Precise guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding Edema, and its management. Highly recommended for II B.Sc Nursing Students.

1. Mr. Aby Thankachan , M.Sc(N), PGDSH
Lecturer
KMCH College of Nursing
Coimbatore

3.  Edema is an abnormal accumulation of
fluid in the interstitium, located beneath
the skin and in the cavities of the body.
 Edema is a normal response of the body to
inflammation or injury. For example, a twisted
ankle, a bee sting, or a skin infection will all
result in edema in the involved area.
 In some cases, such as in an infection, this
may be beneficial. Increased fluid from the
blood vessels allows more infection-
fighting white blood cells to enter the
affected area.

5. Five factors can contribute to the formation of edema:
1. Increased hydrostatic pressure;
2. Reduced plasma oncotic pressure
3. Increased blood vessel wall permeability e.g.
INFLAMMATION;
4. Obstruction of fluid clearance in the lymphatic
system;
5. Changes in the water retaining properties of the tissues
themselves. Raised hydrostatic pressure often reflects
retention of water and sodium by the kidney

6. Edema can be classified as GENERALISED or
LOCALISED.
• GENERALIZED EDEMA is a condition when you
notice swelling, puffiness, and water retention in
various body parts, including your abdomen,
arms, legs, face, and feet.
• Symptoms include bloating, tightening of skin,
and skin that holds an imprint or looks pitted
• Conditions leading to generalised edema:
1. Congestive Heart Failure
2. Nephrotic syndrome
3. Cirrhosis of Liver
4. Systemic Infection etc.

8. • LOCALISED EDEMA can be defined as
the type of edema confined to a
particular part/organ of the body.
• Various conditions that lead to
localised edema are:
1. Trauma
2. Infection
3. Lymphatic Obstruction like Filariasis
4. Venous Obstruction (e.g.- thrombosis)

10. Edema can also be classified as PITTING or NON-
PITTING.
Cutaneous edema is referred to as “PITTING" when,
after pressure is applied to a small area, the
indentation persists after the release of the pressure.
Peripheral pitting edema is the more common type,
resulting from water retention. It can be caused by
systemic diseases, pregnancy in some women, either
directly or as a result of heart failure, or local
conditions such as varicose veins, thrombophlebitis,
insect bites, and dermatitis.
 “NON-PITTING EDEMA” is observed when the
indentation does not persist. It is associated with
conditions such as lymphedema, lipedema, and
myxoedema.

12. There are different types of edema. Some of them
are specific to certain parts of the body, while
others may be more generalized.
Edema can be majorly classified into following
types:
a) PERIPHERAL EDEMA
b) PULMONARY EDEMA
c) CEREBRAL EDEMA

13.  Peripheral edema mainly occurs in the legs, feet, and ankles. This is
the most common type of edema and it causes swelling in the lower
extremities.
 This type of edema may be caused by increasing age,
pregnancy, hypertension, congestive heart failure, kidney
problems or other health conditions.
 You also may experience peripheral edema if you have been sitting
or standing for extended hours. Some medications may also cause
peripheral edema:
1. NSAIDs (ibuprofen, naproxen)
2. Corticosteroids (prednisone, methylprednisolone)

15.  Pulmonary edema is the accumulation of fluids in the lungs due
to the blockage of the pulmonary veins. As blood pressure rises
in the blood vessels of the lungs, fluids rush in to fill the lungs.
 The pleural cavity can also be filled with fluid. In such cases, the
pulmonary edema is said to also present with pleural effusion.
 Pulmonary edema is usually caused by the malfunctioning of
the left ventricle of the heart (leads to ↑sed pulm. vein pressure
which causes ↑sed hydrostatic pressure).
 Other causes can be:
a) Acute Respiratory Distress Syndrome.
b) Hypersensitivity Reaction
(Pink Frothy Sputum is the classical symptom of this edema.)

18.  In cerebral edema, fluids accumulates in the intracellular
and extracellular spaces of the brain. It can be caused by
metabolic abnormalities due to an underlying disease or as a
response to oxygen deprivation at high altitudes.
 Cerebral edema is a very serious form of edema. It can lead
 to loss of consciousness and brain damage.
 Cerebral edema can be further divided into 3 subtypes of
edema. These are :
1. Vasogenic
2. Cytotoxic
3. Interstitial cerebral edema.

20.  Signs of edema include:
Swelling or puffiness of the tissue
directly under your skin, especially in
your legs or arms
Stretched or shiny skin
Skin that retains a dimple (pits), after
being pressed for several seconds
Increased abdominal size

23.  When possible, treatment involves
resolving the underlying cause.
 Treatment may also involve positioning
the affected body parts to improve drainage.
 For example, swelling in feet or ankles may
be reduced by having the person lie down in
bed or sit with the feet propped up on
cushions.
 Intermittent pneumatic compression can
be used to pressurize tissue in a limb,
forcing fluids—both blood and lymph—to
flow out of the compressed area.

24.  For mild edema, rise the affected limb
higher than heart.
 More-severe edema may be treated
with drugs that help body to expel excess
fluid in the form of urine (diuretics).
 One of the most common diuretics is
furosemide (Lasix).

25.  If edema is caused by lung disease, such
as emphysema or chronic bronchitis, quitting
smoking would be advised if the patient smokes.
 For patients with chronic heart failure, these
measures would be advised: treating coronary
artery disease; monitoring weight, fluid, and salt
intake; and cutting down on excess alcohol.
 If the cause is related to a medication, stopping
the medication will cause the swelling to resolve.

26.  Put a pillow under your legs while lying down or
sitting for prolonged periods. (Keep legs
elevated above the level of your heart.)
 Do not sit or stand for long periods of time
without moving.
 Wear support stockings, which put pressure on
legs and keep fluids from collecting in legs and
ankles. These stockings can be purchased at
most drugstores.
 Ask doctor about limiting salt intake.

27. • If left untreated, edema can cause:
• Increasingly painful swelling
• Difficulty walking
• Stiffness
• Stretched skin, which can become itchy and
uncomfortable
• Increased risk of infection in the swollen area
• Scarring between layers of tissue
• Decreased blood circulation
• Decreased elasticity of arteries, veins, joints and
muscles
• Increased risk of skin ulcers