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Causes of Adult respiratory distress syndrome

Contents
  1. Adult respiratory distress syndrome: Introduction
  2. List of Causes
  3. Causes Discussion
  4. Hidden causes
  5. Excerpts from book chapters
  6. Complication causes
  7. Causes of symptoms
  8. News
  9. Related cause information

List of causes of Adult respiratory distress syndrome

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Adult respiratory distress syndrome) that could possibly cause Adult respiratory distress syndrome includes:

More causes: see full list of causes for Adult respiratory distress syndrome

Causes of Adult respiratory distress syndrome (Diseases Database):

The follow list shows some of the possible medical causes of Adult respiratory distress syndrome that are listed by the Diseases Database:

Source: Diseases Database

Adult respiratory distress syndrome Causes: Book Excerpts

Adult respiratory distress syndrome as a complication of other conditions:

Other conditions that might have Adult respiratory distress syndrome as a complication may, potentially, be an underlying cause of Adult respiratory distress syndrome. Our database lists the following as having Adult respiratory distress syndrome as a complication of that condition:

Adult respiratory distress syndrome as a symptom:

Conditions listing Adult respiratory distress syndrome as a symptom may also be potential underlying causes of Adult respiratory distress syndrome. Our database lists the following as having Adult respiratory distress syndrome as a symptom of that condition:

What causes Adult respiratory distress syndrome?

Causes: Adult respiratory distress syndrome: Pulmonary edema but not from heart problems.

Medical news summaries relating to Adult respiratory distress syndrome:

The following medical news items are relevant to causes of Adult respiratory distress syndrome:

Related information on causes of Adult respiratory distress syndrome:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Adult respiratory distress syndrome may be found in:

Causes of Adult respiratory distress syndrome: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Adult respiratory distress syndrome.

Periorbital Edema: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Conjunctivitis
  • Allergy
    –Systemic (e.g., reaction to medication, urticaria/angioedema)
    –Local (e.g., insect bite)
  • Contact dermatitis/dermatitis medicamentosa
  • Chalazion
    –Zeis or Meibomian gland obstruction of eyelid
  • Orbital disease (see “Proptosis/Exophthalmos” entry)
  • Preseptal/periorbital cellulitis
  • Acute dacryocystitis (infection of the lacrimal ducts)
  • Orbital fat herniation through attenuated or dehiscent orbital septum and/or orbicularis oculi muscle (aging changes)
  • Herpes simplex/zoster
  • Blepharitis/dermatitis
  • Trauma/postsurgical (e.g., orbital fracture)
  • Dermatomyositis/polymyositis
    –Associated with a heliotropic (violet colored) rash on the upper eyelids
  • Chemical, ultraviolet, or thermal burn
  • Cardiac failure (generalized edema)
  • Renal failure
  • Nephrotic syndrome
  • Blepharitis/rosacea
  • Dacryoadenitis
  • Hypothyroidism
    –Associated with fatigue, pretibial edema, and delayed relaxation of reflexes
  • Superior vena cava syndrome
  • Sebaceous gland carcinoma
  • Squamous or basal cell carcinoma
  • Discoid lupus
  • Ocular cicatricial pemphigoid (symblepharon)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Peripheral Edema: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Venous insufficiency
    –Caused by incompetent venous valves
    –Skin characteristically has superficial varicose veins associated with a reddish-brown pretibial discoloration (“venous stasis skin changes”)
    –Swelling is typically worse after legs are held in a dependent position and is least noticeable after a night's sleep
  • Congestive heart failure
    –Associated with pitting peripheral edema
    –Other signs of heart failure include a third heart sound, cardiomegaly, and hepatomegaly
  • Cellulitis
    –Usually unilateral
    –Edematous legs are typically red, warm, and inflamed
    –The patient may exhibit signs of systemic toxicity with fever and leukocytosis
    • Deep venous thrombosis
      –Typically unilateral swelling
      –May exhibit a palpable cord representing a thrombosed vein
      –Homan's sign (pain in the calf with passive dorsiflexion of the foot)
      –Virchow's triad (hypercoagulable states, venous stasis, and vessel injury) are risk factors
    • Cirrhosis
      –Advanced liver disease results in hypoalbuminemia and poor venous return through cirrhotic liver tissue
      –Other stigmata of chronic liver disease include caput medusae, ascites, and spider angiomata
    • Nephrotic syndrome
      –Glomerular damage results in protein loss and decreased oncotic pressure
    • Less common etiologies (“zebras”) include filariasis (lymphatic infection by Wuchereria bancrofti worm), myxedema (seen in patients with severe hypothyroidism), Milroy's disease (congenital lymphedema), chronic lymphedema (e.g., lymphatic damage due to surgery, such as vein harvesting for CABG), and gout

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Periorbital Edema: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Periorbital cellulitis
    –Also described as preseptal cellulitis (infection is anterior to the orbital septum and thus does not affect the orbit or globe)
    –Usual pathogens are streptococcal species, Staphylococcus aureus, and Haemophilus influenzae
  • Orbital cellulitis
    –Also described as postseptal and affects the preseptal structures as well as the extraocular muscles and the optic nerve
    –Bacterial pathogens are the same as periorbital cellulitis and may reflect direct spread
    –May be accompanied by orbital abscess and may spread via the sinuses to the brain
  • Other infections
    –Conjunctivitis
    –Sinusitis
    –Dental abscess
  • Allergic reaction
    –Conjunctivitis
    –Urticaria/angioedema
    –Drug reaction
  • Local ocular causes
    –Insect bites
    –Contact dermatitis
    –Trauma
    –Foreign body
  • Systemic disorders with generalized edema
    –Hypoproteinemia
    –Renal disease
    –Congestive heart failure
  • Malignancy
    –Neuroblastomas: Associated with ecchymoses, “raccoon eyes,” and proptosis
    –Leukemia: Associated with fever, fatigue, anemia, bone pain, lymphadenopathy, splenomegaly

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Edema: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

    • Kidney disease (nephrotic syndrome)
      –Insidious onset, periorbital and lower extremity edema, abdominal distension
      –Various types include minimal change disease (MCNS), focal segmental glomerulosclerosis, acute and chronic glomerulonephritis
  • Chronic renal failure from any cause may result in impaired fluid excretion
  • Liver disease from any cause resulting in impaired production of albumin
  • Congestive heart failure (CHF)
    • Protein losing enteropathy
      –Menetrier disease (typically CMV), inflammatory bowel disease, neuroblastoma, intestinal lymphangiectasia, trypsinogen deficiency
  • Celiac disease
  • Sepsis, with capillary leak (movement of fluid out of the blood vessels into the interstitium)
  • Hereditary angioneurotic edema
    –Intermittent swelling of extremities
    –Often preceded by trauma
    –Decreased C4 and C1 esterase inhibitor
  • Rocky Mountain spotted fever
  • Stevens-Johnson syndrome
  • Vitamin E deficiency
  • Hypothyroidism
  • Severe malnutrition
    –Marasmus (calorie deficiency)
    –Kwashiorkor (protein deficiency)
  • Zinc deficiency
  • Hydrops fetalis
  • Impaired lymphatic drainage
    –Milroy disease
    –Meigs syndrome
    –Yellow nail syndrome
    –Lymphedema praecox
  • Filariasis (nematode infection resulting in elephantiasis)
  • Immobility including placement of body casts and paralysis

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Accessory muscle use: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Acute respiratory distress syndrome (ARDS). In ARDS, a life-threatening disorder, accessory muscle use increases in response to hypoxia. It’s accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.

❑ Airway obstruction. Acute upper airway obstruction can be life-threatening — fortunately, most obstructions are subacute or chronic. Typically, this disorder increases accessory muscle use. Its most telling sign, however, is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.

❑ Amyotrophic lateral sclerosis. Typically, this progressive motor neuron disorder affects the diaphragm more than the accessory muscles. As a result, increased accessory muscle use is characteristic. Other signs and symptoms include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski’s reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech, difficulty chewing or swallowing and breathing, urinary frequency and urgency and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient’s mental status remains intact, his poor prognosis may cause periodic depression.

❑ Asthma. During acute asthma attacks, the patient usually displays increased accessory muscle use. Accompanying it are severe dyspnea, tachypnea, wheezing, a productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.

❑ Chronic bronchitis. With chronic bronchitis, a form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Cyanosis and weight gain from edema account for the characteristic label of “blue bloater.” A low-grade fever may occur with secondary infection.

❑ Emphysema. Increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough in this form of COPD. Sometimes called a pink puffer, the patient will display pursed-lip breathing and tachypnea. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.

❑ Pneumonia. Bacterial pneumonia usually produces increasedaccessory muscle use. Initially, this infection produces a sudden high fever with chills. Its associated signs and symptoms include chest pain, a productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.

❑ Pulmonary edema. With acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.

❑ Pulmonary embolism. Although signs and symptoms vary with the size, number, and location of the emboli, pulmonary embolism is a life-threatening disorder that may cause increased accessory muscle use. Typically, it produces dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, a productive cough, a low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.

❑ Spinal cord injury. Increased accessory muscle use may occur, depending on the location and severity of the injury. An injury below Ll typically doesn’t affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.

Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski’s reflex, hyperactive deep tendon reflexes, spasticity, and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner’s syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur with lower cervical cord injury.

❑ Thoracic injury. Increased accessory muscle use may occur, depending on the type and extent of injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.

Other causes

❑ Diagnostic tests and treatments. Pulmonary function tests (PFTs), incentive spirometry, and intermittent positive-pressure breathing can increase accessory muscle use.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Edema of the leg: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Burns

Two days or less after injury, leg burns may cause mild to severe edema, pain, and tissue damage.

Cellulitis

Pitting edema and orange peel skin are caused by a streptococcal or staphylococcal infection that most commonly occurs in the lower extremities. Cellulitis is also associated with erythema, warmth, and tenderness in the infected area.

Envenomation

Mild to severe localized edema may develop suddenly at the site of a bite or sting, along with erythema, pain, urticaria, pruritus, and a burning sensation.

Heart failure

Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, a ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.

Leg trauma

Mild to severe localized edema may form around the trauma site.

Osteomyelitis

When osteomyelitis — a bone infection — affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows a fever, localized tenderness, and pain that increases with leg movement.

Thrombophlebitis

Deep and superficial vein thrombosis may cause unilateral mild to moderate edema. Deep vein thrombophlebitis may be asymptomatic or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as a fever, chills, and malaise. Superficial thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.

Venous insufficiency (chronic)

Moderate to severe, unilateral or bilateral leg edema occurs in patients with venous insufficiency. Initially, the edema is soft and pitting; later, it becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle. Venous insufficiency generally occurs in females.

Other causes

Diagnostic tests

Venography is a rare cause of leg edema.

Coronary artery bypass surgery

Unilateral venous insufficiency may follow saphenous vein retrieval.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Edema, generalized: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Angioneurotic edema or angioedema

Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera — may be the result of a food or drug allergy or emotional stress or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.

Burns

Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.

Heart failure

Severe, generalized pitting edema — occasionally ana-
sarca — may follow leg edema late in this disorder. The edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, a slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema typify right-sided heart failure.

Malnutrition

Anasarca in malnutrition may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.

Myxedema

With myxedema, which is a severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.

Nephrotic syndrome

Although nephroticsyndrome is characterized by generalized pitting edema, it's initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.

Pericardial effusion

With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, a nonproductive cough, a pericardial friction rub, jugular vein distention, dysphagia, and a fever.

Pericarditis (chronic constructive)

Resembling right-sided heart failure, pericarditisusually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul's sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.

Renal failure

With acute renal failure, generalized pitting edema occurs as a late sign. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.

Other causes

Drugs

Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as phenylbutazone, ibuprofen, and naproxen.

Treatments

I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Edema of the arm: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Angioneurotic edema

Angioneurotic edema is a common reaction that's characterized by the sudden onset of painless, nonpruritic edema affecting the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although swelling usually doesn't itch, it may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur

Arm trauma

Shortly after a crush injury, severe edema may affect the entire arm. Ecchymoses or superficial bleeding, pain or numbness, and paralysis may occur.

Burns

Twodays or less after injury, arm burns may cause mild to severe edema, pain, and tissue damage.

Envenomation

Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, a fever, chills, hypotension, a headache and, in severe cases, dyspnea, seizures, and paralysis.

Superior vena cava syndrome

Bilateral arm edema usually progresses slowly and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of a headache, vertigo, and vision disturbances.

Thrombophlebitis

Thrombophlebitis, which can result from peripherally inserted central catheters and arm portocaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, a fever, chills, and malaise; superficial thrombophlebitis alsocauses redness, tenderness, and induration along the vein.

Other causes

Treatments

Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Infant respiratory distress syndrome: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Although airways and alveoli of a neonate’s respiratory system are present by 27 weeks’ gestation, the intercostal muscles are weak and the alveolar capillary system is immature. The premature neonate with IRDS develops widespread alveolar collapse due to a lack of surfactant, a lipoprotein pres-ent in alveoli and respiratory bronchioles. Surfactant lowers surface tension and helps prevent alveolar collapse. This surfactant deficiency results in widespread atelectasis, which leads to inadequate alveolar ventilation with shunting of blood through collapsed areas of lung, causing hypoxemia and acidosis.

IRDS occurs almost exclusively in neonates born before 37 weeks’ gestation (in 60% of those born before the 28th week). The incidence is greatest in the 1,000 to 1,500 g birthweight group. Infants of diabetic mothers, those born by cesarean delivery, second-born twins, infants with perinatal asphyxia, and those delivered suddenly after antepartum hemorrhage are more commonly afflicted.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Lung cancer: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Most experts agree that lung cancer is attributable to inhalation of carcinogenic pollutants by a susceptible host. Who's most susceptible? Any smoker older than age 40, especially if he began to smoke before age 15, has smoked a whole pack or more per day for 20 years, or works with or near asbestos.

Pollutants in tobacco smoke cause progressive lung cell degeneration. Lung cancer is 10 times more common in smokers than in nonsmokers; 80% of patients with lung cancer are smokers. Cancer risk is determined by the number of cigarettes smoked daily, the depth of inhalation, how early in life smoking began, and the nicotine content of cigarettes. Two other factors also increase susceptibility: exposure to carcinogenic industrial and air pollutants (asbestos, uranium, arsenic, nickel, iron oxides, chromium, radioactive dust, and coal dust) and familial susceptibility.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Toxic shock syndrome: Causes
(Professional Guide to Diseases (Eighth Edition))

Theoretically, tampons may contribute to development of TSS by introducing S. aureus into the vagina during insertion (insertion with fingers instead of the supplied applicator increases the risk) or traumatizing the vaginal mucosa during insertion, thus leading to infection.

When TSS isn’t related to menstruation, it appears to be linked to S. aureus infections, such as abscesses, osteomyelitis, and postsurgical infections. It's also associated with prior antibiotic use.

Risk factors include recent use of barrier contraceptives (diaphragms or vaginal sponges), childbirth, and surgery.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Hypovolemic shock: Causes
(Professional Guide to Diseases (Eighth Edition))

Hypovolemic shock usually results from acute blood loss — about one-fifth of total volume. Such massive blood loss may result from GI bleeding, internal hemorrhage (hemothorax and hemoperitoneum), external hemorrhage (accidental or surgical trauma), or from any condition that reduces circulating intravascular plasma volume or other body fluids such as in severe burns. Other underlying causes of hypovolemic shock include intestinal obstruction, peritonitis, acute pancreatitis, ascites and dehydration from excessive perspiration, severe diarrhea or protracted vomiting, diabetes insipidus, diuresis, or inadequate fluid intake.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pulmonary edema: Causes
(Professional Guide to Diseases (Eighth Edition))

Pulmonary edema usually results from left-sided heart failure due to arteriosclerotic, hypertensive, cardiomyopathic, or valvular cardiac disease. In such disorders, the compromised left ventricle in unable to maintain adequate cardiac output; increased pressures are transmitted to the left atrium, pulmonary veins, and pulmonary capillary bed. This increased pulmonary capillary hydrostatic force promotes transudation of intravascular fluids into the pulmonary interstitium, decreasing lung compliance and interfering with gas exchange. Other factors that may predispose the patient to pulmonary edema include:

❑ excessive infusion of I.V. fluids

❑ decreased serum colloid osmotic pressure as a result of nephrosis, protein-losing enteropathy, extensive burns, hepatic disease, or nutritional deficiency

❑ impaired lung lymphatic drainage from Hodgkin’s disease or obliterative lymphangitis after radiation

❑ mitral stenosis, which impairs left atrial emptying

❑ pulmonary veno-occlusive disease.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Atelectasis: Causes
(Professional Guide to Diseases (Eighth Edition))

Atelectasis commonly results from bronchial occlusion by mucus plugs. It’s a problem in many patients with chronic obstructive pulmonary disease, bronchiectasis, or cystic fibrosis and in those who smoke heavily. (Smoking increases mucus production and damages cilia.) Atelectasis may also result from occlusion by foreign bodies, bronchogenic carcinoma, and inflammatory lung disease.

Other causes include respiratory distress syndrome of the neonate (hyaline membrane disease), oxygen toxicity, and pulmonary edema, in which alveolar surfactant changes increase surface tension and permit complete alveolar deflation.

External compression, which inhibits full lung expansion, or any condition that makes deep breathing painful, may also cause atelectasis. Such compression or pain may result from abdominal surgical incisions, rib fractures, pleuritic chest pain, tight dressings around the chest, stab wounds, impalement accidents, car accidents in which the driver slams into the steering column, or obesity (which elevates the diaphragm and reduces tidal volume).

Prolonged immobility may also cause atelectasis by producing preferential ventilation of one area of the lung over another. Mechanical ventilation using constant small tidal volumes without intermittent deep breaths may also result in atelectasis. Central nervous system depression (as in drug overdose) eliminates periodic sighing and is a predisposing factor of progressive atelectasis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Accessory muscle use: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acute respiratory distress syndrome (ARDS)

In ARDS—a life-threatening disorder—accessory muscle use increases in response to hypoxia. It’s accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.

Airway obstruction

An acute upper airway obstruction can be life-threatening; fortunately, most obstructions are subacute or chronic. Typically, this disorder increases accessory muscle use. Its most telling sign, however, is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.

Amyotrophic lateral sclerosis (ALS)

Because ALS affects the diaphragm more than the accessory muscles, increased accessory muscle use is characteristic of this disorder. Other signs and symptoms include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski’s reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech; difficulty chewing or swallowing and breathing; urinary frequency and urgency; and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient’s mental status remains intact, his poor prognosis may cause periodic depression.

Asthma

During acute asthma attacks, the patient usually displays increased accessory muscle use accompanied by severe dyspnea, tachypnea, wheezing, productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.

Chronic bronchitis

In this form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Patients with chronic bronchitis are sometimes called “blue bloaters” because of the cyanosis and weight gain from edema that commonly occur. Low-grade fever may occur with secondary infection.

Diffuse infiltrative (or fibrotic) lung disease

In diffuse infiltrative lung disease, progressive pulmonary degeneration eventually increases accessory muscle use. Typically, though, the patient reports progressive dyspnea on exertion as his chief complaint. He may also have a cough, anorexia, weakness, fatigue, vague chest pain, tachypnea, and crackles at the base of the lungs.

Emphysema

Increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough in this form of COPD. These patients are sometimes called “pink puffers” because of their characteristic pursed-lip breathing, tachypnea, and a pink or red complexion. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.

Pneumonia

Bacterial pneumonia initially produces sudden high fever with chills. Associated signs and symptoms include increased accessory muscle use, chest pain, productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.

Pulmonary edema

In acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.

Pulmonary embolism

Although signs and symptoms vary with the size, number, and location of the emboli, this life-threatening disorder may cause increased accessory muscle use. Common findings include dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, productive cough, low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.

Spinal cord injury

An injury below Ll typically doesn’t affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.

Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski’s reflex; hyperactive deep tendon reflexes; spasticity; and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner’s syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur in lower cervical cord injury.

Thoracic injury

Increased accessory muscle use may occur, depending on the type and extent of the injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.

Other causes

Diagnostic tests and treatments

Pulmonary function tests, incentive spirometry, and intermittent positive-pressure breathing can increase accessory muscle use.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Respirations, grunting: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Asthma

Grunting respirations may be apparent during a severe asthma attack, usually triggered by a upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, audible wheezing, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor. Immediate bronchodilator therapy is needed.

Heart failure

A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.

Pneumonia

Life-threatening bacterial pneumonia is common after an upper respiratory tract infection or cold. Pneumocystis carinii pneumonia commonly affects children infected with human immunodeficiency virus. It causes grunting respirations accompanied by high fever, tachypnea, a productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, the patient may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention.

Respiratory distress syndrome

The result of lung immaturity in a premature infant (less than 37 weeks’ gestation) usually of low birth weight, this syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions; tachycardia; and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Edema of the leg: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Burns

Mild to severe edema, pain, and tissue damage may occur up to 2 days after a leg burn.

Cellulitis

Caused by a streptococcal or staphylococcal infection that usually affects the legs, cellulitis produces pitting edema and orange peel skin along with erythema, warmth, and tenderness in the infected area.

Cirrhosis

Cirrhosis commonly causes bilateral edema, which is associated with ascites, jaundice, and abdominal swelling.

Heart failure

Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, a ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.

Hypoproteinemia

Malnourished patients may develop bilateral leg edema secondary to decreased protein and osmotic pressures.

Leg trauma

Mild to severe localized edema may form around the trauma site.

Nephrotic syndrome

Nephrotic syndrome is commonly seen in children and results in bilateral leg edema. It’s associated with polyuria and eyelid swelling.

Osteomyelitis

When this bone infection affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows fever, localized tenderness, and pain that increases with leg movement.

Phlegmasia cerulea dolens

Severe unilateral leg edema and cyanosis may spread to the abdomen and flank in this rare form of venous thrombosis. Other signs and symptoms include pain, cold skin, absent pulse in the affected leg, and signs of shock, such as hypotension and tachycardia.

Rupture of the gastrocnemius muscle

Ruptured gastrocnemius muscle can cause leg edema and often occurs in runners. Pain is usually sudden, and ecchymosis is evident on the ankles.

Rupture of a popliteal (Baker’s) cyst

A ruptured popliteal cyst can cause sudden onset of unilateral calf pain and edema, usually after walking or exercising. This type of cyst is common in patients with arthritis. It can compress vascular structures and cause severe edema and thrombophlebitis.

Thrombophlebitis

Both deep and superficial vein thrombosis may cause unilateral mild to moderate edema. Deep vein thrombophlebitis may be asymptomatic or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as fever, chills, and malaise. Superficial vein thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.

Venous insufficiency (chronic)

Moderate to severe unilateral or bilateral leg edema occurs in patients with this disorder, which generally affects females. Initially soft and pitting, the edema later becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle.

Other causes

Coronary artery bypass surgery

Unilateral venous insufficiency may follow saphenous vein retrieval. Edema often occurs in the affected leg or ankle and usually resolves after 6 to 8 weeks.

Diagnostic tests

Venography is a rare cause of leg edema.

Drugs

Estrogen, hormonal contraceptives, lithium, nonsteroidal anti-inflammatory drugs, vasodilators, and drugs that cause sodium retention can cause bilateral leg edema.

Envenomation

Mild to severe localized edema may develop suddenly at the site of a bite or sting along with erythema, pain, urticaria, pruritus, and a burning sensation.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Edema, generalized: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Angioneurotic edema or angioedema

Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes—especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera—may be the result of a food or drug allergy or emotional stress, or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.

Burns

Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.

Cirrhosis

A late sign of chronic cirrhosis, edema usually starts in the legs and thighs and may progress to anasarca. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, pruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.

Heart failure

Severe, generalized pitting edema—occasionally anasarca—may follow leg edema late in heart failure. The edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify left-sided heart failure; jugular vein distention, hepatomegaly, and peripheral edema typify right-sided heart failure.

Malnutrition

Anasarca in this disorder may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.

Myxedema

In this severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.

Nephrotic syndrome

Although nephrotic syndrome is characterized by generalized pitting edema, the edema is initially localized around the eyes. Anasarca develops in severe cases, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.

Pericardial effusion

In pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, a nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever.

Pericarditis (chronic constructive)

Like right-sided heart failure, this disorder usually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul’s sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.

Protein-losing enteropathy

Increased albumin levels lead to progressive generalized pitting edema in this disorder. The patient may also have a mild fever and abdominal pain with bloody diarrhea and steatorrhea.

Renal failure

Generalized pitting edema is a late sign of acute renal failure. In chronic failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.

Septic shock

A late sign of this life-threatening disorder, generalized edema typically develops rapidly. The edema is pitting and moderately severe. Accompanying it may be cool skin, hypotension, oliguria, tachycardia, cyanosis, thirst, anxiety, and signs of respiratory failure.

Other causes

Drugs

Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.

Treatments

I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Edema of the arm: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Angioneurotic edema

Angioneurotic edema is a common reaction that’s characterized by sudden onset of painless, nonpruritic edema in the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although these swellings usually don’t itch, they may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.

Arm trauma

Shortly after a crush injury, severe edema may affect the entire arm. It may be accompanied by ecchymoses or superficial bleeding, pain or numbness, and paralysis.

Burns

Mild to severe edema, pain, and tissue damage may occur up to 2 days after an arm burn.

Superior vena cava syndrome

Bilateral arm edema usually progresses slowly in this disorder and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of headache, vertigo, and vision disturbances.

Thrombophlebitis

Thrombophlebitis, which can result from peripherally inserted central catheters or arm portacaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, fever, chills, and malaise; superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.

Other causes

Envenomation

Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache and, in severe cases, dyspnea, seizures, and paralysis.

Treatments

Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Edema of the face: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Abscess, periodontal

This type of abscess, which usually results from poor oral hygiene, is commonly caused by anaerobic organisms. It can cause edema of the side of the face, pain, warmth, erythema, and a purulent discharge around the affected tooth.

Abscess, peritonsillar

This complication of tonsillitis may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.

Allergic reaction

Facial edema may characterize both a local allergic reaction and anaphylaxis. A local reaction produces facial edema, erythema, and urticaria. In life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur.

Cavernous sinus thrombosis

Cavernous sinus thrombosis is a rare but serious disorder that may begin with unilateral edema that quickly progresses to bilateral edema of the forehead, base of the nose, and eyelids. It may also produce chills, fever, headache, nausea, lethargy, exophthalmos, and eye pain.

Chalazion

A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.

Conjunctivitis

Conjunctivitis is an inflammation that causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.

Corneal ulcers, fungal

Accompanying red, edematous eyelids in this disorder are conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious amounts of a purulent eye discharge make the eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.

Dacryoadenitis

Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, a purulent discharge, and temporal pain.

Dacryocystitis

Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. In acute cases, pain and tenderness near the tear sac accompany a purulent discharge.

Dermatomyositis

Periorbital edema and a heliotropic rash develop gradually in this rare disease. An itchy, lilac-colored rash appears on the bridge of the nose, cheeks, and forehead. Localized or diffuse erythema, eye pain, and fever may also occur.

Facial burns

Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress such as inspiratory stridor.

Facial trauma

The extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated features also depend on the type of injury.

Frontal sinus cancer

This rare form of cancer causes cheek edema on the affected side, reddened skin over the sinus, unilateral nasal bleeding or discharge, and exophthalmos. Pain over the forehead and unilateral hypoesthesia or anesthesia may occur later.

Herpes zoster ophthalmicus (shingles)

In herpes zoster ophthalmicus, edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt.

Hordeolum (stye)

Typically, a hordeolum produces localized eyelid edema, erythema, and pain.

Malnutrition

Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and decreased pulse and respiratory rates.

Melkersson’s syndrome

Facial edema (especially of the lips), facial paralysis, and folds in the tongue are the three characteristic signs of this rare disorder.

Myxedema

Myxedema eventually causes generalized facial edema, waxy dry skin, hair loss or coarsening, and other signs of hypothyroidism.

Nephrotic syndrome

Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.

Orbital cellulitis

Sudden onset of periorbital edema marks this inflammatory disorder. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.

Osteomyelitis

When osteomyelitis affects the frontal bone, it may cause forehead edema as well as fever, chills, headache, and cool, pallid skin.

Preeclampsia

Edema of the face, hands, and ankles is an early sign of this disorder of pregnancy. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.

Rhinitis, allergic

In allergic rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.

Sinusitis

Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, a purulent nasal discharge, and red, swollen nasal mucosa.

Superior vena cava syndrome

Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.

Trachoma

In trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.

Trichinosis

This relatively rare infectious disorder causes sudden onset of eyelid edema with fever (102° F to l04° F [38.9° C to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.

Other causes

Diagnostic tests

An allergic reaction to contrast media used in radiologic tests may produce facial edema.

Drugs

Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect.

Herb Alert

Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles. Feverfew and chrysanthemum parthenium can cause swelling of the lips, irritation of the tongue, and mouth ulcers. Licorice may cause facial edema and water retention or bloating, especially if used before menses.

Surgery and transfusion

Facial edema may result from cranial, nasal, or jaw surgery or from a blood transfusion that causes an allergic reaction.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Salivation, increased [Polysialia, ptyalism]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Bell’s palsy

Paralysis of the facial nerve causes an inability to control salivation or close the eye on the affected side.

Pregnancy

In the early months of pregnancy, many women experience increased salivation, nausea, and breast tenderness.

Stomatitis

Mucosal ulcers may be accompanied by moderately increased salivation, mouth pain, fever, and erythema. Spontaneous healing usually occurs in 7 to 10 days, but scarring and recurrence are possible.

Syphilis

With secondary syphilis, mucosal ulcers cause increased salivation that may persist up to a year. Related findings include fever, malaise, headache, anorexia, weight loss, nausea, vomiting, sore throat, and generalized lymphadenopathy. A bilaterally symmetrical rash appears on the arms, trunk, palms, soles, face, and scalp. Condylomata develop in the genital and perianal areas.

Tuberculosis

Certain forms of tuberculosis may produce solitary, irregularly shaped mouth or tongue ulcers, covered with exudate, that cause increased salivation. Other findings include weight loss, anorexia, fever, fatigue, malaise, dyspnea, cough, night sweats (a common sign), and hemoptysis.

Other causes

Arsenic poisoning

Common effects of arsenic poisoning are diarrhea, diffuse skin hyperpigmentation, and edema of the eyelids, face, and ankles; increased salivation occurs infrequently. The patient may also exhibit garlicky breath odor, pruritus, alopecia, irritated mucous membranes, headache, drowsiness, and confusion. He may also develop muscle aching, weakness, seizures, and paresthesia in a stocking-glove distribution pattern.

Drugs

Increased salivation may occur with iodide toxicity, but the earliest symptoms are a brassy taste and a burning sensation in the mouth and throat. Associated findings include sneezing, irritated eyelids, and (commonly) pain in the frontal sinus.

Pilocarpine and other miotics used to treat glaucoma may be absorbed systemically, increasing salivation. Cholinergics, such as bethanechol, may also cause this symptom.

Mercury poisoning

Stomatitis, characterized by increased salivation and a metallic taste, commonly occurs in those with mercury poisoning. The patient’s teeth may be loose and his gums are painful, swollen, and prone to bleeding. A blue line appears on the gingivae. The patient may also experience personality changes, memory loss, abdominal cramps, diarrhea, paresthesia, and tremors of the eyelids, lips, tongue, and fingers.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Tearing, increased [Epiphora]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Blepharophimosis

Increased tearing and exposure keratitis—corneal inflammation with incomplete lid closure—are common signs of this disorder. Examination also reveals ectropion; a small, expressionless face with deep-set eyes and pursed lips; and a high-arched palate.

Conjunctival foreign body or abrasion

Increased tearing may accompany localized conjunctival injection, severe eye pain, and photophobia. A foreign-body sensation may be present.

Conjunctivitis

Typically, increased tearing is accompanied by conjunctival injection and itching in this disorder. Allergic conjunctivitis also causes a stringy discharge. Bacterial conjunctivitis also causes a copious purulent discharge, burning, a foreign-body sensation and, possibly, eye pain if the cornea is involved. Associated signs of fungal conjunctivitis include lid edema, burning, and a copious thick, purulent discharge that may form sticky crusts on the lids. The patient complains of photophobia and pain if the cornea is involved. Highly contagious viral conjunctivitis also causes a foreign-body sensation, slight exudate, and lid edema.

Corneal abrasion

Marked by severe corneal pain that’s aggravated by blinking, this injury also causes increased tearing. Associated features are a foreign-body sensation, blurred vision, conjunctival injection, and photophobia, which makes opening the lids difficult.

Corneal foreign body

When a foreign body lodges in the cornea, the patient experiences increased tearing, blurred vision, a foreign-body sensation, photophobia, eye pain, miosis, and conjunctival injection. A dark speck may also be visible in the cornea.

Corneal ulcer

In this vision-threatening disorder, increased tearing is accompanied by severe photophobia and eye pain. Typically, the disorder begins with pain that’s aggravated by blinking. Ulcers also cause blurred vision, conjunctival injection, and a white opaque cornea. Bacterial ulcers also produce a copious purulent discharge that may form sticky crusts on the lids.

Dacryocystitis

Increased tearing and a purulent discharge are the chief complaints in this disorder, which usually affects only one eye. Associated signs and symptoms include pain and tenderness around the tear sac with marked eyelid edema and redness near the lacrimal punctum. Pressure on the tear sac expresses a thick, purulent discharge or, in chronic cases, a mucoid discharge.

Dry eye syndrome

Excessive dryness of the cornea and conjunctiva can cause reflex stimulation of the lacrimal gland and excess tearing.

Episcleritis

Commonly unilateral, this disorder causes increased tearing, photophobia, and—if the sclera is inflamed—eye pain and tenderness on palpation. Inspection reveals conjunctival injection and edema, a purplish pink sclera, and episcleral edema.

Eyelid contractions

In this disorder, increased tearing usually results from stricture of the canaliculi. Because eyelid contractions are caused by burns or chemical or mechanical trauma, eyelid scars are also commonly visible.

Herpes zoster

Increased tearing usually occurs when herpes zoster affects the trigeminal nerve. It’s accompanied by severe unilateral facial and eye pain that’s followed in several days by the eruption of vesicles. The patient’s eyelids are red and swollen with scanty serous discharge. Other common findings include a white, cloudy cornea and conjunctival injection.

Psoriasis vulgaris

When these psoriatic lesions affect the eyelids and extend into the conjunctivae, they may cause irritation, increased tearing, and a foreign-body sensation. The lesions are typically preceded by signs of chronic conjunctivitis, such as a copious mucoid discharge and conjunctival injection.

Punctum misplacement

Increased tearing is characteristic when ectropion involves the punctum, causing misplacement. It may be accompanied by exposure keratitis.

Raeder’s syndrome

This syndrome is characterized by periodic attacks of unilateral paroxysmal neuralgic pain in the face lasting 5 minutes or longer. The patient may exhibit increased tearing, ptosis, diplopia, enophthalmos, abnormal pupillary response, ipsilateral headache, and anhidrosis of the face and neck.

Scleritis

This rare chronic disorder causes increased tearing, photophobia, and severe eye pain with tenderness on palpation. Examination reveals conjunctival injection and a bluish purple sclera.

Thyrotoxicosis

This disorder may cause increased tearing, usually in both eyes. Other ocular effects include ptosis, lid edema, photophobia, a foreign-body sensation, conjunctival injection, chemosis, diplopia and, at times, exophthalmos. Common associated features are heat intolerance, weight loss despite increased appetite, nervousness, diaphoresis, diarrhea, tremors, tachycardia, palpitations, and an enlarged thyroid gland.

Trachoma

An early sign of trachoma, increased tearing is accompanied by visible conjunctival follicles, red and edematous eyelids, pain, photophobia, and exudation. If the infection is untreated, conjunctival follicles enlarge into inflamed papillae that later become yellow or gray and small blood vessels invade the cornea under the upper lid.

Other causes

Cholinergics

Miotics, such as pilocarpine, may increase tearing.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Edema: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Congestive heart failure

❑ Venous insufficiency

❑ Hypoalbuminemia

❑ Drugs

❑ Cirrhosis

❑ Deep vein thrombosis

❑ Inferior vena cava obstruction

❑ Lymphatic obstruction

❑ Glomerular injury

❑ Idiopathic edema

❑ Myxedema

❑ Lipedema

❑ Toxemia

❑ Cyclical edema

❑ Refeeding

❑ Filariasis

❑ Milroy

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Source: Field Guide to Bedside Diagnosis, 2007

Shock: Differential Overview
(Field Guide to Bedside Diagnosis)

Cardiogenic

❑ Anterior myocardial infarction

❑ Arrhythmia

❑ Dilated cardiomyopathy

❑ Aortic stenosis

❑ Acute mitral regurgitation

Obstructive

❑ Massive pulmonary embolism

❑ Pericardial tamponade

❑ Constrictive pericarditis

❑ Tension pneumothorax

Hypovolemic

❑ Hemorrhage

❑ Fluid depletion

Distributive

❑ Sepsis

❑ Anaphylaxis

❑ Adrenal insufficiency

❑ Neurogenic

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Source: Field Guide to Bedside Diagnosis, 2007

Respiratory distress syndrome: Causes
(Handbook of Diseases)

Although the airways and alveoli of a neonate’s respiratory system are present by the 27th week of gestation, the intercostal muscles are weak and the alveoli and capillary blood supply are immature. In respiratory distress syndrome, the premature neonate develops widespread alveolar collapse because of lack of surfactant, a lipoprotein present in alveoli and respiratory bronchioles.

Surfactant normally lowers surface tension and aids in maintaining alveolar patency, preventing collapse, particularly at end expiration. But a deficiency results in widespread atelectasis, which leads to inadequate alveolar ventilation with shunting of blood through collapsed areas of lung, causing hypoxia and acidosis.

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Source: Handbook of Diseases, 2003

Lung abscess: Causes
(Handbook of Diseases)

A lung abscess is a manifestation of necrotizing pneumonia, commonly the result of aspiration of oropharyngeal contents. Poor oral hygiene with dental or gingival (gum) disease is strongly associated with a putrid lung abscess. Septic pulmonary emboli commonly produce cavitary lesions. Infected cystic lung lesions and cavitating bronchial carcinoma must be distinguished from lung abscesses.

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Source: Handbook of Diseases, 2003

Lung cancer: Causes
(Handbook of Diseases)

Most experts agree that lung cancer is attributable to inhalation of carcinogenic pollutants by a susceptible host. Most susceptible are those persons who smoke or who work with or near asbestos.

Pollutants in tobacco smoke cause progressive lung cell degeneration. Lung cancer is 10 times more common in smokers than in nonsmokers; indeed, 80% of lung cancer patients are or were smokers.

Cancer risk is determined by the number of cigarettes smoked daily, the depth of inhalation, how early in life smoking began, and the nicotine content of the cigarettes. Two other factors also increase susceptibility: exposure to carcinogenic industrial and air pollutants (asbestos, uranium, arsenic, nickel, iron oxides, chromium, radioactive dust, and coal dust), and familial susceptibility.

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Source: Handbook of Diseases, 2003

Toxic shock syndrome: Causes
(Handbook of Diseases)

Although tampons are clearly implicated in TSS, their exact role is uncertain. Theoretically, tampons may contribute to development of TSS by:

❑ introducing S. aureus into the vagina during insertion

❑ absorbing toxin from the vagina

❑ traumatizing the vaginal mucosa during insertion, thus leading to infection

❑ providing a favorable environment for the growth of S. aureus.

When TSS isn’t related to menstruation, it seems to be linked to S. aureus infections, such as abscesses, osteomyelitis, and postsurgical infections.

gender influence  Menstruating women who use tampons and women using barrier contraceptive devices, such as dia-phragms and sponges, are at risk for developing TSS. Women who have recently experienced childbirth are also at risk, as are individuals who have recently had surgery.

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Source: Handbook of Diseases, 2003

Hypovolemic shock: Causes
(Handbook of Diseases)

Hypovolemic shock usually results from acute blood loss — about one-fifth of the total volume. Such massive blood loss may result from GI bleeding, internal hemorrhage (hemothorax and hemoperitoneum), or external hemorrhage (accidental or surgical trauma) or from any condition that reduces circulating intravascular plasma volume or other body fluids such as in severe burns. Other underlying causes of hypovolemic shock include intestinal obstruction, peritonitis, acute pancreatitis, ascites and dehydration from excessive perspiration, severe diarrhea or protracted vomiting, diabetes insipidus, diuresis, and inadequate fluid intake.

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Source: Handbook of Diseases, 2003

Pulmonary edema: Causes
(Handbook of Diseases)

Pulmonary edema usually results from left-sided heart failure due to arteriosclerotic, hypertensive, cardiomyopathic, or valvular heart disease. In such disorders, the compromised left ventricle requires increased filling pressures to maintain adequate output; these pressures are transmitted to the left atrium, pulmonary veins, and pulmonary capillary bed.

This increased pulmonary capillary hydrostatic force promotes transudation of intravascular fluids into the pulmonary interstitium, decreasing lung compliance and interfering with gas exchange. Other factors that may predispose a person to pulmonary edema include:

❑ infusion of excessive volumes of I.V. fluids

❑ decreased serum colloid osmotic pressure as a result of nephrosis, extensive burns, hepatic disease, or nutritional deficiency

❑ impaired lung lymphatic drainage from Hodgkin’s disease or obliterative lymphangitis after radiation

❑ mitral stenosis and left atrial myxoma, which impair left atrial emptying

❑ pulmonary veno-occlusive disease.

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Source: Handbook of Diseases, 2003

Acuterespiratory distress syndrome: Causes
(Handbook of Diseases)

ARDS can result from any one of several respiratory and nonrespiratory causes:

  • aspiration of gastric contents
  • sepsis (primarily gram-negative), trauma (lung contusion, head injury, long bone fracture with fat emboli), or oxygen toxicity
  • viral, bacterial, or fungal pneumonia or microemboli (fat or air emboli or disseminated intravascular coagulation)
  • drug overdose (barbiturates, glutethimide, narcotics) or blood transfusion
  • smoke or chemical inhalation (nitrous oxide, chlorine, ammonia)
  • pancreatitis, hypertransfusion, cardiopulmonary bypass
  • near drowning.

    Altered permeability of the alveolocapillary membranes causes fluid to accumulate in the interstitial space. If the pulmonary lymphatics can’t remove this fluid, interstitial edema develops. The fluid collects in the peribronchial and peribronchiolar spaces, producing bronchiolar narrowing.

    Hypoxemia occurs as a result of fluid accumulation in alveoli and subsequent alveolar collapse, causing the shunting of blood through nonventilated lung regions. In addition, regional differences in compliance and airway narrowing cause regions of low ventilation and inadequate perfusion, which also contribute to hypoxemia.

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    Source: Handbook of Diseases, 2003

    Atelectasis: Causes
    (Handbook of Diseases)

    Atelectasis commonly results from bronchial occlusion by mucus plugs and is frequently a problem in patients with chronic obstructive pulmonary disease, bronchiectasis, or cystic fibrosis and in those who smoke heavily. (Smoking increases mucus production and damages cilia.) Atelectasis may also result from occlusion by foreign bodies, bronchogenic carcinoma, and inflammatory lung disease.

    Other causes include respiratory distress syndrome of the neonate (hyaline membrane disease), oxygen toxicity, and pulmonary edema, in which alveolar surfactant changes increase surface tension and permit complete alveolar deflation.

    External compression, which inhibits full lung expansion, or any condition that makes deep breathing painful may also cause atelectasis. Such compression or pain may result from upper abdominal surgical incisions, rib fractures, pleuritic chest pain, tight dressings around the chest, or obesity (which elevates the diaphragm and reduces tidal volume).

    Atelectasis may also result from prolonged immobility, which causes preferential ventilation of one area of the lung over another, or mechanical ventilation using constant small tidal volumes without intermittent deep breaths.

    Central nervous system depression (as in drug overdose) eliminates periodic sighing and is a predisposing factor of progressive atelectasis.

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    Source: Handbook of Diseases, 2003

    Cardiogenic shock: Causes
    (Handbook of Diseases)

    Cardiogenic shock can result from any condition that causes significant left ventricular dysfunction with reduced cardiac output, such as an MI (most common), myocardial ischemia, papillary muscle dysfunction, end-stage cardiomyopathy and other cardiomyopathies (viral, toxic), cardiac arrest, ventricular arrhythmias (fibrillation, tachycardia), cardial amyloidosis, and myocardial degeneration.

    Compensatory mechanisms

    Regardless of the underlying cause, left ventricular dysfunction sets into motion a series of compensatory mechanisms that attempt to increase cardiac output and, in turn, maintain vital organ function.

    As cardiac output falls in patients with left ventricular dysfunction, aortic and carotid baroreceptors initiate sympathetic nervous responses. These responses, in turn, increase heart rate, left ventricular filling pressure, and peripheral resistance to flow to enhance venous return to the heart.

    These compensatory responses initially stabilize the patient’s condition but later cause deterioration with rising oxygen demands of the already compromised myocardium. The result? A vicious circle of low cardiac output, sympathetic compensation, myocardial ischemia, and even lower cardiac output.

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    Source: Handbook of Diseases, 2003

    Electric shock: Causes
    (Handbook of Diseases)

    Electric shock usually follows accidental contact with exposed parts of electrical appliances or wiring, but it may also result from lightning or the flash of electric arcs from high-voltage power lines or machines.

    The increased use of electrical medical devices in the hospital, many of which are connected directly to the patient, has raised serious concern for electrical safety and has led to the development of electrical safety standards. However, even well-designed equipment with reliable safety features can cause electric shock if it’s mishandled. (See Preventing electric shock, page 292.)

    CLINICAL TIP: Electric current can cause injury in three ways: true electrical injury as the current passes through the body, arc or flash burns from current that doesn’t pass through the body, and thermal surface burns caused by associated heat and flames.

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    Source: Handbook of Diseases, 2003

    Respirations, grunting: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Asthma

    Grunting respirations and wheezing may be apparent during a severe asthma attack, usually triggered by an upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor. Immediate bronchodilator and corticosteroid therapy is needed.

    Heart failure

    A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.

    Pneumonia

    Life-threatening bacterial pneumonia is common after an upper respiratory tract infection or cold. Pneumocystis carinii (jiroveci) pneumonia commonly affects children infected with human immunodeficiency virus. It causes grunting respirations accompanied by high fever, tachypnea, nonproductive or scantly productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, patients may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention. Oxygen therapy is often needed.

    Respiratory distress syndrome

    The result of lung immaturity in a premature infant (less than 37 weeks’ gestation) usually of low birth weight, respiratory distress syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions accompanied by tachycardia and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur. This disease can occur in all age groups, as a result of aspiration, infection, embolism, shock, trauma, and other causes. Findings are similar in all ages.

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    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Edema, facial: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Abscess (periodontal)

    Periodontal abscess is an infection that usually results from poor oral hygiene and is commonly caused by anaerobic organisms. It can cause edema of the side of the face, pain, warmth, erythema, and purulent discharge around the affected tooth.

    Abscess (peritonsillar)

    Peritonsillar abscess is a complication of tonsillitis that may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.

    Allergic reaction

    Facial edema may characterize both local allergic reactions and anaphylaxis. With life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema, page 129.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.

    Cavernous sinus thrombosis

    Cavernous sinus thrombosis is a rare but serious disorder that may begin with unilateral edema that quickly progresses to bilateral edema of the forehead, base of the nose, and eyelids. It may also produce chills, fever, headache, nausea, lethargy, exophthalmos, and eye pain.

    Chalazion

    A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.

    Conjunctivitis

    Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.

    Corneal ulcers (fungal)

    Accompanying red, edematous eyelids in corneal ulcers are conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious, purulent eye discharge makes eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.

    Dacryoadenitis

    Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, purulent discharge, and temporal pain.

    Dacryocystitis

    Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. With acute cases, pain and tenderness near the lacrimal sac accompany purulent discharge.

    Dermatomyositis

    Periorbital edema and heliotropic rash develop gradually in dermatomyositis — a rare disease. An itchy, lilac-colored rash appears on the bridge of the nose, cheeks, and forehead. Localized or diffuse erythema, eye pain, and fever may also occur.

    Facial burns

    Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress, such as inspiratory stridor.

    Facial trauma

    The extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated symptoms also depend on the type of injury.

    Frontal sinus cancer

    Frontal sinus cancer is a rare form of cancer that causes cheek edema on the affected side, reddened skin over the sinus, unilateral nasal bleeding or discharge, and exophthalmos. Pain over the forehead and unilateral hypoesthesia or anesthesia may occur later.

    Herpes zoster ophthalmicus (shingles)

    With herpes zoster ophthalmicus, edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt.

    Hordeolum (stye)

    Typically, localized eyelid edema, erythema, and pain occur with a hordeolum.

    Malnutrition

    Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and slowed pulse and respiratory rates.

    Melkersson’s syndrome

    Facial edema (especially of the lips), facial paralysis, and folds in the tongue are the three characteristic signs of Melkersson’s syndrome.

    Myxedema

    Myxedema eventually causes generalized facial edema, waxy dry skin, hair loss or coarsening, and other signs of hypothyroidism.

    Nephrotic syndrome

    Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.

    Orbital cellulitis

    Sudden onset of periorbital edema marks orbital cellulitis. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.

    Osteomyelitis

    When osteomyelitis affects the frontal bone, it may cause forehead edema as well as fever, chills, headache, and cool, pallid skin.

    Preeclampsia

    Edema of the face, hands, and ankles is an early sign of preeclampsia — a disorder of pregnancy. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.

    Rhinitis (allergic)

    With rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.

    Sinusitis

    Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.

    Superior vena cava syndrome

    Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.

    Trachoma

    With trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.

    Trichinosis

    Trichinosis is a relatively rare infectious disorder that causes sudden onset of eyelid edema with fever (102° to l04° F [38.9°to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.

    Other causes

    Diagnostic tests

    An allergic reaction to contrast media used in radiologic tests may produce facial edema.

    Drugs

    Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect.

    Herbal remedies

    Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles. Feverfew and chrysanthemum parthenium can cause swelling of the lips, irritation of the tongue, and mouth ulcers. Licorice may cause facial edema and water retention or bloating, especially if used before menses.

    Surgery and transfusion

    Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.

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    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Edema, generalized: Medical causes
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Angioneurotic edema or angioedema

    Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera — may be the result of a food or drug allergy or emotional stress, or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.

    Burns

    Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.

    Cirrhosis

    Edema that usually starts in the legs and thighs and may progress to the degree of anasarca. Edema is a late sign of cirrhosis — a chronic disease. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, pruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.

    Heart failure

    Severe, generalized pitting edema — occasionally anasarca — may follow leg edema late in heart failure. Edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema typify right-sided heart failure.

    Malnutrition

    Anasarca in malnutrition may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.

    Myxedema

    With myxedema — the severe form of hypothyroidism — generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin, a puffy face, and an upper eyelid droop. Assessment also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.

    Nephrotic syndrome

    Although nephrotic syndrome is characterized by generalized pitting edema, the edema is initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.

    Pericardial effusion

    With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever.

    Pericarditis (chronic constructive)

    Resembling right-sided heart failure, pericarditis usually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul’s sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.

    Protein-losing enteropathy

    Increased albumin levels lead to progressive generalized pitting edema in protein-losing enteropathy. The patient may also have mild fever and abdominal pain with bloody diarrhea and steatorrhea.

    Renal failure

    With acute renal failure, generalized pitting edema occurs as a late sign. With chronic failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.

    Septic shock

    A late sign of septic shock — a life-threatening disorder — generalized edema typically develops rapidly. The edema is pitting and moderately severe. Accompanying it may be cool skin, hypotension, oliguria, tachycardia, cyanosis, thirst, anxiety, and signs of respiratory failure.

    Other causes

    Drugs

    Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatories, such as celecoxib, ibuprofen, and naproxen.

    Medical treatments

    I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.

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    Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

    Accessory muscle use: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Acute respiratory distress syndrome

    In acute respiratory distress syndrome (ARDS), accessory muscle use increases in response to hypoxia. It’s accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics of this life-threatening disorder include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.

    Airway obstruction

    Acute upper airway obstruction can be life-threatening — fortunately, most obstructions are subacute or chronic. Typically, this disorder increases accessory muscle use. Its most telling sign, however, is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.

    Amyotrophic lateral sclerosis

    Typically, amyotrophic lateral sclerosis (ALS) affects the diaphragm more than the accessory muscles. As a result, increased accessory muscle use is characteristic. Other signs and symptoms of this progressive motor neuron disorder include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski’s reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech; difficulty chewing or swallowing and breathing; urinary frequency and urgency; and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient’s mental status remains intact, his poor prognosis may cause periodic depression.

    Asthma

    During acute asthma attacks, the patient usually displays increased accessory muscle use. Accompanying it are severe dyspnea, tachypnea, wheezing, productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.

    Chronic bronchitis

    With chronic bronchitis, a form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Cyanosis and weight gain from edema account for the characteristic label of “blue bloater.” Low-grade fever may occur with secondary infection.

    Emphysema

    With emphysema, a form of COPD, increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough. Sometimes called a “pink puffer,” the patient will display pursed-lip breathing and tachypnea. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.

    Pneumonia

    Bacterial pneumonia usually produces increasedaccessory muscle use. Initially, this infection produces sudden high fever with chills. Its associated signs and symptoms include chest pain, productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.

    Pulmonary edema

    With acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.

    Pulmonary embolism

    Although signs and symptoms vary with the size, number, and location of the emboli, this life-threatening disorder may cause increased accessory muscle use. Commonly, it produces dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, productive cough, low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.

    Spinal cord injury

    Depending on the location and severity of a spinal cord injury, increased accessory muscle use may occur. An injury below Ll typically doesn’t affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.

    Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski’s reflex; hyperactive deep tendon reflexes; spasticity; and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner’s syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur with lower cervical cord injury.

    Thoracic injury

    With thoracic injury, increased accessory muscle use may occur, depending on the type and extent of injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.

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    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Respirations, grunting: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Asthma

    Grunting respirations may be apparent during a severe asthma attack, usually triggered by an upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, audible wheezing, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor.

    Heart failure

    A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.

    Pneumonia

    Life-threatening bacterial pneumonia is common after an upper respiratory tract infection or cold. Pneumocystis carinii pneumonia commonly affects children infected with human immunodeficiency virus. It causes grunting respirations accompanied by high fever, tachypnea, a productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, the patient may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention.

    Respiratory distress syndrome

    The result of lung immaturity in a premature infant (one who’s less than 37 weeks’ gestation) usually of low birth weight, respiratory distress syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions; tachycardia; and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur.

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    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Edema of the leg: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Burns

    Two days or less after injury, leg burns may cause mild to severe edema, pain, and tissue damage. Depending on the degree of the burn, the patient may also have erythema; blisters; white, brown, or leathery tissue; or charring.

    Cellulitis

    With cellulitis, pitting edema and orange peel skin are caused by a streptococcal or staphylococcal infection that most commonly occurs in the lower extremities. Cellulitis is also associated with erythema, warmth, and tenderness in the infected area.

    Envenomation

    Mild to severe localized edema may develop suddenly at the site of a bite or sting, along with erythema, pain, urticaria, pruritus, and a burning sensation. Later signs include nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache, and, in severe cases, dyspnea, seizures, and paralysis.

    Heart failure

    Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.

    Hypoproteinemia

    Malnourished patients suffer bilateral leg edema secondary to decreased protein and osmotic pressures. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.

    Leg trauma

    Mild to severe localized edema may form around the site of leg trauma. Ecchymoses or bleeding, pain or numbness, and paralysis may occur. If a fracture has occurred, deformities may be present.

    Nephrotic syndrome

    Nephrotic syndrome is commonly seen in children and results in bilateral leg edema. It’s associated with polyuria and eyelid swelling. Generalized pitting edema may also occur as well as ascites, fatigue, malaise, depression, and pallor.

    Osteomyelitis

    When osteomyelitis, a bone infection, affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows fever, localized tenderness, and pain that increases with leg movement.

    Rupture of popliteal cyst

    A ruptured popliteal (Baker’s) cyst can cause sudden onset of unilateral calf pain and edema, usually after walking or exercising. This type of cyst is common in patients with arthritis. It can compress vascular structures and cause severe edema and thrombophlebitis.

    Thrombophlebitis

    Both deep and superficial vein thrombosis may cause unilateral mild to moderate edema. Deep vein thrombophlebitis may not produce symptoms or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as fever, chills, and malaise. Superficial thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.

    Venous insufficiency (chronic)

    Moderate to severe, unilateral or bilateral leg edema occurs in patients with chronic venous insufficiency. Initially, the edema is soft and pitting; later, it becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle. Venous insufficiency generally occurs in females.

    Other causes

    Coronary artery bypass surgery

    Unilateral venous insufficiency may follow saphenous vein retrieval.

    Medications

    Estrogen, hormonal contraceptives, lithium, nonsteroidal anti-inflammatory drugs, vasodilators, and drugs that cause sodium retention can cause bilateral leg edema.

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    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Edema, generalized: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Angioneurotic edema or angioedema

    Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera — may be the result of a food or drug allergy or emotional stress; they may also be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.

    Burns

    Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn. Depending on the degree of edema, the patient may experience signs and symptoms of reduced or absent circulation and airway obstruction.

    Cirrhosis

    Edema is a late sign of cirrhosis, a chronic disease. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, pruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.

    Heart failure

    Severe, generalized pitting edema — occasionally anasarca — may follow leg edema late in a patient with heart failure. The edema may improve with exercise or elevation of the limbs and tends to be worse at the end of the day. Other classic late findings include hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient also experiences tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue signal left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema signal right-sided heart failure.

    Myxedema

    With myxedema, a severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.

    Nephrotic syndrome

    Although nephrotic syndrome is characterized by generalized pitting edema, the edema is initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.

    Pericardial effusion

    With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever.

    Renal failure

    Generalized pitting edema occurs as a late sign of acute renal failure. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.

    Other causes

    Drugs

    Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as phenylbutazone, ibuprofen, and naproxen.

    Treatments

    I.V. saline solution infusions and enteral feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Edema of the arm: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Angioneurotic edema

    Angioneurotic edema is a common reaction characterized by sudden onset of painless, nonpruritic edema affecting the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although these swellings usually don’t itch, they may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.

    Arm trauma

    Shortly after a crush injury, severe edema may affect the entire arm. Ecchymoses or superficial bleeding, pain or numbness, and paralysis may occur. If a fracture has occurred, deformities may also be present.

    Burns

    Two days or less after injury, arm burns may cause mild to severe edema, pain, and tissue damage. Depending on the burn degree, the patient may also have erythema; blisters; white, brown, or leathery tissue; or charring.

    Envenomation

    Envenomation initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, fever, chills, hypotension, headache and, in severe cases, dyspnea, seizures, and paralysis.

    Superior vena cava syndrome

    With superior vena cava syndrome, bilateral arm edema usually progresses slowly and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of headache, vertigo, and vision disturbances.

    Thrombophlebitis

    Thrombophlebitis may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, fever, chills, and malaise. Superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.

    Other causes

    Treatments

    Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.

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    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Edema of the face: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Abscess (periodontal)

    A periodontal abscess can cause edema of the side of the face, pain, warmth, erythema, and purulent discharge around the affected tooth. The gums may be bright red and inflamed.

    Abscess (peritonsillar)

    A peritonsillar abscess, a complication of tonsillitis, may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.

    Allergic reaction

    Facial edema may characterize local allergic reactions and anaphylaxis. With life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.

    Chalazion

    A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface. The patient may report increased tearing and photophobia.

    Conjunctivitis

    Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.

    Corneal ulcers (fungal)

    In patients with fungal corneal ulcers, red, edematous eyelids accompany conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious, purulent eye discharge makes eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.

    Dacryocystitis

    With dacryocystitis, lacrimal sac inflammation causes prominent eyelid edema and constant tearing. In acute cases, pain and tenderness near the tear sac accompany purulent discharge.

    CULTURAL CUE:

    Dacryocystitis rarely occurs in blacks because they tend to have a larger nasolacrimal ostium and a shorter, straighter lacrimal canal than whites.

    Facial burns

    Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs and eyebrows, red mucosa, sooty sputum, and signs of respiratory distress, such as inspiratory stridor.

    Facial trauma

    With facial trauma, the extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated signs and symptoms also depend on the type of injury.

    Herpes zoster ophthalmicus

    With herpes zoster ophthalmicus (also known as shingles), edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt. Fever and malaise may also occur.

    Hordeolum

    Typically, localized eyelid edema, erythema, and pain occur with a hordeolum (stye). The patient may report photophobia and a foreign body sensation.

    Malnutrition

    Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and slowed pulse and respiratory rates.

    Myxedema

    Myxedema eventually causes generalized facial edema; waxy, dry skin; hair loss or coarsening; and other signs of hypothyroidism. Upper eyelid drooping may also be apparent.

    Nephrotic syndrome

    Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.

    Orbital cellulitis

    Sudden onset of periorbital edema marks orbital cellulitis, an inflammatory disorder. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.

    Preeclampsia

    Edema of the face, hands, and ankles is an early sign of preeclampsia. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.

    Rhinitis (allergic)

    With allergic rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.

    Sinusitis

    Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.

    Superior vena cava syndrome

    Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.

    Other causes

    Diagnostic tests

    An allergic reaction to contrast media used in radiologic tests may produce facial edema.

    Drugs

    Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect. Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles.

    Surgery and transfusion

    Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Salivation, increased: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Bell’s palsy

    With Bell’s palsy, paralysis of the facial nerve causes an inability to control salivation or close the eye on the affected side. The affected side of the face sags and is expressionless, the nasolabial fold flattens, and the palpebral fissure (the distance between the upper and lower eyelids) widens. The corneal reflex may be diminished or absent and the patient may have partial loss of taste or abnormal taste sensation.

    Mercury poisoning

    Stomatitis, characterized by increased salivation and a metallic taste, commonly occurs in those with mercury poisoning. The patient’s teeth may be loose and his gums are painful, swollen, and prone to bleeding. A blue line appears on the gingivae. The patient may also experience personality changes, memory loss, abdominal cramps, diarrhea, paresthesia, and tremors of the eyelids, lips, tongue, and fingers.

    Pregnancy

    In the early months of pregnancy, many women experience increased salivation, nausea, gum swelling, and breast tenderness.

    Stomatitis

    Mucosal ulcers may be accompanied by moderately increased salivation, mouth pain, fever, and erythema. Spontaneous healing usually occurs in 7 to 10 days, but scarring and recurrence are possible.

    Syphilis

    With secondary syphilis, mucosal ulcers cause increased salivation that may persist up to 1 year. Related findings include fever, malaise, headache, anorexia, weight loss, nausea, vomiting, sore throat, and generalized lymphadenopathy. A bilaterally symmetrical rash appears on the arms, trunk, palms, soles, face, and scalp. Condylomata develop in the genital and perianal areas.

    Tuberculosis

    Certain forms of tuberculosis may produce solitary, irregularly-shaped mouth or tongue ulcers, covered with exudate, that cause increased salivation. Other findings include weight loss, anorexia, fever, fatigue, malaise, dyspnea, cough, night sweats (a common sign), and hemoptysis.

    Other causes

    Drugs

    Increased salivation may occur with iodide toxicity, but the earliest symptoms are a brassy taste and a burning sensation in the mouth and throat. Associated findings include sneezing, irritated eyelids, and (commonly) pain in the frontal sinus.

    Pilocarpine and other miotics used to treat glaucoma may be absorbed systemically, increasing salivation. Cholinergics, such as bethanechol and neostigmine, may also cause this symptom.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Tearing, increased: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Conjunctival foreign bodies and abrasions

    Increased tearing may accompany localized conjunctival injection, severe eye pain, and photophobia. A foreign-body sensation may be present. Typically, visual acuity isn’t affected.

    Conjunctivitis

    Typically, increased tearing is accompanied by conjunctival injection and itching. Allergic conjunctivitis also causes a stringy discharge. With bacterial conjunctivitis, other features include copious, purulent discharge; burning; a foreign-body sensation; and possibly eye pain if the cornea is involved. Associated signs of fungal conjunctivitis include lid edema, burning, and a copious, thick, purulent discharge that may form sticky crusts on the lids. The patient complains of photophobia and pain if the cornea is involved. Highly contagious viral conjunctivitis also causes a foreign-body sensation, slight exudate, and lid edema.

    Corneal abrasion

    Marked by severe corneal pain that’s aggravated by blinking, a corneal abrasion also causes increased tearing. Associated features are a foreign-body sensation, blurred vision, conjunctival injection, and photophobia, which makes opening the lids difficult.

    Corneal foreign body

    When a foreign body lodges in the cornea, the patient experiences increased tearing, blurred vision, a foreign-body sensation, photophobia, eye pain, miosis, and conjunctival injection. A dark speck may also be visible in the cornea.

    Corneal ulcers

    With corneal ulcers, a vision-threatening disorder, increased tearing is accompanied by severe photophobia and eye pain. Typically, an early symptom of a corneal ulcer is pain that’s aggravated by blinking. Ulcers also cause blurred vision, conjunctival injection, and a white, opaque cornea. Bacterial ulcers also produce a copious, purulent discharge that may form sticky crusts on the lids.

    Dacryocystitis

    Increased tearing and a purulent discharge are the chief complaints with dacryocystitis, which is commonly unilateral. Associated signs and symptoms include pain and tenderness around the tear sac with marked eyelid edema and redness near the lacrimal punctum. Pressure on the tear sac expresses a thick, purulent discharge or, in chronic cases, a mucoid discharge.

    Dry eye syndrome

    Excessive dryness of the cornea and conjunctiva can cause reflex stimulation of the lacrimal gland and excess tearing. Other signs and symptoms include eye pain, conjunctival injection, and itching.

    Episcleritis

    Commonly unilateral, episcleritis causes increased tearing, photophobia, and — if the sclera is inflamed — eye pain and tenderness on palpation. Inspection reveals conjunctival injection and edema, a purplish pink sclera, and episcleral edema.

    Herpes zoster

    Increased tearing usually occurs when herpes zoster affects the trigeminal nerve. It’s accompanied by severe unilateral facial and eye pain that’s followed by the eruption of vesicles within several days. The patient’s eyelids are red and swollen with scanty serous discharge. Other common findings include a white, cloudy cornea and conjunctival injection.

    Lid contractions

    With lid contractions, increased tearing usually results from stricture of the canaliculi. Because lid contractions are caused by burns or chemical or mechanical trauma, lid scars are also commonly visible.

    Psoriasis vulgaris

    When psoriasis vulgaris lesions affect the eyelids and extend into the conjunctiva, they may cause irritation, increased tearing, and a foreign-body sensation. The lesions are typically preceded by signs of chronic conjunctivitis, such as copious mucoid discharge and conjunctival injection.

    Punctum misplacement

    Increased tearing is characteristic when ectropion involves the punctum, causing misplacement. It may be accompanied by exposure keratitis.

    Thyrotoxicosis

    Thyrotoxicosis may cause increased tearing, usually in both eyes. Other ocular effects include ptosis, lid edema, photophobia, a foreign-body sensation, conjunctival injection, chemosis, diplopia and, at times, exophthalmos. Common associated features are heat intolerance, weight loss despite increased appetite, nervousness, sweating, diarrhea, tremors, tachycardia, palpitations, and an enlarged thyroid.

    Other causes

    Cholinergics

    Miotics, such as pilocarpine, may increase tearing.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Respiratory Distress and Apnea: Principal Causes of Respiratory Distress (Neonatal)
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Upperrespiratory tract obstruction
    2. Lower respiratory tract disorders
      1. Transienttachypnea of the newborn
      2. Respiratory distress syndrome (hyalinemembrane disease)
      3. Meconium aspiration and other aspirationsyndromes
      4. Pneumonia
      5. Pulmonary air leaks
      6. Pulmonary hemorrhage
      7. Bronchopulmonary dysplasia
      8. Congenital malformations of the lungs,bronchi, diaphragm, and rib cage
        1. Lung agenesis and aplasia
        2. Pulmonary hypoplasia
        3. Pulmonary sequestration
        4. Lobar emphysema
        5. Cystic lung lesions
          1. Bronchogeniccyst
          2. Congenital cystic adenomatoid malformation
          3. Intrapulmonary cysts
          4. Congenital pulmonary lymphangiectasia
        6. Chylothorax
        7. Bronchial malformations
        8. Diaphragm lesions
          1. Congenitaldiaphragmatic hernia
          2. Diaphragmatic eventration
          3. Diaphragmatic paralysis or paresis
        9. Rib cage anomalies
      9. Persistent fetal circulation
    3. Cardiac disorders
    4. Hematologic disorders
      1. Anemia
      2. Polycythemia
    5. Metabolic disorders
      1. Hypothermia
      2. Hypoglycemia
      3. Metabolic acidosis
    6. Neurologic and muscle disorders
      1. Braindisorders
      2. Spinal cord injury
      3. Neuromuscular disorders
    7. Drugs

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Edema: Principal Causes of Edema
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Disorderswith normal serum albumin
      1. Increased capillary permeability
        1. Skin disorders
        2. Allergic reaction
        3. Vasculitis
        4. Septicemia
        5. Vitamin E deficiency
        6. Hereditary angioedema
      2. Increased hydrostatic pressure
        1. Increasedblood volume
          1. Fluidoverload
          2. Cardiac failure
          3. Renal disease
        2. Increased venous pressure
          1. Constructivepericarditis
          2. Portal hypertension
          3. Venous thrombosis
          4. Tumor
        3. Increased lymph pressure
          1. Lymphedema
    2. Disorders with decreased serum albumin(decreased oncotic pressure)
      1. Disorders with proteinuria
        1. Renaldisease
          1. Glomerulonephritis
          2. Nephrotic syndrome
      2. Disorders without proteinuria
        1. Acuteand chronic liver disease
          1. Hepatitis
          2. Cirrhosis
        2. Gastrointestinal disease
          1. Protein-losingenteropathy
            1. Cowmilk protein sensitivity
            2. Cystic fibrosis
            3. Celiac disease
            4. Inflammatory bowel disease
            5. Intestinal lymphangiectasia
        3. Protein-calorie malnutrition
        4. Congenital albumin deficiency
    3. Hydrops fetalis: immune and nonimmune

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Accessory muscle use: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Acute respiratory distress syndrome (ARDS).In ARDS, a life-threatening disorder, accessory muscle use increases in response to hypoxia. It's accompanied by intercostal, supracostal, and sternal retractions on inspiration and by grunting on expiration. Other characteristics include tachypnea, dyspnea, diaphoresis, diffuse crackles, and a cough with pink, frothy sputum. Worsening hypoxia produces anxiety, tachycardia, and mental sluggishness.

    Airway obstruction.Acute upper airway obstruction can be life-threatening—fortunately, most obstructions are subacute or chronic. Typically, obstruction increases accessory muscle use. However, its most telling sign is inspiratory stridor. Associated signs and symptoms include dyspnea, tachypnea, gasping, wheezing, coughing, drooling, intercostal retractions, cyanosis, and tachycardia.

    Amyotrophic lateral sclerosis.Typically, this progressive motor neuron disorder affects the diaphragm more than the accessory muscles. As a result, increased accessory muscle use is characteristic. Other signs and symptoms include fasciculations, muscle atrophy and weakness, spasticity, bilateral Babinski's reflex, and hyperactive deep tendon reflexes. Incoordination makes carrying out routine activities difficult for the patient. Associated signs and symptoms include impaired speech, difficulty chewing or swallowing and breathing, urinary frequency and urgency and, occasionally, choking and excessive drooling. ( Note: Other neuromuscular disorders may produce similar signs and symptoms.) Although the patient's mental status remains intact, his poor prognosis may cause periodic depression.

    Asthma.During an acute asthma attack, the patient usually displays increased accessory muscle use. Accompanying it are severe dyspnea, tachypnea, wheezing, a productive cough, nasal flaring, and cyanosis. Auscultation reveals faint or possibly absent breath sounds, musical crackles, and rhonchi. Other signs and symptoms include tachycardia, diaphoresis, and apprehension caused by air hunger. Chronic asthma may also cause barrel chest.

    Chronic bronchitis.With chronic bronchitis, a form of COPD, increased accessory muscle use may be chronic and is preceded by a productive cough and exertional dyspnea. Chronic bronchitis is accompanied by wheezing, basal crackles, tachypnea, jugular vein distention, prolonged expiration, barrel chest, and clubbing. Cyanosis and weight gain from edema account for the characteristic label of “blue bloater.” A low-grade fever may occur with secondary infection.

    Emphysema.Increased accessory muscle use occurs with progressive exertional dyspnea and a minimally productive cough in this form of COPD. Sometimes called a “pink puffer,” the patient will display pursed-lip breathing and tachypnea. Associated signs and symptoms include peripheral cyanosis, anorexia, weight loss, malaise, barrel chest, and clubbing. Auscultation reveals distant heart sounds; percussion detects hyperresonance.

    Pneumonia.Bacterial pneumonia usually produces increased accessory muscle use. Initially, this infection produces a sudden high fever with chills. Its associated signs and symptoms include chest pain, a productive cough, dyspnea, tachypnea, tachycardia, expiratory grunting, cyanosis, diaphoresis, and fine crackles.

    Pulmonary edema.With acute pulmonary edema, increased accessory muscle use is accompanied by dyspnea, tachypnea, orthopnea, crepitant crackles, wheezing, and a cough with pink, frothy sputum. Other findings include restlessness, tachycardia, ventricular gallop, and cool, clammy, cyanotic skin.

    Pulmonary embolism.Although signs and symptoms vary with the size, number, and location of the emboli, pulmonary embolism is a life-threatening disorder that may cause increased accessory muscle use. Typically, it produces dyspnea and tachypnea that may be accompanied by pleuritic or substernal chest pain. Other signs and symptoms include restlessness, anxiety, tachycardia, a productive cough, a low-grade fever and, with a large embolus, hemoptysis, cyanosis, syncope, jugular vein distention, scattered crackles, and focal wheezing.

    Spinal cord injury.Increased accessory muscle use may occur, depending on the location and severity of the injury. An injury below Ll typically doesn't affect the diaphragm or accessory muscles, whereas an injury between C3 and C5 affects the upper respiratory muscles and diaphragm, causing increased accessory muscle use.

    Associated signs and symptoms of spinal cord injury include unilateral or bilateral Babinski's reflex, hyperactive deep tendon reflexes, spasticity, and variable or total loss of pain and temperature sensation, proprioception, and motor function. Horner's syndrome (unilateral ptosis, pupillary constriction, facial anhidrosis) may occur with lower cervical cord injury.

    Thoracic injury.Increased accessory muscle use may occur, depending on the type and extent of injury. Associated signs and symptoms of this potentially life-threatening injury include an obvious chest wound or bruising, chest pain, dyspnea, cyanosis, and agitation. Signs of shock, such as tachycardia and hypotension, occur with significant blood loss.

    Other causes

    Diagnostic tests and treatments.Pulmonary function tests (PFTs), incentive spirometry, and intermittent positive-pressure breathing can increase accessory muscle use.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Respirations, grunting: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Asthma.Grunting respirations may be apparent during a severe asthma attack, usually triggered by an upper respiratory tract infection or an allergic response. As the attack progresses, dyspnea, audible wheezing, chest tightness, and coughing occur. Patients may have a silent chest if air movement is poor. Immediate bronchodilator therapy is needed.

    Heart failure.A late sign of left-sided heart failure, grunting respirations accompany increasing pulmonary edema. Associated features include a productive cough, crackles, jugular vein distention, and chest wall retractions. Cyanosis may also be evident, depending on the underlying congenital cardiac defect.

    Pneumonia.Life-threatening bacterial pneumonia causes grunting respirations accompanied by high fever, tachypnea, a productive cough, anorexia, and lethargy. Auscultation reveals diminished breath sounds, scattered crackles, and sibilant rhonchi over the affected lung. As the disorder progresses, the patient may also develop severe dyspnea, substernal and subcostal retractions, nasal flaring, cyanosis, and increasing lethargy. Some infants display GI signs, such as vomiting, diarrhea, and abdominal distention.

    Respiratory distress syndrome.The result of lung immaturity in a premature infant (less than 37 weeks' gestation) usually of low birth weight, this syndrome initially causes audible expiratory grunting along with intercostal, subcostal, or substernal retractions; tachycardia; and tachypnea. Later, as respiratory distress tires the infant, apnea or irregular respirations replace the grunting. Severe respiratory distress is characterized by cyanosis, frothy sputum, dramatic nasal flaring, lethargy, bradycardia, and hypotension. Eventually, the infant becomes unresponsive. Auscultation reveals harsh, diminished breath sounds and crackles over the base of the lungs on deep inspiration. Oliguria and peripheral edema may also occur.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Edema of the leg: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Burns.Two days or less after injury, leg burns may cause mild to severe edema, pain, and tissue damage.

    Cellulitis.Pitting edema and orange peel skin are caused by a streptococcal or staphylococcal infection that most commonly occurs in the lower extremities. Cellulitis is also associated with erythema, warmth, and tenderness in the infected area.

    Envenomation.Mild to severe localized edema may develop suddenly at the site of a bite or sting, along with erythema, pain, urticaria, pruritus, and a burning sensation.

    Heart failure.Bilateral leg edema is an early sign of right-sided heart failure. Other signs and symptoms include weight gain despite anorexia, nausea, chest tightness, hypotension, pallor, tachypnea, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, a ventricular gallop, and inspiratory crackles. Pitting ankle edema, hepatomegaly, hemoptysis, and cyanosis signal more advanced heart failure.

    Leg trauma.Mild to severe localized edema may form around the trauma site.

    Osteomyelitis.When osteomyelitis—a bone infection—affects the lower leg, it usually produces localized, mild to moderate edema, which may spread to the adjacent joint. Edema typically follows a fever, localized tenderness, and pain that increases with leg movement.

    Thrombophlebitis.Deep and superficial vein thrombosis may cause unilateral mild to moderate leg edema. Deep vein thrombophlebitis may be asymptomatic or may cause mild to severe pain, warmth, and cyanosis in the affected leg as well as a fever, chills, and malaise. Superficial thrombophlebitis typically causes pain, warmth, redness, tenderness, and induration along the affected vein.

    Venous insufficiency (chronic).Moderate to severe, unilateral or bilateral leg edema occurs in patients with venous insufficiency. Initially, the edema is soft and pitting; later, it becomes hard as tissues thicken. Other signs include darkened skin and painless, easily infected stasis ulcers around the ankle. Venous insufficiency generally occurs in females.

    Other causes

    Coronary artery bypass surgery.Unilateral venous insufficiency may follow saphenous vein retrieval.

    Diagnostic tests.Venography is a rare cause of leg edema.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Edema, generalized: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Angioneurotic edema or angioedema.Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes—especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, genitalia, or viscera—may be the result of a food or drug allergy or emotional stress or they may be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema.

    Burns.Edema and associated tissue damage vary with the severity of the burn. Severe generalized edema (4+) may occur within 2 days of a major burn; localized edema may occur with a less severe burn.

    Heart failure.Severe, generalized pitting edema—occasionally anasarca—may follow leg edema late in this disorder. The edema may improve with exercise or elevation of the limbs and is typically worse at the end of the day. Among other classic late findings are hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient has tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, a slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue typify leftsided heart failure; jugular vein distention, enlarged liver, and peripheral edema typify right-sided heart failure.

    Malnutrition.Anasarca in malnutrition may mask dramatic muscle wasting. Malnutrition also typically causes muscle weakness; lethargy; anorexia; diarrhea; apathy; dry, wrinkled skin; and signs of anemia, such as dizziness and pallor.

    Myxedema.With myxedema, which is a severe form of hypothyroidism, generalized nonpitting edema is accompanied by dry, flaky, inelastic, waxy, pale skin; a puffy face; and an upper eyelid droop. Observation also reveals masklike facies, hair loss or coarsening, and psychomotor slowing. Associated findings include hoarseness, weight gain, fatigue, cold intolerance, bradycardia, hypoventilation, constipation, abdominal distention, menorrhagia, impotence, and infertility.

    Nephrotic syndrome.Although nephrotic syndrome is characterized by generalized pitting edema, it's initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression, and pallor.

    Pericardial effusion.With pericardial effusion, generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, a nonproductive cough, a pericardial friction rub, jugular vein distention, dysphagia, and a fever.

    Pericarditis (chronic constrictive).Resembling right-sided heart failure, pericarditis usually begins with pitting edema of the arms and legs that may progress to generalized edema. Other signs and symptoms include ascites, Kussmaul's sign, dyspnea, fatigue, weakness, abdominal distention, and hepatomegaly.

    Renal failure.With acute renal failure, generalized pitting edema occurs as a late sign. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertension, dyspnea, crackles, dizziness, and pallor.

    Other causes

    Drugs.Any drug that causes sodium retention may aggravate or cause generalized edema. Examples include antihypertensives, corticosteroids, androgenic and anabolic steroids, estrogens, and nonsteroidal anti-inflammatory drugs, such as phenylbutazone, ibuprofen, and naproxen.

    Treatments.I.V. saline solution infusions and internal feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Edema of the arm: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Angioneurotic edema.Angioneurotic edema is a common reaction that's characterized by the sudden onset of painless, nonpruritic edema affecting the hands, feet, eyelids, lips, face, neck, genitalia, or viscera. Although swelling usually doesn't itch, it may burn and tingle. If edema spreads to the larynx, signs of respiratory distress may occur.

    Arm trauma.Shortly after a crush injury, severe edema may affect the entire arm. Ecchymoses or superficial bleeding, pain or numbness, and paralysis may occur.

    Burns.Two days or less after injury, arm burns may cause mild to severe edema, pain, and tissue damage.

    Envenomation.Envenomation by snakes, aquatic animals, or insects initially may cause edema around the bite or sting that quickly spreads to the entire arm. Pain, erythema, and pruritus at the site are common; paresthesia occurs occasionally. Later, the patient may develop generalized signs and symptoms, such as nausea, vomiting, weakness, muscle cramps, a fever, chills, hypotension, a headache and, in severe cases, dyspnea, seizures, and paralysis.

    Superior vena cava syndrome.Bilateral arm edema usually progresses slowly and is accompanied by facial and neck edema. Dilated veins mark these edematous areas. The patient also complains of a headache, vertigo, and vision disturbances.

    Thrombophlebitis.Thrombophlebitis, which can result from peripherally inserted central catheters and arm portocaths, may cause arm edema, pain, and warmth. Deep vein thrombophlebitis can also produce cyanosis, a fever, chills, and malaise; superficial thrombophlebitis also causes redness, tenderness, and induration along the vein.

    Other causes

    Treatments.Localized arm edema may result from infiltration of I.V. fluid into the interstitial tissue. A radical or modified radical mastectomy that disrupts lymphatic drainage may cause edema of the entire arm, as can axillary lymph node dissection. Also, radiation therapy for breast cancer may produce arm edema immediately after treatment or months later.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Edema of the face: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Allergic reaction.Facial edema may characterize local allergic reactions and anaphylaxis. With life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.

    Chalazion.A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.

    Conjunctivitis.Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.

    Dacryoadenitis.Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, purulent discharge, and temporal pain.

    Dacryocystitis.Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. With acute cases, pain and tenderness near the tear sac accompany purulent discharge.

    Facial burns.Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress such as inspiratory stridor.

    Facial trauma.The extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated features also depend on the type of injury.

    Herpes zoster ophthalmicus (shingles).With shingles, edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt.

    Myxedema.Myxedema eventually causes generalized facial edema; waxy, dry skin; hair loss or coarsening; and other signs of hypothyroidism.

    Nephrotic syndrome.Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.

    Orbital cellulitis.The sudden onset of periorbital edema marks orbital cellulitis. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, a fever, and extreme orbital pain.

    Periodontal abscess.A periodontal abscess can cause swelling or edema of the gums and can progress to cause facial edema, ear and jaw pain, as well as tooth pain.

    Preeclampsia.Edema of the face, hands, and ankles is an early sign of preeclampsia. Other characteristics include excessive weight gain, a severe headache, blurred vision, hypertension, and midepigastric pain.

    Rhinitis (allergic).With rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, a headache, sinus pain and, sometimes, malaise and a fever.

    Sinusitis.Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, a fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.

    Superior vena cava syndrome.Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as a headache, vision disturbances, and vertigo.

    Trachoma.With trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.

    Trichinosis.Trichinosis is a relatively rare infectious disorder that causes the sudden onset of eyelid edema with a fever (102° to 104° F [38.9° to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.

    Other causes

    Diagnostic tests.An allergic reaction to contrast media used in radiologic tests may produce facial edema.

    Drugs.Long-term use of glucocorticoids may produce facial edema (described as “moon face”). Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may also cause edema.

    Surgery and transfusion.Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Edema: Edema - etiology
    (The 5-Minute Pediatric Consult)

    • Excessive losses:
      • Renal loss of protein
      • GI
    • Inadequate production:
      • Liver disease
      • Malnutrition
    • Local trauma
    • Increased hydrostatic pressure:
      • CHF
      • Pericardial effusion
      • Post cardiac surgery
      • Venous obstruction
        • Superior vena caval syndrome
        • Deep vein thrombosis
      • Lymphatic obstruction

    » READ BOOK EXCERPT ONLINE »

    Source: The 5-Minute Pediatric Consult, 2008


     » Next page: Risk Factors for Adult respiratory distress syndrome

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