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Manifestations of Altered F&E balance Cheat Sheet by

NURS601 Week 1 Concept 1: Oedema

What is an Oedema?

A shift of plasma to inters­titial fluid
An oedema is an accumu­lation of fluid in the inters­titial space
Occurs if venous hydros­tatic pressure rises, plasma oncotic pressure decreases or inters­titial oncotic pressure rises
May also develop if an obstru­ction of lymphatic outflow causes decreased removal of inters­titial fluid


Oedema caused by heart failure

Oedema causes

Extrac­ellular fluid volume excess caused by addition or retention of saline (saline overload)
Leaky cap bed
Obstru­ction to lymph flow
Plasma oncotic pressure decreases
Inters­titial oncotic pressure rises
Increase in intrav­ascular hydros­tatic pressu­re/if venous hydros­tatic pressure
Associated with cardiac, hepatic, or renal failure & venous insuff­iciency

Assessing oedema

Where is the oedema? Localised or Genera­lised?
Related to trauma or inflam­mation.
Other examples of localised oedema: Cerebral, pulmonary, pleural effusion, perica­rdial effusion, and ascites
More uniform distru­bution of fluid in inters­titial spaces
How long has the patient had oedema?
Chronic oedema
Longer than 3 months
What could be the cause?
How does this affect the patient?

Fluid shifts in heart failure


Venous obstru­ction

Fluid spacing

First spacing
All fluids in the body are where they should be. There is normal distri­bution of fluid in the ICF and ECF
Second spacing
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
Third spacing
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.

Measuring oedema

Dependent oedema: Pitting and non-pi­tting
Grading oedema
Slight pittin­g/2mm, disappears rapidly
Deeper pit/4mm, disappears in 10-15s
Deep pit/6mm, may last >1m, extremity swollen
Very deep pit/8mm. lasts 2-5m, extremely grossly distorted

Nursing interv­entions

Ensure underlying cause is being managed approp­ria­tely, attempting to reverse
Position patient to reduce positional fluid collection
Recording measur­ements of pitting oedema
Daily weigh
Admini­stering diuretics if prescribed
Protecting affected tissue from further injury
What is the pathop­hys­iol­ogical rationale?

Effects of oedema: determined by location

Fluid leaves bloods­tream and accumu­lates in inters­titial spaces
Circul­ating blood volume and blood pressure decline
Tissue more suscep­tible to injury
Poor supply of nutrients and oxygen to support healthy tissue
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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