Peripheral Edema – Signs of Liver Cirrhosis (Nursing)

by Rhonda Lawes

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    00:00 First of all, let's take a look at what is edema.

    00:04 I always think of Edema as fluid in inappropriate places.

    00:08 It's out of balance.

    00:10 We're pretty squishy on the inside, but we need fluid to stay in certain spaces.

    00:16 We have it around ourselves at an appropriate level.

    00:19 We have it in our intravascular space at an appropriate level.

    00:23 We even have it inside our cells, but when one of those areas gets out of balance too much or too little, it throws everything out of whack in your body.

    00:33 So edema is the medical term for swelling, if I looked at someone externally it would look like swelling, but you need to know what's going on internally is that fluid in an intracellular or extracellular space is out of balance.

    00:50 Edema always means too much fluid in an inappropriate space.

    00:56 So how does this fluid get into inappropriate spaces? Well, I want you to look at the picture, take a look at the right leg and the left leg and compare them.

    01:06 We definitely have significant differences between that patients right leg and left leg.

    01:12 We've got significant swelling in that left leg.

    01:15 Now look at the foot.

    01:17 That's a little bit closer.

    01:18 Look at the foot that's labeled normal.

    01:21 Look at the one that's labeled pitting edema.

    01:24 What are the differences that you observed? If you and I were walking into a patient's room and we're going to do an assessment, and we saw feet that looked like this.

    01:34 What would we start thinking about? How did the patient get to the status? Because look at that ankle and the pitting edema.

    01:41 Yeah. They don't have one.

    01:43 You often hear those called cankles that is not a medical term.

    01:46 That just means they just have calf straight down, they have no ankle that you can visualize.

    01:54 So how does a patient end up with this kind of Edema? Well, the problem becomes the capillaries that normally keep fluid in proteins in now begin to leak.

    02:05 Whatever protein goes fluid is going to follow.

    02:09 So remember capillaries are these very thin permeable fragile layers right there.

    02:15 They're meant to be that because we need fluid to move back and forth freely in appropriate amounts, but when those capillaries get damaged, they don't keep protein within the intravascular space anymore and that starts leaking out into the tissues that's when you end up with a foot that looks like that because see the fluid gets trapped in those tissues.

    02:37 Once those capillaries are damaged and they start leaking and protein is oozing out of the capillaries, fluid is going to follow it and it gets trapped in there.

    02:48 So it's much more difficult to get that fluid back into the intravascular space than it was for it to first start traveling there once those capillaries have been damaged.

    02:58 Okay, that's a lot of talk about fluid.

    03:00 Let's make sure that you're really solid.

    03:02 Edema always puts tissues and organs at risk.

    03:06 Right? when I have cerebral edema, I can have brain damage.

    03:10 You might think that my feet swelling or not such a big thing, but it is an indication, It's a warning sign that something serious is going on in your patient's body.

    03:20 So how does it happen? Capillaries are fragile when they get damaged and we'll talk about the reasons they get damaged.

    03:28 But when they get damaged that protein doesn't stay in the inter vascular space, it leaks out, fluid follows it, the tissue swell.

    03:37 That's what's going on in any patient that you know edema.

    03:41 So when we talk about pitting edema, that's a particularly nasty kind of Edema.

    03:47 Look at the top of that foot right? You see there's a little mark like a thumbprint on that patient's foot.

    03:53 That's how we measure or assess pitting edema.

    03:57 Let me give you a better picture.

    03:58 There we go.

    03:59 So swelling of the body tissues due to fluid to the extent that after I put slight pressure.

    04:06 There's an indentation left in the tissue.

    04:09 So there's normal tissue start at the left.

    04:12 You've got the finger pointing the tissue.

    04:14 Look, it's light pressure.

    04:15 We're not really getting intense.

    04:17 You're just putting some light pressure on it, remove your finger there shouldn't be a divot.

    04:22 I'm going to go golfing with Dad, you know divots are a big chunk of the grass.

    04:26 Let's take it out after you've got a good shot.

    04:29 On this one, there's no divot or indentation.

    04:33 Look as we move to picture number two.

    04:36 Okay now we're going a little deeper because that tissue is fluid-filled kind of squishy.

    04:42 See it progressed through picture 3, picture 4 and picture 5.

    04:47 That's going to be how you would assess the severity of the pitting edema.

    04:52 Person on the left, doesn't have any edema, person all the way over on the right has severe edema.

    05:00 This level of Edema this is in their legs is going to make it very difficult for them to move because their legs are going to feel like they're made of lead.

    05:09 It's really going to be hard for them to get around and to be mobile.

    05:13 So peripheral edema is a funny word, you hear us use it all the time, but I want to make sure you understand what it means.

    05:20 So underline the word pre-referral, okay.

    05:23 That's what the focus is of this.

    05:25 Remember when I talked about your brain that was cerebral edema.

    05:29 We're talking about something completely different in this video.

    05:32 We're talking about peripheral edema.

    05:35 So the word in front of edema tells you the location of the edema.

    05:38 Cerebral edema, brain.

    05:41 Peripheral edema, is accumulation of fluid that causes swelling in the tissues that are perfused by the peripheral vascular system.

    05:51 Okay, that is what makes peripheral edema peripheral, it's the peripheral vascular system.

    05:59 I don't think I could get the word peripheral in this any more than I already have but I'm using it over and over again to make sure you're very clear when you're assessing that kind of Edema, you know where you're looking for it.

    06:12 Okay so what is the peripheral vascular system? Take a look at the graphic I have there for you.

    06:17 Okay, you see that you have vessels in your arms and in your feet, but we've covered the vessels that are in the middle of the body.

    06:27 The peripheral vascular system is the veins and arteries that are not in the chest or the abdomen and that's why I put that picture there for you, to remind you at least a peripheral, It's not in the center part of the body.

    06:41 That's why I blocked out the vessels, right? In the chest and the abdomen, so we're talking about peripheral edema, we're thinking about arms, hands, legs and feet.

    06:53 Okay, so I think we've talked probably more about that than you wanted to know.

    06:57 But let's give you one more thing.

    06:59 Where are you most likely to assess peripheral edema.

    07:02 So you and I are back with a patient.

    07:05 We're doing our assessment, where we most likely to assess if the patient has or doesn't have peripheral edema? It's usually observed in the legs.

    07:16 Now, Why would we do that? Because that's where the most dependent part of the body is that's where you're most likely to see the edema first.

    07:24 Edema generally starts from the feet working your way up.

    07:30 Now how might the patient described, as so you and I are in the room together and we're asking the patient how they're feeling.

    07:36 These are things in clues that you want to look for.

    07:40 This will help you in practice.

    07:41 It will also help you on exams because this may be part of an exam question where the patient reports, the patient complains of, those are always things you want to focus on because that's helping you identify the topic of the question.

    07:56 So these are things that patient might say, if her feet look like that.

    08:00 Look she's got the thumbprint in there are the fingerprint in there, the indent we know that she has pitting edema, but she may describe it as, my legs feel full or heavy, my legs look swollen.

    08:15 My socks are leaving marks on my legs.

    08:18 Yeah, that's a very very common when you bring a patient in for an assessment and they're wearing socks and you peel off those socks.

    08:26 Sometimes you have significant marks on their legs.

    08:30 That's a sign that we need to talk to them about some different type of Footwear.

    08:34 We know they have edema and we also know it's going to be compromising circulation to their feet which is never a good thing.

    08:41 Lastly. They may say it my skin feels tight on my legs, that is because they're swollen.

    08:47 So look for these clues when you're speaking with your patients, when you're interacting with your patients, if you know, they're at risk for edema, you're going to ask them these types of questions.

    08:58 They may not come in with this script.

    09:00 So you could turn this around and ask it as a nursing question.

    09:04 Excuse me Mrs. Smith.

    09:05 Have you ever noticed your legs feeling full or heavy? Do they look swollen to you or different than normal? What about your socks when you take them off, Do you notice that you have marks? How long do those marks stay on your legs? Does your skin ever feel tight on your legs? See sometimes patients don't know to mention things because they don't think it's a big deal.

    09:26 They don't understand the underlying implications of Edema like you do because you're hanging out with us and walking through these videos.

    About the Lecture

    The lecture Peripheral Edema – Signs of Liver Cirrhosis (Nursing) by Rhonda Lawes is from the course Liver Cirrhosis (Nursing).

    Included Quiz Questions

    1. Capillaries leak fluid and protein into nearby tissues
    2. Fluid and protein accumulate in the intravascular space
    3. Blood leaks through the capillaries into nearby tissues
    4. Lipids leak out of capillaries and fluid follows
    1. Applying pressure and assessing for tissue indentation
    2. Feeling the strength of peripheral pulses
    3. Evaluating the nail beds for blanching or colour change
    4. Checking skin temperature and moisture
    1. Right arm
    2. Brain
    3. Around the eyes
    4. Abdomen
    1. "Do your legs feel heavy?"
    2. "Do you notice marks on your legs when you take off your socks?"
    3. "Does your skin feel tight?"
    4. "How much have you urinated today?"
    5. "Does your abdomen look swollen to you?"
    1. The most dependent part of the body is the lower extremities
    2. There is more fluid in the lower extremities
    3. There are fewer lymphatic vessels in the lower extremities
    4. The capillaries are more fragile in the lower extremities

    Author of lecture Peripheral Edema – Signs of Liver Cirrhosis (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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