EDEMA

CHIEF COMPLAINT

Edema

HPI
1. Concern : Swelling over _______
2. Onset : Gradual/ Sudden
3. Duration:
•Recent
•A few days
•Many days
•A few weeks
•Many weeks
•A few months
•Many months
•A few years
•Many years
•Recurrent
•N/a
4. Size-cms_____
5. Severity
•Mild
•Moderate
•Severe
•Absent
•Normal
•Increased
•Decreased
•Stable
•No significant change from prior visit
6. Location:
•Left: Upper limbs/ Lower limbs
•Right: Upper limbs/ Lower limbs
•Face
•Abdomen
•Whole body
•Details
7. Status-Pitting/Nonpitting
8. Aggravated by –
•Standing
 •Sitting
•Lying down
•Walking
•Rest
9. Relieved by
10.Associated Symptoms
11.Pertinent Negatives
12.Notes

HISTORY (PMFSH)

PAST HISTORY

• Heart diseases
• Jaundice
• Lung diseases
• Hepatitis
• Cirrhosis
• Alcoholism
• Renal disorders

FAMILY HISTORY

• Diabetes
• Hypertension
• Heart diseases
• Renal disorders

ALLERGY-Drugs
-Environment

SOCIAL HISTORY

• Habits: Alcohol / Tobacco /Drugs _____

• Occupation

ROS

PHYSICAL EXAMINATION

ABDOMINAL EXAM:
• Normal, soft, nondistended, NT, nl bowel sounds, no HSM
• Tenderness-
 o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o Details
• Mass
o Fixed
o Mobile
o Solid
o Cystic
o Tender
o Nontender
o Irregular
o Round
o of approximate size (cm.)
 0.5
 1.0
 1.5
 2.0
 2.5
 3.0
 3.5
 4.0
 4.5
 5.0
 details
• Fullness
• Bowel sounds
o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o Details
• Distention
 o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o Details
• Fluid thrill
o Present
o Absent
o Mild
o Moderate
o Severe
o Increased
o Decreased
o Details
• Adenopathy
o none
o anterior
o posterior
o lateral
o tender
o Mobile
o Shotty
o mass of approximate size (cm.)
 0.5
 1.0
 1.5
 2.0
 2.5
 3.0
 3.5
 4.0
 4.5
 5.0
 details
• Wound/incision clean, dry, healing well
• DETAILS
• Location
 o Left upper quadrant
o left lower quadrant
o right upper quadrant
o right lower quadrant
o suprapubic
o mid abdomen
o throughout
o flank
o inguinal
o N/A

LUNG EXAM:

• Normal, clear all fields

• Mild wheezes
• Severe wheezes
• Crackles
• Poor breath sounds
• Location
o all fields
o right upper field
o right mid field
o right lower field
o left upper field
o left mid field
o left lower field
o bilaterally

HEART EXAM:
• Normal, RRR, no MRG
• Rate that was
o tachycardic
o bradycardic
• rhythm was
o regularly irregular
o irregularly irregular
• Murmur
o Physiologic
o S-3
o S-4
o mitral click
SPECIFIC DATA LIKE GRADING ETC

Grading of pitting edema

1+: slight pitting/2 mm, disappears rapidly

2+: somewhat deeper pit/4 mm, disappears in 10-15 sec

3+: deep pit/6 mm, last > 1 minute; deep extremity swollen

4+: very deep pit/8 mm lasts 2-5 min, deep extremity grossly
distorted

TESTS TO BE ORDERED

•Blood tests
o Albumin levels
o Serum electrolyte tests
o CBP
o Hb%
o Heamotocriet value
o Liver function tests
o FBS
•Urinalysis
o Macroscopic
 Urine Appearance.
 Urine Bilirubin
 Urine Blood
 Urine Casts
 Urine Color
 Urine Glucose
 Urine Ketones
 Urine pH
 Urine Protein
 Specific Gravity
 Urine Urobilinogen
o Microscopic
 Urine WBS/hpf
 Urine RBC/hpf
 Urine Casts
 Urine Other
 •ECG
•Treadmill stress test
•Echocardiography
•X-rays
•USG
•T3, T4, TSH
•kidney function tests
•Transesophageal echocardiography (TEE)
•Pulmonary artery catheterization
•B-type natriuretic peptide (BNP)
•MUGA scan

DIFFERENTIAL DIAGNOSIS

BILATERAL

•Heart failure
•Cancer or enlarged lymph nodes,
•Destruction of lymph vessels by radiotherapy
•Elephantiasis
•Cerebral edema
•Pulmonary edema
•Macular edema
•Ascites
•Pleural effusions
•Urticaria
•Congestive heart failure
•Thyroid conditions
•Nephrotic syndrome
•Acute glomerulonephritis
•Chronic kidney disease
•Heart failure
•Liver failure from cirrhosis
•Drugs
o Androgenic and anabolic steroids
o Certain blood pressure medicines
o prednisone
o Estrogen
o NSAIDs
o Calcium channel blockers
o Thiazolidinediones
UNILATERAL
•DVT
•Lymphangiactasis
•Lymphatic obstruction
•Varicose vein
•Previous trauma with venous obstruction
•Failure of the muscle pump due to AFO’s
•Neuromuscular conditions

ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION

•Take potassium supplements and/or to eat foods high in potassium

o Bananas
o Orange juice
o Tomatoes
o Potatoes
•Restrict the fluid intake and sodium intake
•Monitor fluid intake and output
•Avoid alcohol

MEDICATION

•Furosemide
•Torsemide
•Butethamine
•Hydrochlorothiazide
•Metolazone
•Spironolactone
•Triamterene
•Amiloride
•Acetazolamide
•Morphine
•Nitroprusside
•Enalapril
•Captopril
•Aspirin
•Spironolactone
•Eplerenone
•Candesartan
•Irbesartan
•Olmesartan
•Losartan
 •Valsartan
•Telmisartan
•Eprosartan
•Isosorbide dinitrate
•Hydralazine
•Carvedilol
•Metoprolol

FOLLOW UP