edema question-driving my crazy!

leslieanne · Apr 20, 2005

Hello everyone:
I was looking through my notes for a class, and soemthing really has me stumped . Alright, I know right sided heart failure causes edema in the legs.....and I also know that to alleviate edema, you usally would elevate the patient's legs. However, if you elevate the edemic legs of a CHF patient, wouldn't the fluid enter the vasculature that is returning to the heart and increase the work of the heart? I know you want to prevent inc. the work of the heart in a CHF patient (having them rest as to not raise volume of fluid returning to heart, decrease sodium intake, duiretics etc). So, what do you do for the patient position-wise who has right sided heart failure.
:) Thanks everyone!

I'm just guessing here, but I would think that decreasing the heart's workload is first priority. I would position the pt. with the head somewhat elevated and perhaps elevate the legs a bit. I would think the edema would be secondary and hopefully treated with diuretics. I'm a student as well, so I look forward to input from the pros.

les

lady_jezebel · Apr 20, 2005

http://www.csufresno.edu/nursing/n140/studassign/chf.htm

this is a good link. you would place the pt in fowler's or high fowler's to decrease return to heart. the legs would NOT be elevated at/above the heart level -- rather, venous pooling would be treated with medications like lasix (not positioning). the pt would need bedrest & frequent turns (to prevent bedsores).

leslie :-D · Apr 20, 2005

http://www.csufresno.edu/nursing/n140/studassign/chf.htm
this is a good link. you would place the pt in fowler's or high fowler's to decrease return to heart. the legs would NOT be elevated at/above the heart level -- rather, venous pooling would be treated with medications like lasix (not positioning). the pt would need bedrest & frequent turns (to prevent bedsores).

you took the words right out of my mouth.....high fowler's with a couple of pillows placed strategically so the heels don't touch the bed.

leslie

TiffyRN, BSN, PhD · Apr 20, 2005

I took care of a lady with R sided heart failure and severe 4+ edema of her legs up to her thighs. Her primary physician (not her cardiologist) and an MD that was not highly regarded decided one day she would "fix" the edema. She ordered compressions stockings and SCD's (sequential compression devices). The patient went into fulminant (sp?) pulmonary edema and had to be transferred to ICU and intubated until diuresed. She did recover and her legs swelled up again, but she could breathe on her own!!

So I'm saying what the others are saying; elevating the legs, decreasing peripheral edema are not to be prioritized above guarding heart function.