Edema of the arm

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 225.) It commonly results from trauma, venous disorders, toxins, or certain treatments.

Action stat!

Remove rings, bracelets, and watches from the patient's affected arm. These items may act as a tourniquet. Make sure that the patient's sleeves don't inhibit fluid drainage or blood flow. Elevate the affected extremity.

History and physical examination

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.

Determine the edema's severity by comparing the size and symmetry of both arms. Use a tape measure to determine the exact girth, and mark the location where the measurement was obtained in order to make comparative measurements later. Make sure to note whether the edema is unilateral or bilateral, and test for pitting. (See Edema: Pitting or nonpitting?page 226.) Next, examine and compare the color and temperature of both 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. If you detect signs of neurovascular compromise, elevate the arm.

Medical causes

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.

Nursing considerations

▪ Elevate the arm and frequently reposition the patient.

▪ Use bandages and dressings as needed to promote drainage.

▪ Provide meticulous skin care to prevent breakdown and formation of pressure ulcers.

▪ Administer an analgesic and anticoagulant as needed.

Patient teaching

▪ Instruct the patient in postoperative arm care.

▪ Teach the patient arm exercises to prevent lymphedema.

▪ Explain the underlying cause of the patient's arm 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.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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