Edema of the arm

Edema of the arm: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses

The result of excess interstitial fluid in the arm, arm edema may be unilateral or bilateral and may develop gradually or abruptly. It may be aggravated by immobility and alleviated by arm elevation and exercise.

Arm edema signals a localized fluid imbalance between the vascular and interstitial spaces. (See Understanding fluid balance, page 244.) It commonly results from trauma, venous disorders, toxins, or certain treatments.

Emergency Actions

Remove rings, bracelets, and watches from the patient’s affected arm. These items may act as a tourniquet. Make sure the patient’s sleeves don’t inhibit drainage of fluid or blood flow. If you detect signs of neurovascular compromise, elevate the arm.

History

When taking the patient’s history, one of the first questions to ask is “How long has your arm been swollen?” Then find out if the patient also has arm pain, numbness, or tingling. Does exercise or arm elevation decrease the edema? Ask about recent arm injury, such as burns or insect stings. Also, note recent I.V. therapy, surgery, or radiation therapy for breast cancer.

Physical assessment

Determine the edema’s severity by comparing the size and symmetry of the arms. Use a tape measure to determine the exact girth. Be sure to note whether the edema is unilateral or bilateral, and test for pitting. (See Differentiating between pitting and nonpitting edema, page 245.) Next, examine and compare the color and temperature of the arms. Look for erythema and ecchymoses and for wounds that suggest injury. Palpate and compare radial and brachial pulses. Finally, look for arm tenderness and decreased sensation or mobility.

Medical causes

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.

Special considerations

Treatment of the patient with arm edema varies according to the underlying cause. General care measures include elevation of the arm, frequent repositioning, and appropriate use of bandages and dressings to promote drainage and circulation. Be sure to provide the patient with meticulous skin care to prevent breakdown and formation of pressure ulcers. Also, administer an analgesic and anticoagulant as needed.

Pediatric pointers

Arm edema rarely occurs in children, except as part of generalized edema. When it does occur, it may result from such arm trauma as burns and crush injuries.

Patient counseling

Warn the patient who has undergone mastectomy or axillary lymph node dissection of the possibility of arm edema, and advise her not to have blood pressure measurements taken or phlebotomies performed on the affected arm. Teach the patient how to perform arm exercises after surgery to prevent lymphedema.

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Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

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More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

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