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Does the edema pit on pressure? Edema that pits on pressure is more likely to be due to heart, liver, or kidney disease. Edema that does not pit on pressure is more likely due to myxedema or lymphedema.
Is there ... DIAGNOSTIC WORKUP
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...
Is there a periorbital or facial rash? The presence of a periorbital or facial rash should suggest contact dermatitis, angioneurotic edema, trichinosis, and herpes zoster. Remember, herpes zoster is usually ... DIAGNOSTIC WORKUP
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...
Is the edema acute or chronic? Acute edema, if it is localized, should always bring to mind a deep vein thrombophlebitis. It also should bring to mind acute lymphangitis, particularly if there is erythema in ... DIAGNOSTIC WORKUP
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...
What is the bicarbonate level? If this is elevated, the patient has a metabolic alkalosis. If this is decreased, the patient has a respiratory alkalosis associated with salicylate intoxication or hyperventilation syndrome. ... DIAGNOSTIC WORKUP
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...
Periorbital or eyelid edema has many possible etiologies, including mechanical, hemodynamic, infectious, inflammatory, and neoplastic causes. A careful history and physical examination are necessary to determine whether the problem is localized or generalized, and treatment... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Chronic venous insufficiency affects up to 25% of the general population and is the most common cause of edema or swelling of the lower extremities. Normal venous blood return to the heart requires competent venous valves, intermittent muscle... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Periorbital edema is frequently reported by parents via telephone. Unless the cause is obvious and benign, an immediate evaluation is warranted.
Differential Diagnosis
Periorbital cellulitis
–Also described as preseptal ... Workup and Diagnosis ... Treatment
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...
Edema is defined as the accumulation of excessive amounts of fluid in the cells and tissues of the body and is relatively rare in children. It is usually generalized and dependent (i.e., fluid tends to accumulate in the most dependent areas, such as the lower extremities).
... Workup and Diagnosis ... Treatment
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... The mechanism for periorbital and facial edema is similar to that for edema of the extremities. Thus, increased backpressure of the veins will cause periorbital edema in right heart failure, constrictive pericarditis, advanced pulmonary emphysema, and thrombosis or
... READ EXCERPTS »
... Many patients are told they have a low blood pressure and are even treated for it when that blood pressure may be entirely normal for them. Asymptomatic hypotension may not be pathologic at all. At any rate, an expensive investigation for the causes of “hypotension”
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... Edema of the extremities is a common symptom. Most physicians, therefore, have an immediate working diagnosis when the patient walks into the office: congestive heart failure if the edema is bilateral and deep vein phlebitis if it is unilateral. Many times this is right. However, what if
... READ EXCERPTS »
... The differential diagnosis of alkalosis, like acidosis, begins with using the physiologic model of production, excretion, or degradation.
ALKALOSIS (INCREASED PH)
... READ EXCERPTS »
... When breathing requires extra effort, the accessory muscles — the sternocleidomastoid, scalene, pectoralis major, trapezius, internal intercostals, and abdominal muscles — stabilize the thorax during respiration. Some accessory muscle use normally takes... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Leg edema is a common sign that results when excess interstitial fluid accumulates in one or both legs. It may affect just the foot and ankle or extend to the thigh, and may be slight or dramatic, pitting or nonpitting.
Leg edema may result from venous disorders, trauma, and... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... A common sign in severely ill patients, generalized edema is the excessive accumulation of interstitial fluid throughout the body. Its severity varies widely; slight edema may be difficult to detect, especially if the patient is obese, whereas... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... The result of excess interstitial fluid in the arm, arm edema may be unilateral or bilateral and may develop gradually or abruptly. It may be aggravated by immobility and alleviated by arm elevation and exercise.
Arm edema signals a localized... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... Interstitial Disease of Known Etiology
Inorganic dusts
Silica
Silicates, especially asbestos, talc, kaolin, diatomaceous earth
... READ EXCERPTS »
... Hypovolemia
External losses
Hemorrhage
Gastrointestinal loss
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... Elevated Microvascular Pressure
Cardiogenic
Volume overload (especially when associated with low plasma oncotic pressure)
Neurogenic
Head trauma
... READ EXCERPTS »
... Localized
Venous or lymphatic obstruction and/or insufficiency
Venous thrombosis
Baker's cyst
Tumor invasion or compression (e.g.,
... READ EXCERPTS »
... General Factors
Cigarette smoking (especially more than 10 years of one pack of cigarettes per day)
Chronic bronchitis
Older age plus concomitant
... READ EXCERPTS »
... Signs and Symptoms Rapid, shallow breathing; dyspnea, crackles, rhonchi; hypoxemia; bilateral infiltrates on chest X-ray
Treatment (Tx) Treatment of underlying disorder, supportive care (oxygen,... Pictures
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... Infant respiratory distress syndrome (IRDS), also called hyaline membrane disease, is the most common cause of neonatal mortality. In the United States alone, it kills 40,000 neonates every year. IRDS occurs in premature neonates and, if untreated, is fatal within 72... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Productive cough (purulent sputum), pleuritic chest pain, sweating, fever, chills, headache, malaise, weight loss
Treatment (Tx) Antibiotics, oxygen therapy, supportive care (I.V.
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... Even though it's largely preventable, lung cancer has long been the most common cause of cancer death in men and is an increasing cause of cancer death in women. Lung cancer usually develops within the wall or epithelium of the bronchial tree. Its most common types are... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Signs and Symptoms Onset: fewer, chills. Warm phase: pink, flushed skin; low urine output; blood pressure normal or slightly elevated; rapid, bounding pulse; rapid, shallow respirations; altered level of consciousness (anxiety, irritability,... Treatment (Tx)
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... Toxic shock syndrome (TSS) is an acute bacterial infection caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. Initially, the disease was thought to primarily affect menstruating... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Dyspnea; orthopnea; coughing; tachycardia; tachypnea; crackles; jugular vein distention; diastolic gallop; cyanosis; confusion; frothy, bloody sputum; cold, clammy skin
Treatment (Tx) Oxygen therapy,
... READ EXCERPTS »
... In hypovolemic shock, reduced intravascular blood volume causes circulatory dysfunction and inadequate tissue perfusion. Without sufficient blood or fluid replacement, hypovolemic shock syndrome may lead to irreversible cerebral and renal damage, cardiac arrest... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Pulmonary edema is the accumulation of fluid in the extravascular spaces of the lung. In cardiogenic pulmonary edema, fluid accumulation results from elevations in pulmonary venous and capillary hydrostatic pressures. A common complication of cardiac... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Atelectasis is incomplete expansion of lobules (clusters of alveoli) or lung segments, which may result in partial or complete lung collapse. Because parts of the lung are unavailable for gas exchange, unoxygenated blood passes through these areas unchanged, resulting in hypoxemia.... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Cold, pale, clammy skin; hypotension; tachycardia; rapid, shallow respirations; oliguria; restlessness, confusion; obtundation; narrowing pulse pressure; cyanosis
Treatment (Tx) ... Pictures
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... Signs and Symptoms Muscle contraction, loss of consciousness, loss of reflex control, respiratory paralysis, arrhythmias, myocardial infarction, burns, hearing loss, cataracts
Treatment (Tx) CPR, lactated Ringer’s solution,
... READ EXCERPTS »
... When breathing requires extra effort, the accessory muscles—the sternocleidomastoid, scalene, pectoralis major, trapezius, internal intercostals, and abdominal muscles—stabilize the thorax during respiration. Some accessory muscle use normally takes... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Characterized by a deep, low-pitched grunting sound at the end of each breath, grunting respirations are a chief sign of respiratory distress in infants and children. They may be soft and heard only on auscultation, or loud and clearly audible without a stethoscope. Typically,... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pictures
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... Leg edema is a common sign that results when excess interstitial fluid accumulates in one or both legs. It may affect just the foot and ankle or extend to the thigh, and may be slight or dramatic and pitting or nonpitting.
Leg edema may result from venous... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
... READ EXCERPTS »
... A common sign in severely ill patients, generalized edema is the excessive accumulation of interstitial fluid throughout the body. Its severity varies widely; slight edema may be difficult to detect, especially if the patient is obese, whereas massive edema is immediately... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... The result of excess interstitial fluid in the arm, this type of edema may be unilateral or bilateral and may develop gradually or abruptly. It may be aggravated by immobility and alleviated by arm elevation and exercise.
Arm edema... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
... READ EXCERPTS »
... Facial edema refers to either localized swelling—around the eyes, for example—or more generalized facial swelling that may extend to the neck and upper arms. Occasionally painful, this sign may develop gradually or abruptly. Sometimes it precedes onset of peripheral or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Increased salivation is an uncommon symptom that can result from a GI disorder, especially of the mouth. It also accompanies certain systemic disorders and may result from the use of certain drugs or from exposure to toxins. Saliva may also... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Tears normally bathe the eyes, keeping the epithelium moist and flushing away foreign bodies. Excessive lacrimation (tear production) usually results from inadequate tear drainage due to obstruction of the lacrimal drainage system or malposition of the lower lid. Reflex tearing... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Paul Evans and Michael P. Rowane
Edema is defined as a clinically apparent increase in interstitial fluid volume (1–3). A number of possible factors cause edema.
Approach The diagnostic process begins by determining if edema... History ... Physical examination ... Testing ... Diagnostic assessment
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... Cindy Barter
Epigastric distress is a very common presenting complaint in both the emergency room setting and the outpatient setting. Of the multitude of diseases or diagnoses that can present with epigastric distress, gastroesophageal reflux disease ... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Congestive heart failure
❑ Venous insufficiency
❑ Hypoalbuminemia
❑ Drugs
❑ Cirrhosis ... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
Cardiogenic
❑ Anterior myocardial infarction
❑ Arrhythmia
❑ Dilated cardiomyopathy
❑ Aortic... Diagnostic Approach ... Clinical Findings ... Pictures
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... Also called hyaline membrane disease and infant respiratory distress syndrome, respiratory distress syndrome is the most common cause of neonatal mortality.
Respiratory distress syndrome affects 10% of premature... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A lung abscess is an infection accompanied by pus accumulation and tissue destruction. The abscess may be putrid (due to anaerobic bacteria) or nonputrid (due to anaerobes or aerobes), and it commonly has a well-defined border. The availability of effective antibiotics has made lung... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Lung cancer usually develops within the wall or epithelium of the bronchial tree. Its most common types are epidermoid (squamous cell) carcinoma, small cell (oat cell) carcinoma, adenocarcinoma, and large cell (anaplastic) carcinoma.
Although the... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... An acute bacterial infection, toxic shock syndrome (TSS) is caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. The disease primarily affects menstruating women younger than age 30 and is... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
... READ EXCERPTS »
... In hypovolemic shock, reduced intravascular blood volume causes circulatory dysfunction and inadequate tissue perfusion. Without sufficient blood or fluid replacement, hypovolemic shock syndrome may lead to irreversible cerebral and renal damage, cardiac arrest and, ultimately, death.... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... With pulmonary edema, fluid accumulates in the extravascular spaces of the lung. With cardiogenic pulmonary edema, fluid accumulation results from elevations in pulmonary venous and capillary hydrostatic pressures. A common complication of cardiac disorders, pulmonary... Causes ... Signs and symptoms ... Diagnosis ... Treatment
... READ EXCERPTS »
... A form of pulmonary edema that causes acute respiratory failure, acute respiratory distress syndrome (ARDS, shock lung, stiff lung) results from increased permeability of the alveolocapillary membrane. Fluid accumulates in the lung interstitium, alveolar spaces, and small... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Atelectasis is marked by incomplete expansion of lobules (clusters of alveoli) or lung segments, which may result in partial or complete lung collapse. The collapsed areas are unavailable for gas exchange; unoxygenated blood passes through these areas unchanged,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
... READ EXCERPTS »
... Sometimes called pump failure, cardiogenic shock is a condition of diminished cardiac output that severely impairs tissue perfusion. It reflects severe left-sided heart failure and occurs as a serious complication in nearly 15% of all... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... When an electric current passes through the body, the damage it does depends on the intensity of the current (amperes, milliamperes, or microamperes), the resistance of the tissues it passes through, the kind of current (alternating current,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Characterized by a deep, low-pitched grunting sound at the end of each breath, grunting respirations are a chief sign of respiratory distress in infants and children. They may be soft and heard only on auscultation, or loud and clearly audible... Assessment ... History ... Physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Facial edema refers to either localized swelling — around the eyes, for example — or more generalized facial swelling that may extend to the neck and upper arms. Occasionally painful, this sign may develop gradually or abruptly. Sometimes it precedes... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A common sign in severely ill patients, generalized edema is the excessive accumulation of interstitial fluid throughout the body. Its severity varies widely; slight edema may be difficult to detect, especially if the patient is obese, whereas massive... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... When breathing requires extra effort, the accessory muscles — the sternocleidomastoid, scalene, pectoralis major, trapezius, internal intercostal, and abdominal muscles — stabilize the thorax during respiration. Some accessory muscle use normally... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Characterized by a deep, low-pitched grunting sound at the end of each breath, grunting respirations are a chief sign of respiratory distress in infants and children. They may be soft and heard only on auscultation, or loud and clearly audible without a... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Patient counseling ... Pictures
... READ EXCERPTS »
... Leg edema is a common sign that results when excess interstitial fluid accumulates in one or both legs. It may affect just the foot and ankle or extend to the thigh and may be slight or dramatic, pitting or nonpitting.
... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A common sign in severely ill patients, generalized edema is the excessive accumulation of interstitial fluid throughout the body. Its severity varies widely; slight edema may be difficult to detect, especially if the patient is obese, whereas massive edema is immediately... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... The result of excess interstitial fluid in the arm, arm edema may be unilateral or bilateral and may develop gradually or abruptly. It may be aggravated by immobility and alleviated by arm elevation and exercise.
Arm edema signals a localized... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Facial edema refers to either localized swelling — around the eyes, for example — or more generalized facial swelling that may extend to the neck and upper arms. Occasionally painful, this sign may develop gradually or... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Increased salivation (also known as polysialia or ptyalism) is an uncommon symptom that can result from a GI disorder, especially of the mouth. It also accompanies certain systemic disorders and may result from the use of certain... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Tears normally bathe the eyes, keeping the epithelium moist and flushing away foreign bodies. Excessive lacrimation (tear production), also known as epiphora, usually results from inadequate tear drainage due to obstruction of the lacrimal drainage... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
...Signs of respiratory distress include tachypnea,dyspnea, nasal flaring, grunting, retractions, and cyanosis. Apneais an extreme form of respiratory distress. Respiratory distress(neonatal and postneonatal) is discussed in the first part of thechapter... Principal Causes of Respiratory Distress (Neonatal) ... Clinical Features and Diagnosis: Respiratory Distress (Neonatal) ... Principal Causes of Respiratory Distress (Postneonatal) ... Clinical Features and Diagnosis: Respiratory Distress (Postneonatal) ... Diagnostic Approach: Respiratory Distress ... Principal Causes of Apnea ... Clinical Features and Diagnosis: Apnea ... Diagnostic Approach: Apnea ... References
... READ EXCERPTS »
...Generalized edema—excessive accumulationof fluid in interstitial space—is usually obvious first inankles, lower legs, and eyelids. Principal Causes of Edema Disorderswith normal serum albumin Increased capillary permeability Skin ... Clinical Features and Diagnosis ... Table 17.1. Principal Causes of Hydrops Fetalis ... Diagnostic Approach ... References
... READ EXCERPTS »
... When breathing requires extra effort, the accessory muscles—the sternocleidomastoid, scalene, pectoralis major, trapezius, internal intercostals, and abdominal muscles—stabilize the thorax during respiration. Some accessory muscle use normally takes place during such activities... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Characterized by a deep, low-pitched grunting sound at the end of each breath, grunting respirations are a chief sign of respiratory distress in infants and children. They may be soft and heard only on auscultation, or loud and clearly audible without a... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Leg edema is a common sign that results when excess interstitial fluid accumulates in one or both legs. It may affect just the foot and ankle or extend to the thigh, and may be slight or dramatic, pitting or nonpitting.
Leg edema may result from... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A common sign in severely ill patients, generalized edema is the excessive accumulation of interstitial fluid throughout the body. Its severity varies widely; slight edema may be difficult to detect, especially if the patient is obese, whereas massive edema is immediately apparent... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... The result of excess interstitial fluid in the arm, arm edema may be unilateral or bilateral and may develop gradually or abruptly. It may be aggravated by immobility and alleviated by arm elevation and exercise.
Arm edema signals a... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Facial edema refers to either localized swelling—around the eyes, for example—or more generalized facial swelling that may extend to the neck and upper arms. Occasionally painful, this sign may develop gradually or abruptly. Sometimes it... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
...
The mechanism for periorbital and facial edema is similar to that for
edema of the extremities. Thus, increased backpressure of the veins will
cause periorbital edema in right heart failure, constrictive pericarditis,
advanced pulmonary... Pictures
... READ EXCERPTS »
...
Many patients are told that they have a low blood pressure and are even
treated for it when that blood pressure may be entirely normal for them.
Asymptomatic hypotension may not be pathologic at all. At any rate, an
expensive... Pictures
... READ EXCERPTS »
...
Edema of the extremities is a common symptom. Most physicians,
therefore, have an immediate working diagnosis when the patient walks into
the office: Congestive heart failure (CHF) if the edema is bilateral and
deep vein phlebitis if it is... Pictures
... READ EXCERPTS »
...
The differential diagnosis of alkalosis, like acidosis, begins with
using the physiologic model of production, excretion, or
degradation.
Production ... Pictures
... READ EXCERPTS »
... Author:
Mindy Dickerman, MD
What to Do - Take Action
One third of all burn unit admissions and deaths involve children. Flame
and scald burns are the major mechanisms of injury in the pediatric burn
population. Children younger than 4 years of age... Suggested Readings
... READ EXCERPTS »
... Author:
Sarika Joshi, MD
What to Do - Gather Appropriate Data
It is important for pediatricians to recognize the signs and symptoms of
respiratory distress, as it is a common presenting complaint for children.
With a careful history and physical exam,... Suggested Readings
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... Richard M. Kravitz, MD Atelectasis - BASICS Atelectasis - description State of collapsed and airless alveoli May be subsegmental, segmental, or lobar, or may involve the entire lung A radiographic sign ... Atelectasis - DIAGNOSIS ... Atelectasis - TREATMENT ... Atelectasis - FOLLOW UP ... Atelectasis - bibliography ... Atelectasis - CODES ... Atelectasis - FAQ
... READ EXCERPTS »
... Lawrence Copelovitch, MDMitchell Schwartz, MD (4th edition) Edema - BASICS Edema - description Presence of abnormal amount of fluid in the extracellular spaces of the body; usually secondary to low albumin, obstruction of venous or lymphatic... Edema - DIAGNOSIS ... Edema - TREATMENT ... Edema - FOLLOW UP ... Edema - bibliography ... Edema - CODES ... Edema - FAQ
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