Edema of the leg
Leg edema is a common sign that results when excess interstitial fluid accumulates in one or both legs. It may affect just the foot and ankle or extend to the thigh, and may be slight or dramatic, pitting or nonpitting.
Leg edema may result from venous disorders, trauma, and certain bone and cardiac disorders that disturb normal fluid balance. (See Understanding fluid balance,page 225.) It may result from nephrotic syndrome, cirrhosis, acute and chronic thrombophlebitis, chronic venous insufficiency (most common), cellulitis, lymphedema, and drugs. However, several nonpathologic mechanisms may also cause leg edema. For example, prolonged sitting, standing, or immobility may cause bilateral orthostatic edema. This pitting edema usually affects the foot and disappears with rest and leg elevation. Increased venous pressure late in pregnancy may cause ankle edema. Constricting garters or pantyhose may mechanically cause lower-extremity edema.
History and physical examination
To evaluate the patient, first ask how long he has had the edema. Did it develop suddenly or gradually? Does it decrease if he elevates his legs? Is it painful when touched or when he walks? Is it worse in the morning, or does it get progressively worse during the day? Ask about a recent leg injury or recent surgery or illness that may have immobilized the patient. Does he have a history of cardiovascular disease? Finally, obtain a drug history.
Begin the physical examination by examining each leg for pitting edema. (See Edema: Pitting or nonpitting?page 226.) Because leg edema may compromise arterial blood flow, palpate or use a Doppler to auscultate peripheral pulses to detect an insufficiency. Observe leg color and look for unusual vein patterns. Then palpate for warmth, tenderness, and cords, and gently squeeze the calf muscle against the tibia to check for deep pain. If leg edema is unilateral, dorsiflex the foot to look for Homans'sign, which is indicated by calf pain. Finally, note skin thickening or ulceration in edematous areas.
Medical causes
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.
Nursing considerations
▪ Provide an analgesic and antibiotic as needed.
▪ Prepare the patient for the application of a compression boot (Unna's boot), if indicated, to help reduce edema.
▪ Monitor the patient's intake and output, and check his weight and leg circumference daily to detect any change in the edema.
▪ Prepare the patient for diagnostic tests, such as blood and urine studies and X-rays.
▪ Monitor the affected extremity for skin breakdown.
▪ Elevate the affected extremity.
Patient teaching
▪ Tell the patient avoid prolonged sitting or standing, to elevate his legs as necessary, and not to cross his legs.
▪ Teach the application of antiembolism stockings or bandages.
▪ Instruct the patient in appropriate leg exercises.
▪ Explain food or fluid restrictions.
▪ Explain the underlying cause of the edema and its treatment.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Ear swelling
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