EDEMA AND MANAGEMENT TERM PAPER.docx

A TERM PAPER ON EDEMA AND MANAGEMENT IN PALLIATIVE CARE NURSING SUBMITTED BY GROUP 6 MEMBERS SULAIMAN KAWTHAR 205099 ALAO ANUOLUWAPO 206834 OYERINDE DEBORAH 205098 BANKOLE HAMEEDAT 205092 AJAYI TAIWO 205085 IN PARTIAL FULFILLMENT OF THE AWARD OF BACHELOR OF NURSING SCIENCE, DEPARTMENT OF NURSING, UN...

A TERM PAPER ON EDEMA AND MANAGEMENT IN PALLIATIVE CARE NURSING SUBMITTED BY GROUP 6 MEMBERS SULAIMAN KAWTHAR 205099 ALAO ANUOLUWAPO 206834 OYERINDE DEBORAH 205098 BANKOLE HAMEEDAT 205092 AJAYI TAIWO 205085 IN PARTIAL FULFILLMENT OF THE AWARD OF BACHELOR OF NURSING SCIENCE, DEPARTMENT OF NURSING, UNIVERSITY OF IBADAN. COURSE: NSG 528 COURSE TITLE: PALLIATIVE CARE NURSING LECTURER IN CHARGE: DR. IFEOLUWAPO KOLAWOLE FEBRUARY, 2024. OUTLINE Overview of Edema------------------------------------------------------------------------------------------------------3 Types of Edema----------------------------------------------------------------------------------------------------------3 Causes of Edema--------------------------------------------------------------------------------------------------------4 Signs and Symptoms of Edema---------------------------------------------------------------------------------------5 Diagnosis and Testing--------------------------------------------------------------------------------------------------6 Management of Edema-------------------------------------------------------------------------------------------------7 Complications-----------------------------------------------------------------------------------------------------------8 Prevention---------------------------------------------------------------------------------------------------------------8 Prognosis----------------------------------------------------------------------------------------------------------------9 Conclusion--------------------------------------------------------------------------------------------------------------9 References--------------------------------------------------------------------------------------------------------------10 OVERVIEW OF EDEMA Edema refers to swelling and puffiness in different areas of the body. This swelling is due to fluid build-up in bodily tissues. 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 is a normal reaction to inflammation or injury. For example, a sprained ankle, an insect bite, or a surgical site may swell. This can be beneficial, because the increased fluid brings more white blood cells, which fight infection, to the area. And it can also be a sign of serious medical condition that requires prompt intervention. Edema mainly occurs in older adults and pregnant people, but anyone can experience it. Depending on the cause, edema can be clinically classified as pitting (when pressure is applied to the swollen area, a “pit” or indentation will remain) or nonpitting (no indentation upon applying pressure). The pitting edema is often due to an inflammatory process or organ damage, whereas the non-pitting oedema is seen in cases of lymphatic obstruction and thyroid disease. TYPES OF EDEMA There are many types of edema. Each one can indicate a range of further health conditions. Types include: Peripheral Edema An abnormal buildup of fluid in the upper and lower extremities is called peripheral edema. This affects the feet, ankles, legs, hands, and arms. Increased capillary or venule leakage from the peripheral circulatory bed causes fluid to flow into the interstitial space, resulting in venous edema. Dysfunction or obstruction of the lymphatic system’s ability to drain from the legs results in lymphatic edema. As a result, the ankles become swollen. Symptoms include swelling, puffiness, and difficulty moving certain body parts. Pulmonary Edema This occurs when there is accumulation of fluid in the lungs. Breathing becomes challenging because of the fluid build-up in the many air sacs in the lungs. Pulmonary oedema is frequently brought on by cardiac issues. However, there are other causes for fluid to build up in the lungs. These include pneumonia, exposure to specific poisons, and drugs, injuries to the chest wall, and visiting or exercising at high altitudes. Cerebral Edema Edema or swelling brought on by trapped fluid can occur anywhere in the body. However, if brain edema develops, it may have serious consequences. Fluid accumulates around the brain, increasing intracranial pressure. The amount of blood that gets to the brain can be limited by cerebral edema. The oxygen that the brain needs to function is carried to it by blood. Brain cells may get damaged or even die if there is not enough oxygen in the brain. Depending on the underlying cause, intracranial pressure can either damage a small portion of the brain or the entire brain. Symptoms include: Headache, Neck pain or stiffness, Whole or partial vision loss, Changes in consciousness or mental state. 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. It is typically brought on by fluid build-up from blood vessel leaks that are damaged or irregular. Macular edema can develop issues with the retina (a sensitive region at the back of the eye) such as macular degeneration and retinal vein occlusion or retinal dystrophies (uncommon conditions). Additionally, inflammation after eye surgery, trauma, or inflammatory retinal disorder can result in macular edema. CAUSES OF EDEMA Edema is the abnormal buildup of fluid in the body. It is a common condition for people with cancer. It can be caused by cancer, cancer treatment, or another problem that is unrelated to the cancer. Common causes of edema in people include: Certain types of cancer: such as kidney, liver, and ovarian cancers, are more likely to cause edema. Chemotherapy drugs: such as cisplatin and docetaxel (Taxotere), can cause edema. Side effects from Medications: medications given during cancer treatment or to treat other health conditions can cause edema. These include: Steroid medications Hormone replacement therapy Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen Some blood pressure medications Nutrition problems: Low levels of protein in the blood, caused by poor nutrition, can lead to edema. This condition can cause fluid to leak from inside blood vessels to the surrounding tissue. Not eating a well-balanced diet or eating a lot of foods high in salt (sodium), can also cause buildup of fluids in different parts of the body. Physical inactivity: lack of adequate exercise can cause fluid to collect in the legs. Gravity: Spending a lot of time sitting or standing in one place for too long causes water to naturally pull down into the arms, legs and feet (dependent edema). Weakened valves of your veins (venous insufficiency): When the valves in the veins are weak, it is hard for the veins to push blood back up to the heart, and leads to varicose veins and a buildup of fluid in the legs. Pregnancy: Swelling in the legs during pregnancy occurs as the uterus puts pressure on the blood vessels in the lower trunk of the body. Compromised immune system: An allergic reaction, infection, burns, trauma or clots can lead to edema. Other health problems: Edema can also be a side effect of kidney, liver, or heart problems. A blood clot in the leg or arm can cause swelling. Damage to lymph nodes and lymph vessels during surgery can also cause edema. SIGNS AND SYMPTOMS OF EDEMA Puffiness, swelling, or a "heavy" feeling. Swelling of the feet, ankles, legs, arms, hands, or face. Clothes, shoes, or jewelry feels too tight on the body. Less flexibility of the joints in the arms and legs, such as the ankles, wrists, and fingers. Shiny, tight, or stiff skin A dent when the skin is pressed. Sudden or rapid weight gain. Lower amount of urine than usual. Shortness of breath. Difficulty breathing when lying flat. DIAGNOSIS AND TESTING 1.History taking: The history should include the timing of the edema, whether it changes with position, and if it is unilateral or bilateral, as well as medication history and an assessment for systemic diseases. Unilateral swelling from compression or compromise of venous or lymphatic drainage can result from DVT, venous insufficiency, venous obstruction by tumor (e.g., tumor obstruction of the iliac vein), lymphatic obstruction (e.g., from a pelvic tumor or lymphoma), or lymphatic destruction (e.g., congenital vs. secondary from a tumor, radiation, or filariasis). Bilateral or generalized swelling suggests a systemic cause, such as CHF (especially right-sided), pulmonary hypertension, chronic renal or hepatic disease (causing hypoalbuminemia), protein-losing enteropathies, or severe malnutrition. 2. Physical Examination: The physical examination should assess for systemic causes of edema, such as heart failure (e.g., jugular venous distention, crackles), renal disease (e.g., proteinuria, oliguria), hepatic disease (e.g., jaundice, ascites, asterixis), or thyroid disease (e.g., exophthalmos, tremor, weight loss). Edema should also be evaluated for pitting, tenderness, and skin changes. Pitting describes an indentation that remains in the edematous area after pressure is applied.Lower extremity examination should focus on the medial malleolus, the bony portion of the tibia, and the dorsum of the foot. Changes in skin temperature, color, and texture provide clues to the cause of edema. For example, acute DVT and cellulitis may produce increased warmth over the affected area. 3. Brain Natriuretic Peptide measurement (for CHF) 4. Creatinine measurement and urinalysis (for renal disease) 5. Hepatic enzyme and albumin measurement (for hepatic disease). 6. D-dimer enzyme-linked immunosorbent assay can rule out DVT in low risk patients. 7. Ultrasonography: Venous ultrasonography is the imaging modality of choice in the evaluation of suspected DVT. 8. Echocardiography: Echocardiography to evaluate pulmonary arterial pressures is recommended for patients with obstructive sleep apnea and edema. 9. Magnetic Resonance Imaging: Magnetic resonance angiography with venography of the lower extremity and pelvis can be used to evaluate for intrinsic or extrinsic pelvic or thigh DVT. MANAGEMENT AND TREATMENT OF EDEMA IN PALLIATIVE CARE In palliative care, managing and treating edema focuses on providing comfort and improving quality of life for patients, rather than solely aiming for a cure. Edema, or swelling caused by fluid retention, can be distressing for patients and may contribute to discomfort and decreased mobility. Some approaches to managing and treating edema in palliative care includes: 1. Identify Underlying Causes: Understanding the underlying causes of edema is crucial for effective management. Common causes in palliative care may include heart failure, liver disease, kidney failure, and lymphedema. 2. Medication Management: Diuretics, such as furosemide or spironolactone, may be prescribed to help reduce fluid retention and alleviate edema. However, for patients with end-of-life edema, diuretics may not sufficiently control pulmonary edema. Other medications including scopolamine, atropine, hyoscyamine, or morphine may be used to relieve the congestion caused by fluid build-up around the lungs. Also, medication choices should be carefully considered based on the patient's overall condition, comorbidities, and goals of care. 3. Compression Therapy: Compression stockings or bandages may be used to help reduce swelling and improve circulation in the affected limbs. It's important to ensure proper fitting and monitoring to prevent complications such as skin breakdown. 4. Elevation of Limbs: Elevating the affected limbs above heart level when possible can help reduce swelling and promote drainage of excess fluid. 5. Physical Therapy: Gentle exercises and movement can help improve circulation and lymphatic drainage, reducing the severity of edema and enhancing overall comfort. 6. Massage Therapy: Gentle massage techniques, such as manual lymphatic drainage, can help stimulate lymphatic flow and reduce swelling. However, caution should be exercised to avoid causing discomfort or exacerbating existing conditions. 7. Nutritional Management: Limiting sodium intake and maintaining adequate hydration can help prevent fluid retention and reduce the severity of edema. Dietary adjustments should be made based on the patient's preferences, nutritional needs, and overall health status. 8. Psychosocial Support: Addressing the psychosocial impact of edema is essential in palliative care. Patients may experience emotional distress, body image issues, and decreased quality of life due to swelling. Providing emotional support, counseling, and holistic care can help alleviate psychological symptoms and improve well-being. 9. Comfort Measures: Providing supportive measures such as soft padding, positioning aids, and frequent position changes can help enhance patient comfort and reduce discomfort associated with edema. 10. Regular Assessment and Monitoring: Regular assessment of edema, including measurement of limb circumference and evaluation of skin integrity, is essential for monitoring changes and adjusting treatment interventions as needed. COMPLICATIONS 1. Skin Ulcers: Prolonged edema can lead to skin breakdown and ulceration, particularly in the lower limbs. 2. Infections: Edematous tissues are more prone to infections, such as cellulitis. 3. Limited Mobility: Severe edema can restrict movement and affect daily activities. 4. Compromised Circulation: Chronic edema can impair blood flow, increasing the risk of blood clots and deep vein thrombosis (DVT). 5. Underlying Health Issues: Edema can be a symptom of underlying medical conditions such as heart failure, kidney disease, or liver disease. PREVENTION 1. Healthy Lifestyle: Maintain a balanced diet, exercise regularly, and manage weight to prevent fluid retention. 2. Elevate Affected Limbs: Elevate legs and feet when resting to facilitate fluid drainage. 3. Avoid Prolonged Sitting or Standing: Change positions frequently, and avoid sitting or standing for long periods to prevent fluid buildup in the lower extremities. 4. Compression Garments: Wear compression stockings or sleeves to promote circulation and reduce swelling. 5. Medication Adherence: Take medications as prescribed, especially if edema is a symptom of an underlying medical condition. PROGNOSIS The prognosis for edema varies depending on its underlying cause and severity. Acute edema caused by temporary factors often resolves with proper treatment and lifestyle changes. However, chronic edema associated with conditions like heart failure or chronic kidney disease may require ongoing management and lifestyle modifications. Complications can arise if edema is left untreated or if underlying conditions worsen. Early diagnosis and appropriate treatment can improve outcomes and prevent complications associated with edema. Conclusion: In palliative care, the primary goal of managing and treating edema is to optimize symptom control, improve comfort, and enhance overall quality of life for patients. A multidisciplinary approach involving healthcare professionals, patients, and caregivers is essential to address the complex needs of individuals with edema in the palliative care setting. References: Braunwald E, Loscalzo J. Edema. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2011. http://www.accessmedicine.com/content.aspx?aid=9097476. Accessed January 7, 2012. O'Brrien JG, Chennubhotla SA, Chennubhotla RV. Treatment of edema. Am Fam Physician. 2005;71(11):2111-2117. Cho S, Atwood JE. Peripheral edema. Am J Med. 2002;113(7):580-586. Rudkin GH, Miller TA. Lipedema: a clinical entity distinct from lymphedema. Plast Reconstr Surg. 1994;94(6):841-847. Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo A. Deep vein thrombosis: a clinical review. J Blood Med. 2011;2:59-69 Yale SH, Mazza JJ. Approach to diagnosing lower extremity edema. Compr Ther. 2001;27(3):242-252. https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/march/21/managing-swelling-and-edema-at-end-of-life https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/fluid-retention-or-edema.