experienced nurses (edema question)

mamamerlee, LPN · Oct 9, 2009

This is usually referred to dependent edema, simply due to the position. Her legs need to be elevated to encourage better circulation. Water, or any type of liquid will always find the lowest point of gravity. Does she get edema on her back/buttocks when laying supine?

The problem is exacerbated by the lack of movement.

Best wishes.

07302003, ASN, RN · Oct 10, 2009

How is her nutritional status? I've seen many bedbound people with low albumin / pre-albumin (a blood test for protein in the blood that tells you how someone's nutritional status is) get very edematous, like a baloon, almost. That could be part of it.

cocosmama · Oct 10, 2009

Can she wear ted hose (support stockings)? Elevation and some support should take care of the problem. Also, the nutritional angle is something to look into too.

AnnemRN · Oct 10, 2009

How is her nutritional status? I've seen many bedbound people with low albumin / pre-albumin (a blood test for protein in the blood that tells you how someone's nutritional status is) get very edematous, like a baloon, almost. That could be part of it.

True, low protein levels can cause edema. It may be a combination of both - sitting with legs dependant and possible low albumin.

penny0314 · Oct 10, 2009

These suggestions are wonderful. TED hose definitely help with dependent edema. Just one note: these stockings are often called "antiembolism" (against blood clots) stockings and purportedly used to prevent clots in the legs. Don't kid yourself. Studies have shown them useless for that. To prevent clots, try elevating the legs and doing some range of motion exercises regularly. TED hose without both those measures are useless against clots, and there's some evidence they may contribute to them.

amydayre · Oct 10, 2009

Another problem may be the fact that the muscles in her legs just don't get used. The body uses the natural muscle action around veins to return blood back to the heart and then onto the kidneys where excess water is filtered out. Because your daughter sits so much of the time her muscles don't have the chance to help move the blood back to her heart. I would absolutely look into passive range of motion exercises for her, and maybe have the edema evaluated by a physician. Especially if your daughter is overweight it may signal some new onset congestive heart failure. Good luck with the wound care!

seaspray700777 · Oct 11, 2009

Thanks to you all for explaining this for me. I have tried to use ted stocking in the distant past but she does not want them used now, because it is almost impossible to put them on because of her rebound spasticity. She does not get edema on anywhere except her legs. She is mostly on her back in bed. Sometimes if she isnt in to much pain I do get her in her chair for a couple of hours. Her wound specialist doesnt want her in her chair any longer for fear of reopening her bed ulcer on her bottom. Sorry to write so much be she is complicated. Well her health of course, not her,. I never thought of the blood not filtering right because she doesnt use her muscles very much.

Thanks to you all.:redbeathe:yeah:

amydayre · Oct 12, 2009

Not related, but I have a 21 year old with CP, when she was very small we did "Jane Fonda's" to strengthen her legs. It may help. You begin by manipulating the ankle, flexion and extension, then doing the knee, then the hip and back down. It helped my daughter to finally be able to walk.

MAISY, RN-ER, BSN, RN · Oct 12, 2009

All great answers-I don't know the extent of your daughter's movement but there is a pedaling machine that can be used either in active or passive motion-we use it for my mom's Parkinson's. It may be something to consider for ROM and lessened edema if your daughter is able to put her feet in the enclosed pedals.

Good luck....

seaspray700777 · Oct 13, 2009

Thanks to you all again. Just when I feel so alone in this world, I come here and life is great!. Dear Amydayre: When my daughter was young I did all the ROM and tone exercises that the PT said to do from about 3yrs to 12 or 13 then she said no more.

My daughter is very independent in her own way, and I know now because of her stubborn, independent way this has kept her alive when many a doctor or wound care specialist has just patted me on the back and gave me a hug and said, "if you pray you might want to now".

You see, the main reason I think my daughter went downhill since 16, is she made a decision to live away from me (with a so called friend) because she thought I was to controlling, Hence PT. anyways, not to go on and on but, this life altering decision that was made so many years ago has incumbered her present ability to heal well.

I finally stepped in when she was 20, hence hospitlized, and told her I love her and I will stand by her but she needed to trust family and not just anyone.

To shorten this up I know she was meant to be here for a reason. For some of the other posts questions. she is a quadrapaligic and when she was young, of course in 1978, was told she would never talk and just put her away, boy were they wrong, she can talk up a storm! back to the first question I had about edema, you all have been an immence help!!!!!!!!!!! I understand much better. God bless and Goodnight,

I have to go back to studing the Krebs cycle. AHHHHHHHHHHHHHHHHH. :eek: :loveya: :yeah:

amydayre · Oct 13, 2009

One more thing you might try would be if she is in a hospital type bed, position her legs higher than her head for about 15-20 minutes a couple of times a day. This may help her venous return. Good luck with Krebs...it never really goes away!