edema question

Not everything is black and white. There are frequently mixed etiologies for signs and symptoms.

Definitely! That is so frustrating :-)

One more question... why would he be on IV fluids-0.9% NS at 80 ml/hr? Just for the infection? even though he has all of this edema in his legs?

I also had a pt who had edema and cellulitis. and cellulitis possibly caused the edema. Im sure the foot? is really big yeah? did u listen to lung sounds and hear crackles? if theres none, then its probably not from the CHF. but i am def not a hundred percent sure about this. and maybe he's on IV to increase cardiac output maybe? hows his blood pressure? Actually i have no idea, I am just putting things out there. I would also like to know....

thanks for the ideas! I talked to my instructor today...she wasn't sure since we only briefly had this patient. But since he has had this edema issue for 20+ yrs she was guessing that maybe it was from long standing CHF. She also questioned why the IV was set at 80ml/hr and not slower since he probably didn't need much extra fluid...maybe just an IV for his antibiotics. BP was fine...it got lower after he took some lasix but WNL. no crackles in the lungs so maybe that with the edema means right sided heart failure instead of left (in which fluid would end up in the lungs)?? who knows really. kind of a mystery with this one!

Heres another thought. Do you know if he is taking any diuretics? in order to reduce the edema? and at the same time, the IV is for risk of dehydration? total guess right now.

if pitted edema +1, +2, +3 to check for right heart failure. But i'll probably would say SOB because of the obesity haha

The fluids are at 80 ml/hr because of his CHF. If you give someone with CHF IV fluid at a rapid rate, you run the risk of putting them into a hypervolemic state, and, possibly, pulmonary edema. Even rates of 125 or 150 ml/hr can be too much for some of these patients. When it comes to CHF patients with preexisting edema, it's better to be safe than sorry when it comes to fluid administration. HCTZ is a diuretic that is often combined with a medication, in this case an ACE, to reduce blood pressure and manage edema. The SOB on activity is probably due to multiple factors. The patient is obese, has CHF, and edema. Due to the fluid accumulation, the decreased heart function, and the obesity, he has SOB, and probably activity intolerance. The edema is also probably a mixed cause. The CHF and lymphedema probably each contribute to the edema your patient is experiencing. The patient does need IV fluids in order to maintain an IV line so that your patient can be treated with antibiotics for the cellulitis, as well as other medications. The fluids may also be used to regulate fluid and electrolyte balance, especially if your patient is NPO, on a special diet, or not eating and drinking like he should be.

Good post above. Additionally, just because someone has +4 edema, does not mean that they are fluid overloaded intravascularly, i.e. think third spacing. You can have pts who have gross edema but are dry in the vascular space. Not sure how long the pt has been inpatient, but nutrition status can affect oncotic/osmotic pressure/fluid regulation i.e. proteins. Very multifactorial and def not a black and white case

as iheartdukecticu says, lousy serum proteins make low oncotic pressure so fluid will exit the vascular space, and can leave the vascular space dry. also cellulitis and inflammation makes capillary walls more permeable, so fluid leaks out more easily. check this patient's serum proteins -- albumin and prealbumin-- if they are low, that's one big clue.

also-- and this is big-- low serum proteins make it very hard to heal & to keep your immune system up to snuff. implications for an obese cellulitic guy, ya think? i see people all the time with chronic nonhealing wounds that nobody's bothered to look at that.