Topic Resources Edema is common during late pregnancy. It typically involves the lower extremities but occasionally appears as swelling or puffiness in the face or hands. The most common cause of edema in pregnancy is Physiologic edema Physiologic edema results from hormone-induced sodium retention. Edema may also occur when the enlarged uterus intermittently compresses the inferior vena cava during recumbency, obstructing outflow from both femoral veins. Pathologic causes of edema are less common but often dangerous. They include DVT is more common during pregnancy because pregnancy is a hypercoagulable state, and women may be less mobile. Preeclampsia results from pregnancy-induced hypertension; however, not all women with preeclampsia develop edema. Peripartum cardiomyopathy can cause other nonspecific symptoms of pregnancy, including dyspnea and fatigue. When extensive, cellulitis, which usually causes focal erythema, may resemble general edema.  Evaluation of patients with lower-extremity edema during late pregnancy aims to exclude DVT, preeclampsia, peripartum cardiomyopathy, and other pathologic causes of edema. Physiologic edema is a diagnosis of exclusion. History of present illness should include symptom onset and duration, exacerbating and relieving factors (physiologic edema is reduced by lying in the left lateral decubitus position), and risk factors for DVT, preeclampsia, and peripartum cardiomyopathy. Risk factors for DVT include
Risk factors for preeclampsia include
Risk factors for peripartum cardiomyopathy include
Review of symptoms should seek symptoms of possible causes, including the following:
Examination begins with review of vital signs, particularly blood pressure. Areas of edema are evaluated for distribution (ie, whether bilateral and symmetric or unilateral) and presence of redness, warmth, and tenderness. General examination focuses on systems that may show findings of preeclampsia. Eye examination includes testing visual fields for deficits, and funduscopic examination should check for papilledema. Cardiovascular examination includes auscultation of the heart and lungs for evidence of fluid overload (eg, audible S3 or S4 heart sounds, tachypnea, rales, crackles) and inspection of neck veins for jugular venous distention. The abdomen should be palpated for tenderness, especially in the epigastric or right upper quadrant region. Neurologic examination should assess mental status for confusion and seek focal neurologic deficits. The following findings are of particular concern:
Although edema is common during pregnancy, considering and ruling out the most dangerous causes (preeclampsia, peripartum cardiomyopathy, and DVT) are important:
If preeclampsia is suspected, urine protein is measured; hypertension plus proteinuria indicates preeclampsia. Urine dipstick testing is used routinely, but if diagnosis is unclear, urine protein may be measured in a 24-hour collection. Many laboratories can more rapidly assess urine protein by measuring and calculating the urine protein:urine creatinine ratio. Proteinuria is no longer required to diagnose preeclampsia; abnormal laboratory or clinical findings of preeclampsia in patients with hypertension may also confirm preeclampsia. If DVT is suspected, lower-extremity duplex ultrasonography is done. If peripartum cardiomyopathy is suspected, ECG, chest X-ray, and echocardiography are done. BNP or NT-proBNP is measured. Specific causes of edema during pregnancy are treated. Physiologic edema can be reduced by the following:
Click here for Patient Education Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Which areas would the nurse assess when using a speculum during the examination of the patients nose?The nose should be inspected with a nasal speculum to assess nasal septal anatomy (Fig. 434-1), the most caudal aspect of the inferior turbinates (Fig. 434-2), and the possibility of large nasal polyps (Fig. 434-3) or other masses.
Which pulse the nurse palpate while assessing the inguinal area of a patient?Femoral pulse
Maximal pulsation of the femoral artery occurs immediately below the level of the inguinal ligament. Use the pads of your fingertips to press on this area.
Which lymph nodes would the nurse check while assessing the patient's neck?For which lymph nodes would the nurse check while assessing the patient's neck? Cervical lymph nodes are located in the neck region. Therefore the nurse would assess for cervical lymph node enlargement while assessing the patient's neck.
Which action will the nurse take when assessing the neck area of a patient?The nurse would test muscle strength of the neck against resistance by having the patient bend the head forward and back, turn the head to each side, and shrug the shoulders. The nurse grades tonsil size when examining the mouth and throat, not the neck.
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Which area would the nurse assess to determine the presence of pretibial edema in a patient
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