedema: The lymphatic system helps remove excess fluid from tissues. Any damage to this system — from a surgical procedure, an infection, or a tumour, for example — can result in edema.

Miscellaneous conditions

Some other possible causes of edema include:

Prolonged immobility: People who are immobile can develop edema in their skin for a long time. This can be due both to fluid pooling in gravity-dependent areas and the release of antidiuretic hormone from the pituitary.

High altitude: This, combined with physical exertion, can increase the risk of edema. Acute mountain sickness can lead to high-altitude pulmonary edema or high-altitude cerebral edema.

Burns and sunburn: The skin reacts to burns by retaining fluid. This causes localized swelling.

Infection or inflammation: Any infected or inflamed tissue can become swollen. This is usually most noticeable in the skin.

Menstruation and pre-menstruation: Hormone levels fluctuate during the menstrual cycle. During the days before menstruation, levels of progesterone are lower, and this may cause fluid retention.

Birth control pills: Any medication that contains estrogen can cause fluid retention. It is not uncommon for people to gain weight when they first start using birth control pills.

Menopause: Around menopause, hormone fluctuations can cause fluid retention. Hormone replacement therapy can also trigger edema.

Thyroid disease: Hormonal imbalances associated with thyroid problems can lead to edema.

Complications of Edema

Untreated edema can lead to:

  1. Painful swelling, with pain that gets worse
  2. Stiffness and difficulty walking
  3. Stretched, itchy skin
  4. Infection in the area of swelling
  5. Scarring between the layers of tissue
  6. Poor blood circulation
  7. Loss of elasticity in the arteries, veins, and joints
  8. Ulcerations on the skin
  • Any underlying condition needs medical treatment to prevent it from becoming more serious.

Nursing Assessment for Fluid Volume Excess/Edema

Assessment is required to distinguish possible problems that may have led to fluid volume excess and identify any incident that may occur during nursing care.

AssessmentRationales
Review the patient’s history to determine the probable cause of the fluid imbalance. Such information can assist in directing management. History may include increased fluids or sodium intake.
Monitor weight regularly using the same scale and preferably wearing the same amount of clothing at the same time of day.Sudden weight gain may mean fluid retention. Different scales and clothing may show false weight inconsistencies.
Monitor input and output closely.Dehydration may result from fluid shifting even if overall fluid intake is adequate.
Assess weight in relation to nutritional status.In some patients with heart failure, the weight may be a poor indicator of fluid volume status. Poor nutrition and decreased appetite over time result in a decrease in weight, which may be accompanied by fluid retention even though the net weight remains unchanged.
Record intake if a patient is on fluid restriction.Patients should be reminded to include items that are liquid at room temperatures, such as gelatin, sherbet, soup, and frozen juice pops.
Monitor and note BP and HR.Sinus tachycardia and increased BP are evident in the early stages.
Review chest x-ray reports.The x-ray studies show cloudy white lung fields as interstitial edema accumulates.
Assess urine output in response to diuretic therapy.Recording two voids versus six voids after a diuretic medication may provide more useful information. Medications may be given intravenously because FVE in the abdomen may interfere with the absorption of oral diuretic medications.
Note for the presence of edema by palpating over the tibia, ankles, feet, and sacrum.Edema occurs when fluid accumulates in the extravascular spaces. Dependent areas more readily exhibit signs of edema formation. Edema is graded from trace (indicating barely perceptible) to 4 (severe edema). Pitting edema is manifested by a depression that remains after one’s finger is pressed over an edematous area and then removed. Measurement of an extremity with a measuring tape is another method of the following edema.
Assess for crackles in the lungs, changes in respiratory pattern, shortness of breath, and orthopnea.These signs are caused by an accumulation of fluid in the lungs.
Assess for bounding peripheral pulses and S3.These assessment findings are signs of fluid overload.
Check for distended neck veins and ascites. Monitor abdominal girth to follow any ascites accurately.Distended neck veins are caused by elevated CVP. Ascites occurs when fluid accumulates in extravascular spaces.
Review serum electrolytes, urine osmolality, and urine specific gravity.All are indicators of fluid status and guide therapy.
Consider the need for an external or indwelling urinary catheter.Treatment focuses on diuresis of excess fluid. Urinary catheters provide a more accurate measurement of the response to diuretics.
Check for excessive response to diuretics.Significantly increased response to diuretics may lead to fluid deficit.

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Nursing care plans for edema plus interventions with examples 2

Nursing Interventions for Fluid Volume Excess

The following are the therapeutic nursing interventions for Fluid Volume Excess:

InterventionsRationales
Instruct patient, caregiver, and family members regarding fluid restrictions, as appropriate.Information and knowledge about the condition are vital to patients who will be co-managing fluids.
Limit sodium intake as prescribed.Restriction of sodium aids in decreasing fluid retention
Monitor fluid intake.This enhances compliance with the regimen.
Take diuretics as prescribed.Diuretics aid in the excretion of excess body fluids.
Elevate edematous extremities, and handle with care.Elevation increases venous return to the heart and, in turn, decreases edema. Edematous skin is more susceptible to injury.
Consider interventions related to specific etiological factors (e.g., inotropic medications for heart failure, paracentesis for liver disease).Knowledge of etiological factors gives direction for subsequent interventions.
For acute cases of Fluid Volume Excess:
Cooperate with the pharmacist to maximally concentrate IV fluids and medications.Concentration decreases unnecessary fluids.
Anticipate admission to an acute care setting for hemofiltration or ultrafiltration.These therapies are very efficient techniques to draw off extra fluid.
Administer IV fluids through an infusion pump, if possible.Pumps guarantee precise delivery of IV fluids.
Apply a heparin lock device.This device maintains IV access and patency but decreases fluid delivered to the patient in a 24-hour period.
Place the patient in a semi-Fowler’s or high-Fowler’s position.Raising the head of the bed provides comfort in breathing.
Aid with repositioning every 2 hours if the patient is not mobile.Repositioning prevents fluid accumulation independent areas.
Educate patient and family members regarding fluid volume excess and its causes.Information is key to managing problems.
Explain the rationale and intended effect of the treatment program.Follow-up care will be the patient’s or caregiver’s responsibility. Information is necessary to make correct choices in the future.
Explain the need to use anti embolic stockings or bandages, as ordered.These aids help promote venous return and minimize fluid accumulation in the extremities.
Educate patient and family members on the importance of proper nutrition, hydration, and diet modification.Knowledge heightens compliance with the treatment plan.

Summary

Edema occurs when fluid builds up in the body. This causes swelling, which can sometimes be painful.

There are several potential causes of edema, including pregnancy, heart failure, liver disease, and certain medications. The treatment a person receives will depend on the cause.

References

  • ncbi.gov
  • scholar.google.com