Swelling of the legs in bed patients
Edema - fluid accumulation in cavities and tissuesas a result of the disturbance of water exchange. In the development of edema, the main role is played by increased diffusion of fluid from blood vessels into the tissue and fluid retention by tissue. The edema fluid is characterized by low relative density and low protein content.
Appearance of obvious edema is preceded by latentthe period of fluid retention, which is manifested by a decrease in the amount of excreted urine and the increase in body weight (determined by daily weighing). In severe cases, there are massive swelling of the legs and trunk. The skin becomes dry, smooth, pale, scaly; it is insensitive to heat. Therefore, giving the patient a warming-up, we must ensure that there are no burns. When pressing on the skin in places of edema remains a long-terminating fossa. Skin creases appear on the skin.
Patients with edema have a tendency tothe formation of bedsores, so they need to change the position in bed more often (it is best to give the patient a semi-sitting position). There should be no wrinkles or crumbs on the sheet. Under the buttocks and the rump are put an inflatable rubber circle covered with a diaper. The contiguous surfaces of the skin (under the mammary glands of women, in the inguinal folds) are powdered with talc or pierced by gauze between them. The patient's skin is wiped with an aqueous solution of alcohol, cologne or other disinfectants.
The protective properties of the skin with swelling are reduced. Therefore, if after the injection there is a hole in the skin from which the edematous fluid seeps, you need to lubricate it with iodine and apply a sterile gauze to prevent infection and suppuration.
A patient with swelling should be weighed daily andto measure its daily water balance, i.e., the ratio between liquid drunk per day and the amount of urine extracted. Drink liquid includes liquid dishes (soup, tea, fruit, etc.). The urine is collected in a separate bowl. In the morning, measure the amount of urine with a volumetric flask. The daily records of these data and the daily weighing of patients allow us to judge the dynamics of edema-their decrease or increase.
The edema fluid usually accumulates in the mostlow-lying parts of the body. With the vertical position of the body, edema appears on the legs and increases toward evening. In lying patients, swelling, in the first place, appears in the lumbar region. Renal edema appears on the face under the eyes due to the friability of the subcutaneous tissue. All patients with edema should be under the supervision of a doctor who prescribes a diet with restriction of table salt and liquid.