NURS601 Week 1 Concept 1: Oedema
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A shift of plasma to interstitial fluid
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An oedema is an accumulation of fluid in the interstitial space
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Occurs if venous hydrostatic pressure rises, plasma oncotic pressure decreases or interstitial oncotic pressure rises
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May also develop if an obstruction of lymphatic outflow causes decreased removal of interstitial fluid
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Extracellular fluid volume excess caused by addition or retention of saline (saline overload)
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Leaky cap bed
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Obstruction to lymph flow
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Plasma oncotic pressure decreases
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Interstitial oncotic pressure rises
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Increase in intravascular hydrostatic pressure/if venous hydrostatic pressure
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Associated with cardiac, hepatic, or renal failure & venous insufficiency
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Where is the oedema? Localised or Generalised?
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Localised
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Related to trauma or inflammation.
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Other examples of localised oedema: Cerebral, pulmonary, pleural effusion, pericardial effusion, and ascites
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Generalised
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More uniform distrubution of fluid in interstitial spaces
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How long has the patient had oedema?
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Chronic oedema
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Longer than 3 months
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What could be the cause?
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How does this affect the patient?
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First spacing
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All fluids in the body are where they should be. There is normal distribution of fluid in the ICF and ECF
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Second spacing
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Abnormal accumulation of fluid in interstitial spaces, such as oedema. This abnormal accumulation can still be easily moved back to ICF/ECF, where it should be
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Third spacing
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Abnormal accumulation of fluid trapped in spaces where it is difficult or impossible to return to where it should be, such as ascites or burn related injuries. This requires medical intervention to reverse.
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Dependent oedema: Pitting and non-pitting
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Grading oedema
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1+
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Slight pitting/2mm, disappears rapidly
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2+
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Deeper pit/4mm, disappears in 10-15s
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3+
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Deep pit/6mm, may last >1m, extremity swollen
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4+
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Very deep pit/8mm. lasts 2-5m, extremely grossly distorted
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Ensure underlying cause is being managed appropriately, attempting to reverse
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Position patient to reduce positional fluid collection
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Recording measurements of pitting oedema
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Daily weigh
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Administering diuretics if prescribed
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Protecting affected tissue from further injury
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What is the pathophysiological rationale?
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Fluid leaves bloodstream and accumulates in interstitial spaces
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Circulating blood volume and blood pressure decline
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Tissue more susceptible to injury
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Poor supply of nutrients and oxygen to support healthy tissue
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Up to 50% of patients suffering from oedema experience leg ulceration, with 31% of these people having the ulcer for more than 5 years
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