Edema and Home Health
By Ralph Santos,
Center4PT Services, Inc.
January 2016
In the home
health setting we often encounter cases of edema which typically occur in the
bilateral lower extremities. This edema
can often deter the patient’s ability to perform their activities of daily
living (ADLs), can cause a decreased active range of motion (AROM), can
contribute to pain or discomfort, can negatively affect our clients emotional
well being, can disrupt our clients circadian rhythms, can induce harmful
stress levels and so much more. As home
health therapists we need to understand what are the causes of the edema, how
to properly assess and document the edema and how to properly treat the edema.
Causes of
edema. Edema or swelling is the
accumulation of fluids in the tissues which can be attributed to either a
systemic cause. The
organs that generally contribute to the systemic related edema are the liver,
the heart and the kidneys which can be related to excessive sodium levels. Another cause of edema related to the liver
and the kidneys can be a decrease in albumin levels.
Pitting
Edema versus Non Pitting Edema. Edema is
often measured by two subjective tests:
(1) how deep is the space on the limb after you release pressure with a
finger and (2) how long will it take for the limb to return to its resting
state. Pitting edema can be seen by
applying pressure with ones fingers to the affected limb or in many of my patient’s
case, by removing their shoe or socks and looking for what appears to be a tourniquet
or indentation caused by the shoe or sock.
In non pitting edema, the skin does not indent and one of the major causes
for non pitting edema can be the diagnosis of lymphedema which affects the
lymph system. My own experience is that
with lymphedema the cause is related to breast cancer with a subsequent
mastectomy, lymph node surgery, radiation therapy and or an increased stress
level. Other reasons for non-pitting
edema may be a low thyroid level or a deep vein thrombosis (DVT).
Here is a
scale that I found in the 2015 Corridor Group Therapy Quickflips:
Edema Score
|
Scale
|
Depth of Pitting
|
Response time to Refill
|
Trace
|
1+
|
Slight
|
Rapid
|
Mild
|
2+
|
0.6
cm (0-1/4 in)
|
10-15
Seconds
|
Moderate
|
3+
|
0.6
– 1.3 cm (1/4 in – ½ in)
|
1-2
Minutes
|
Severe
|
4+
|
1.3
– 2.5 cm (1/2 in – 1 in)
|
2-5
Minutes
|
I can
honestly say that assessing edema can be quite subjective but this scale and others
like the:
1. O’Sullivan, S.B. and
Schmitz T.J. (Eds.). (2007). Physical rehabilitation: assessment and treatment
(5th ed.). Philadelphia: F. A. Davis Company. p.659
2. Hogan, M (2007)
Medical-Surgical Nursing (2nd ed.). Salt Lake City: Prentice Hall
are other
options, with the bottom line being that we as home health therapists need to
be consistent when documenting edema.
How to treat
edema? The conservative edema reduction
strategies can include:
(1) Teach
and encourage active range of motion exercises (AROM) to help with circulation
and assist the heart in pumping excess fluid.
(2) Elevating the affected limb above the level
of the heart. I usually tell my patients
to elevate their limb(s) when going to sleep since we spend half of our lives
in bed. I also tell my patients to avoid
dependent positions during the day using chairs with arm rests, splints and other
external devices for positioning.
(3) A very superficial massage where you elevate
the limb above the heart and massage the fluids back towards the heart may be
helpful. When I was going to school,
this was often referred to as a retrograde massage and when I got my certification
in lymphedema, I learned that the lymph system is very superficial and a light
massage is often very effective.
(4) Compression via TED Hoses or other
garments. These garments provide a
certain amount of MM Hg (millimeter of mercury) and are often prescribed by a
physician. The only problem with these
garments is the actual donning/doffing process but otherwise it will help with
preventing fluid from collecting in the tissue.
(5) Skin
Hydration. I always tell my patient’s to
keep their skin clean and well moisturized.
I usually recommend an aloe vera based lotion during the summer months
and a butter based lotion during the winter months. I myself stay away from thick oil based
lotions such as A&D, unless there is a certain medical reason to use said
lotions.
(6)
Salt. Reducing the amount of foods that
contain sodium is essential. A
television dinner, a microwavable noodle soup, and other foods that our
patients consume due to ease of preparation contain a ton of sodium and this
will only contribute to their edema battles.
Finally, the
physicians will often look at other treatments such as using diuretics which
have their own pros and cons. My thought
is that we as home health therapists need to be cognizant of the causes of
edema, how to properly assess/document edema, and how to teach our patients to
incorporate conservative edema reduction strategies.
Sources:
1. Therapy Quikflips, The Corridor Guide for
Home Health Therapists. 2015.
2. http://www.mayoclinic.org/
3. http://www.medicinenet.com/
4. http://geriatrictoolkit.missouri.edu/cv/pitting_edema.htm
As a clinician and active owner of the Center4PT Services,
Inc., I believe that client care is the utmost priority with our company being
on the leading edge with its customer care!
We are home health staffing agency that partners up with skilled home
health agencies and hospice agencies in the Los Angeles County to provide
skilled Physical Therapy, Occupational Therapy, Speech Therapy and Social Work
Services for homebound clients. Our
mission is to be the leading provider of in-the-home Therapy Services in the
Greater Los Angeles area by providing Timely, Quality, Efficient, &
Competent Therapy Services to all of the Clients that we Serve!
Our focus is on the rehabilitation of our clients and
ensuring that our clients get better and progress towards independence! We know that through hard work and through
perseverance our clients get better, stronger faster! We also realize that in today's medical model
we have to do more with less with often medical insurers authorizing less
visits and demanding more functional results.
We have made many adaptations to include using on line resources for our
clients and making those vital phone calls to ensure that our clients indeed
are making gains with our staff.
I cannot stress enough how important it is for our staff to
be competent and compassionate towards each other and towards our clients. If you are looking for a solid home health
company with lots of experience and lots of support, then the Center4PT
Services, Inc. is your new home!
(626) 683-9959 Office Email: Ralph@Center4PT.com
(626) 683-9969 Fax Website:
www.Center4PT.com
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