Physiological Adaptation Q 41
The best method of evaluating the amount of peripheral edema is:
A. Weighing the client daily
B. Measuring the extremity
C. Measuring the intake and output
D. Checking for pitting
Correct Answer: B. Measuring the extremity
The best indicator of peripheral edema is measuring the extremity. A paper tape measure should be used rather than one of plastic or cloth, and the area should be marked with a pen, providing the most objective assessment. The circumferential method is one of the girth measurement techniques. For consistent measurements, each upper extremity or lower extremity is marked with a semi-permanent marker at a certain part with reference to the bony prominences.
Option A: Weighing the client will not indicate peripheral edema. The accumulation of fluid occurs when local or systemic conditions disrupt this equilibrium, leading to increased capillary hydrostatic pressure, increased plasma volume, decreased plasma oncotic pressure (hypoalbuminemia), increased capillary permeability, or lymphatic obstruction.
Option C: Measuring the intake and output will not indicate peripheral edema. The most commonly used tools to measure edema are: volume measurements (with a water volumeter); girth measurements (with a tape measure); and pitting edema assessment (based on the depth and duration of the indentation). Water displacement and ankle circumference had shown a high inter-examiner agreement (intraclass correlation coefficient 0.93, 0.96 right; 0.97, 0.97 left).
Option D: Checking for pitting edema is less reliable than measuring with a paper tape measure. There are two types of edema, pitting and non- pitting edema. Pitting edema is described as an indentation that remains in the edematous area after pressure is applied. Its location, timing, and extent are determined for treatment response. It is mainly assessed on the medial malleolus, the bony portion of the tibia, and the dorsum of the foot. Non-pitting edema is seen in lymphoedema, myxedema, and lipedema.