Peripheral edema

Diuretics have become the cornerstone of all treatment regimens of CHF (III—II3). They can reheve symptoms of pulmonary and peripheral edema. In mild CHF, the thia2ide-type diuretics are adequate unless the GFR falls below 30 ml,/min, as compared to 120 ml,/min in normal subjects. Diuretics improve left ventricular function in CHF due in part to decrease of preload. Indapamide has been shown to cause reduction of pulmonary arterial pressure and pulmonary wedge pressure. 

If the drug is given is given to treat congestive heart failure (ie, carvedilol), the patient is assessed for evidence of the disease, such as dyspnea (especially on exertion), peripheral edema, distended neck veins, and cough. 

The nurse should assess patients receiving the calcium channel blockers for signs of CHF dyspnea, weight gain, peripheral edema, abnormal lung sounds (crackles/rales), and jugular vein distention. Any symptoms of CHF are reported immediately to the primary healtii care provider. 

Hot flushes, hypertension, dizziness, paresthesia, insomnia, rash, constipation, nausea, diarrhea, nocturia, hematuria, peripheral edema, bone pain, dyspnea, general pain, back pain, asthenia, infection... 

Lethargy, dizziness, insomnia, anorexia, nausea, sexual dysfunction, headache, emotional lability, depression, sweating, acne, breast atrophy, peripheral edema, lower urinary trad symptoms, hot flashes, pain, edema, upper respiratory tract infedion, rash... 

Nicardipine 1-A hour 5-10 minute 2.5-15 mg/hour Tachycardia, headache, heart failure, flushing, peripheral edema Long half-life, precluding rapid titration... 

Peripheral edema (e.g., pedal edema, which is swelling of feet and ankles)... 

Amlodipine Hypotension, dependent peripheral edema, gingival hyperplasia BP every shift during oral administration during hospitalization, then every 6 months following hospital discharge dental exam and teeth cleaning every 6 months... 

The pathophysiologic mechanisms of portal hypertension and of cirrhosis itself are entwined with the mechanisms of ascites (Fig. 19-3). Cirrhotic changes and the subsequent decrease in synthetic function lead to a decrease in production of albumin (hypoalbuminemia). Albumin is the major intravascular protein involved in maintaining oncotic pressure in the vascular system low serum albumin levels and increased capillary permeability allow fluid to leak from the vascular space into body tissues. This can result in peripheral edema, ascites, and fluid in the pulmonary system. The obstruction of hepatic sinusoids and... 

The target in treating ascites is to effect a fluid loss of approximately 0.5 L per day.22 Because ascites equilibrates with vascular fluid at a much slower rate than does peripheral edema, aggressive diuresis is associated with intravascular volume depletion and should be avoided unless patients have concomitant peripheral edema. Patients with peripheral edema in addition to ascites may require increasing furosemide doses until euvolemia is achieved intravenous diuretics are often necessary.22 Diuretic therapy in cirrhosis is typically lifelong. 

Evaluate effectiveness of diuretic therapy with regard to ascitic fluid accumulation and development of peripheral edema. Ask the patient directed questions about abdominal girth, fullness, tenderness, and pain. Weigh the patient at each visit, and ask the patient to keep a weight diary. Assess for peripheral edema at each visit. 

Severe, acute respiratory acidosis produces a variety of neurologic abnormalities. Initially these include headache, blurred vision, restlessness, and anxiety. These may progress to tremors, asterixis, somnolence, and/or delirium. If untreated, terminal manifestations include peripheral vasodilation leading to hypotension and cardiac arrhythmias. Chronic respiratory acidosis is typically associated with cor pulmonale and peripheral edema. 

Gabapentin Modulate calcium channels and enhance GABA activity Loading dose Not recommended due to short half-life Maintenance dose 900-3600 mg/day in 3-4 divided doses (doses up to 1 0,000 mg/day have been tolerated) Half-life Not established 5-7 hours (proportional to creatinine clearance) Apparent volume of distribution 0.6-0.8 L/kg Protein binding less than 10% Primary elimination route Renal Drowsiness, sedation Peripheral edema, weight gain... 

Combination OC 30-40 meg formulations24 gastrointestinal (Gl) upset, headache, peripheral edema... 

INVEST79 Peripheral edema (amlodipine) Caution with heart rate less than 60 bpm (verapamil, diltiazem) Extended-release formulations are preferred for once- or twice-daily medication administration... 

It is this reduction in preload that, in some cases, is beneficial to patients experiencing heart failure or hypertension. Unlike a healthy heart, a failing heart is unable to pump all of the blood returned to it. Instead, the blood dams up and overfills the chambers of the heart. This results in congestion and increased pressures in the heart and venous system and the formation of peripheral edema. Because the failing heart is operating on the flat portion of a depressed cardiac function curve (see Figure 14.2), treatment with diuretics will relieve the congestion and edema, but have little effect on stroke volume and cardiac output. 

Anastrazole -nonsteroidal aromatase inhibitor -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes... 

Leuprolide -LHRH agonist -endocrine effects -hot flashes -decreased libido -gynecomastia (3%) -breast tenderness -impotence (2%) -nausea and vomiting (uncommon) -transient increase in bone pain -peripheral edema -dizziness, headache... 

E 67. A 76-year-old male with a combined history of bronchiogenic carcinoma and CHF is maintained on a diuretic to control pulmonary and peripheral edema. Recent measurement of blood electrolytes reveals an elevated serum Ca2. ... 

The answer is c. (Katz ng, p 239. Hardman, pp 772—773.) Constipation, particularly severe with verapamil, may occur with Ca channel blockers. In addition, excessive vasodilation may also occur. This can cause dizziness, hypotension, headache, flushing, nausea, and diminished sensation in fingers and toes. Constipation, lethargy, nervousness, and peripheral edema are also seen with the use of Ca channel blockers. 

Hot flushes, leg cramps, venous thromboembolism, peripheral edema, rare cataracts and gallbladder disease black box warning for fatal stroke... 

Fluid overload can result in pulmonary congestion and peripheral edema. Nonspecific symptoms may include fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite, ascites, mental status changes, and weight gain. 

Physical examination findings may include pulmonary crackles, an S3 gallop, cool extremities, Cheyne-Stokes respiration, tachycardia, narrow pulse pressure, cardiomegaly, symptoms of pulmonary edema (extreme breathlessness, anxiety, sometimes with coughing pink, frothy sputum), peripheral edema, jugular venous distention, hepatojugular reflux, and hepatomegaly. 

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