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.