Edema
Edema is swelling caused by excess fluid trapped in the body's tissues. It most commonly occurs in the feet, ankles, legs, and hands (peripheral edema), but can affect any part of the body. Edema may indicate heart failure, kidney disease, liver disease, or other serious conditions that the CNA must report.
Exam Tip
Pitting edema: press skin, indent remains. Grade 1+ (2mm) to 4+ (8mm+). Elevate affected extremities. Daily weights if ordered (report 2+ lb gain in 24 hours). Edematous skin is fragile and at risk for breakdown. Report new or worsening swelling immediately.
What Is Edema?
Edema occurs when fluid leaks from blood vessels into surrounding tissues, causing visible swelling. In healthcare settings, CNAs frequently encounter edema in elderly and immobile patients. Recognizing, measuring, and reporting edema is an important CNA observation skill.
Types of Edema
| Type | Location | Common Causes |
|---|---|---|
| Peripheral edema | Feet, ankles, legs, hands | Heart failure, kidney disease, prolonged sitting/standing |
| Pulmonary edema | Lungs | Heart failure (medical emergency) |
| Pitting edema | Lower extremities | Press skin and an indentation remains |
| Non-pitting edema | Legs, feet | Lymphedema, thyroid disease |
| Dependent edema | Lowest body parts | Gravity-related, improves with elevation |
| Sacral edema | Sacrum/lower back | Common in bed-bound patients |
Pitting Edema Scale
| Grade | Depth | Rebound Time |
|---|---|---|
| 1+ (trace) | 2mm indent | Rebounds immediately |
| 2+ (mild) | 4mm indent | Rebounds in a few seconds |
| 3+ (moderate) | 6mm indent | Rebounds in 10-20 seconds |
| 4+ (severe) | 8mm+ indent | Rebounds in > 20 seconds |
CNA Responsibilities
- Observe and report any new or worsening swelling
- Elevate affected extremities as ordered (above heart level when possible)
- Measure intake and output accurately (fluid monitoring is critical)
- Weigh patient daily if ordered (same time, same scale, same clothing)
- Apply anti-embolism stockings (TED hose) if ordered
- Monitor skin over edematous areas (fragile, prone to breakdown)
- Report tight rings, shoes, or clothing that indicate new swelling
- Encourage prescribed fluid/sodium restrictions if applicable
Warning Signs to Report Immediately
- Sudden onset of swelling (especially one leg - could indicate blood clot)
- Shortness of breath with swelling (could indicate pulmonary edema)
- Rapid weight gain (2+ pounds in 24 hours or 5+ pounds in a week)
- Skin that is shiny, stretched, warm, or discolored over swollen areas
Exam Alert
CNAs must recognize and report edema. Key points: pitting edema is tested by pressing the skin and observing the indent. Elevate edematous extremities as ordered. Daily weights are essential for monitoring fluid balance (report gains of 2+ lbs/day). Edematous skin is fragile and at high risk for breakdown. Always report new or worsening swelling.
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Related Terms
Vital Signs
Vital signs are the fundamental measurements of basic body functions: temperature, pulse (heart rate), respirations (breathing rate), blood pressure, and pain (often called the "5th vital sign"). They provide critical data about a patient's physiological status and are assessed by all levels of nursing staff.
Intake and Output (I&O)
Intake and Output (I&O) is a nursing measurement that tracks all fluids entering (intake) and leaving (output) a patient's body over a specified period, typically 24 hours. Accurate I&O monitoring is essential for assessing fluid balance, kidney function, and hydration status.
Activities of Daily Living (ADLs)
Activities of Daily Living (ADLs) are the fundamental self-care tasks that individuals perform daily, including bathing, dressing, eating, toileting, transferring (mobility), and continence. Assessing ADLs helps nurses determine a patient's functional status and care needs.
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