Weepy arms

[laderalis]

I work in LTC and take care if a resident that is morbidly obese with DM, a fib, probably CHF and has a pacemaker. Recently her arms have begun to weep clear fluid. We just put her on a fluid restriction. Her weight has actually been very stable although the edema in her hands and arms has increased dramatically. My question is where is the fluid coming from, if her weight is stable despite increased edema?

[BriGuyRN]

Sounds like CHF decompensation. The heart can compensate in early heart failure by thickening the myocardium and stretching (increasing preload->increased cardiac output). Eventually, the heart cannot continue compensating because it has stretched too far, and stroke volume is decreased, and fluid cannot circulate, so it moves into other areas (edema).

I'd be more concerned with lung function, as fluid frequently backs into the lungs (pulmonary edema).

[hodgieRN]

Some other factors can added along with the heart failure. Pt's with low albumin levels can have issues with edema (the oncontic/hydrostatic pressures in the vessels). The pt's sodium intake can be an issue. The higher the intake of sodium, the more water a pt will hold. Fluid restriction is good, but it works better if the meals are low salt. Kidney function also plays a role. As the heart failure worsens, the kidneys are poorly perfused, which leads to insufficiency or renal failure (and that will certainly add to the edema). Lastly, if the pt is morbidly obese, then mobility might be a problem. One of the best ways to reduce hand edema is to tell the pt to constantly open and close the hand; wor the hand out and use it. It facilitates draining. And, the best thing for lower leg edema is to walk around. Fluid restriction only does so much on pts with worsening CHF, sedentary lifestyle, kidney issues, and salt diets.