Edema is the abnormal swelling of some part of the body due to the retention of fluid in body tissues. Most often, when physicians refer to edema, they are talking about swelling of the lower legs or ankles. Edema is not a disease itself. Rather, it is a sign that may be related to illness or injury or may simply be related to an inappropriate life style. To treat edema, the underlying cause should be identified; appropriate treatment can then be initiated. While some of the causes of edema are minor, others may be life-threatening; therefore, any unusual swelling should be investigated by a doctor.
Swollen feet and ankles are quite common in people who are on their feet a lot, such as dentists, cashiers or barbers. The problem usually disappears with rest and an appropriate change in daily habits. If a job requires a good deal of standing, the employee should take hourly breaks to sit down and, if possible, raise the feet for a few minutes. This edema occurs when the veins in the lower extremities fail to keep pace with the arteries, the outward flow of blood lagging behind the inward flow. If the large veins of the lower extremities are actually diseased, the edema brought on by standing is likely to be very noticeable.
Swollen ankles also may be caused by tightness around the upper legs, such as that caused by garters, rolled stockings or other constricting garments. In these instances, simply not wearing such garments should end the edema.
Weak leg muscles, particularly those in the calf, also cause edema. Older women, whose leg muscles may deteriorate with normal aging, are thus highly susceptible to edema. Deep varicose veins in the legs, another frequent complaint among older people, contribute to edema as well.
Many women experience some edema just before their menstrual periods, which may be noticeable in their breasts, legs and abdominal areas. It should disappear with the onset of menstruation. Many of the hormonal changes surrounding menstruation, pregnancy and contraception can contribute to edema. It has been a troublesome problem for many women taking birth control pills. The higher the estrogen content of the pill, the more likely it is that the woman will develop edema. Reducing salt intake may help. In fact, excessive salt consumption also may be responsible for edema, in both healthy people and those with special health problems. Since salt tends to hold water in the body, restricting salt intake is frequently advised--and sometimes vital--for those with edema problems.
Organic Disease
Edema also can be a sign of the onset of kidney, liver or heart disease. Repeated episodes of leg or ankle swelling, or any unexplained episode that lasts more than a day or two, should be reported to a physician.
A frequent cause of edema is congestive heart failure, a condition in which the heart fails to pump as effectively as it should. When inadequate amounts of blood are circulating, salt and water are retained by the body in the legs and, sometimes, the abdomen. The result can be a significant weight gain amounting to 10 to 15 pounds or more.
Kidney and liver disorders are other common causes of edema. If the kidneys are unable to excrete the excess salt in the diet from the body, a buildup of body fluid may result. Edema associated with kidney disease is often first noticed as a puffiness in the face. Liver disorders, particularly cirrhosis of the liver, may also lead to excess body fluids. Some drugs, such as the beta blockers used to treat high blood pressure, also may cause sodium retention and edema, unless they are given with a diuretic.
Depending on the cause of edema, the physician may recommend a variety of treatments. Those most often recommended are the restriction of salt intake and the use of diuretics. These are medications that prevent the re-absorption of salt and water by the kidneys, thus decreasing edema and diminishing some of the symptoms of congestive heart failure.
Restricting Salt Intake
Salt is a natural component of most of the foods we eat, so we cannot eliminate it totally from our diet. However, careful monitoring of food and its preparation can eliminate much of the salt that is added during the commercial processing and the traditional cooking of foods. Remember, high quantities of salt are hidden in many foods, particularly canned soups and vegetables, TV dinners, preserved meats (such as hot dogs, ham, bacon and corned beef), cheeses and baked goods.
Summing Up
Edema is a warning sign that some normal body process has gone awry. Sometimes the problem may be localized, and a simple change in life style may eliminate the swelling. At other times, it is a symptom of a generalized disease that warrants treatment. Any recurrent swelling of the legs, or generalized body puffiness or unusual weight gain, should be investigated by a physician.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
