These can include albumin and pre-albumin levels, liver function tests, cardiac ECHO, chest x-ray, and abdominal X-ray or ultrasound to assess ascites. Many times we will give colloids which are large-molecule fluids to help increase the oncotic pressure within the intravascular space.
Family will often find the edema very troubling especially when it is extensive , so calm explanations about how fluid shifts occur can be helpful in assuaging their anxiety. Hope that helps you understand the basics of third-spacing, something you will definitely see a LOT in the clinical setting! What other topics would you like to see covered? Let us know in the comments below! Get this on audio in episode of the Straight A Nursing Podcast. Save Save Save Save. Being a successful nursing student is more than just study tips and test strategies.
A blood clot causing venous congestion will also produce inflammation and cause edema from increased vascular permeability. Edema often results from a reduced osmotic pressure and manifests during many disease processes. Edema due to hypoproteinemia is a commonly recognized form. Decreased COP is commonly due to hypoalbuminemia. The most commonly seen causes of hypoproteinemia are usually related to protein loss from the vasculature or organs gastrointestinal or renal systems , or decreased production from the liver.
Remember that as proteins are either lost from organs or are at too low number the oncotic pull of the remaining proteins in the vasculature is less and fluid will be attracted to those areas that have higher concentrations peritoneum or pleural space. Examples include: protein losing enteropathy, protein losing nephropathy, and liver failure. The resulting edema manifests as third spacing of fluids into the pleural or peritoneal cavity or accumulation within the interstitium.
Edema formation due to lymphatic obstruction can be exemplified in patients that have a neoplastic disease process or post surgical swelling that obstructs lymphatic flow. Lymphoma patients with large lymph nodes in the neck or groin area may have facial, airway, or rear leg swelling. Chemotherapeutics to shrink lymph node size and external warm packs to promote blood flow would be beneficial. Sodium retention is an inciting cause of edema formation.
Sodium is a solute that is freely transportable across cell membranes meaning that it will attempt to equalize in both the intracellular and extracellular space. In cases of renal failure where the kidneys cannot excrete sodium adequately, increasing levels of sodium will occur in the extracellular space. As a result the osmotic pressure of the interstitial space may become greater than the osmotic pressure of the intravascular space.
A pressure gradient will form that serves to pull fluid out into the interstitial space. And finally, edema may form as a result of inflammation, ischemia, or sepsis causing increased permeability of cell membranes. Insults to the vascular endothelium, result in cellular membranes that become increasingly permeable or "leaky" and allow larger size particles to exude into the interstitium.
Once the larger size particles leak out into the interstitium, osmotic pressure gradients are created and serve to pull more fluids out of the vasculature. Any disease process causing ischemia to tissues or systemic inflammation response may manifest with complications of edema. Cases of severe pancreatitis are widely recognized as developing considerable tissue edema and bicavitary pleural and abdominal effusion.
Edema can present as a life-threatening condition or a more chronic complication of disease. In cases of heart failure and pleural effusion immediate action is necessary. The use of diuretic drugs and thoracic drainage would be indicated. Treatment for nonemergent presentations would be focused on treating the underlying disease while attempting management of tissue or cavitary edema. Diuretics are very commonly used to manipulate increased hydrostatic pressure and increased sodium retention edemas.
Local management of edema is indicated in some cases of lymphatic obstruction edema where very large lymph nodes or swelling of an extremity may be involved. A wide range of conditions can lead to third spacing, usually those that cause severe trauma, obstruction, or inflammation , such as:.
There are two distinct phases of third spacing. Phase 1 is also called fluid loss. In this phase, fluid moves from the blood into the interstitial spaces or body cavities. This typically occurs directly following surgery, trauma, or any other cause of severe inflammation, and lasts for 48—72 hours. During Phase 1, the smallest blood vessels, the capillaries, become more fragile and permeable.
When this occurs, they allow fluids and proteins to leak into areas where inflammation, trauma, or obstructions develop. Phase 2 is also called reabsorption. In this phase, capillaries start to heal and regain their normal permeability, blockages clear, and fluid volume shifts back into the blood. Once in the blood, the kidneys eventually excrete these fluids. Phase 2 usually occurs once someone is recovering in the hospital. Healthcare professionals may monitor someone for signs that the circulatory system has become overwhelmed, such as:.
If surgery leads to third spacing, most people complete phase 2 and recover on the third day after surgery. It is usually difficult to tell whether someone is experiencing third spacing. This makes it harder to diagnose the condition early and reduce the risk of complications. During or after surgery or a major disease or trauma, third spacing may trigger some symptoms that doctors, nurses, or medical monitoring may pick up on, such as:.
The best treatment for third spacing usually depends on the underlying cause and phase of the condition. Managing phase 1 typically includes administering intravenous fluids , often crystalloid or colloid fluid. Doctors may also give people hypertonic fluids before undergoing anesthesia and isotonic fluids during surgery. During Phase 1, healthcare professionals will monitor various vital signs to avoid complications, such as:.
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