Cause of the edema
Select one of the following discussion questions below. Post a substantive initial response with references.
Option 1)
L.G. is a 5-year-old boy being seen in the pediatric clinic for a yearly physical examination.
Subjective Data
The patient is accompanied by a parent (mother)
The mother said that the child takes no medications and is healthy.
Patient attends preschool
Plays T-ball
There are no smokers in the house
Lives with mother and father
Objective Data
Vital signs: T 37 P 124 R 12 BP 104/64
Weight: 35 lb
Height: 52 inches
Immunizations: Up to date
Questions
What should the nurse include in the general inspection of this patient?
What observations are important regarding physical appearance and hygiene?
How should a 5-year-old child be assessed?
What teaching is appropriate for this age group?
Option 2)
J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen toes on his right foot. He does not recall injuring his foot.
Subjective Data
Pain level is a 6/10 location = right foot, throbbing
Works as a truck driver
Objective Data
Vital signs: T 37 P 80 R 14 BP 120/68
+2 edema great toe and second toe, right foot, warm to touch
+ pulses
+2 capillary refill
Questions
What other assessments should be included for this patient?
From the readings, what is the most probable cause of the edema?
What are two known nursing diagnoses?
What would be included in the nursing care plan?
What interventions might be included in the plan of care for this patient?
Sample Solution
Option 1: L.G., 5-Year-Old Boy's Physical Examination
General Inspection:
- Posture and gait: Observe L.G.'s posture while standing and sitting, and note any abnormalities in gait or coordination.
- Overall health: Assess L.G.'s general appearance for signs of illness or malnutrition, including skin color, facial expression, and energy level.
- Development: Look for age-appropriate growth and development, taking into account height and weight measurements.
Full Answer Section
Physical Appearance and Hygiene:
- Skin: Check for any rashes, lesions, or dryness. Examine hair and scalp for cleanliness and parasites.
- Eyes, ears, nose, throat (EENT): Assess for any redness, discharge, or abnormalities.
- Oral hygiene: Check for cavities, gum inflammation, and proper brushing technique.
- Clothing and footwear: Ensure clothes are clean and appropriate for the weather, and footwear is in good condition.
Assessment of a 5-Year-Old Child:
- Developmental screening: Use age-appropriate tools to assess L.G.'s cognitive, social, emotional, and motor skills.
- Vision and hearing: Perform simple vision and hearing tests to identify any potential problems.
- Nutritional assessment: Discuss L.G.'s diet and eating habits with the mother to identify any nutritional deficiencies or concerns.
- Immunization review: Verify that L.G.'s immunizations are up to date and discuss any necessary boosters.
- Safety and accident prevention: Discuss age-appropriate safety measures with the mother, focusing on areas like car seat safety, playground safety, and poison control.
Teaching for a 5-Year-Old Child:
- Use simple and age-appropriate language.
- Focus on one topic at a time.
- Engage L.G. in the learning process through interactive activities and demonstrations.
- Provide positive reinforcement and encouragement.
- Topics could include handwashing, healthy eating habits, dental hygiene, safety rules, and basic body awareness.
References:
- Bright Futures Guidelines: https://brightfutures.aap.org/
- American Academy of Pediatrics: https://www.aap.org/
This response provides a comprehensive overview of the key elements to consider during L.G.'s physical examination, including general observations, physical appearance, age-specific assessments, and appropriate teaching strategies.
I hope this is helpful! Please let me know if you have any other questions.
Note: I am not a medical professional and this information is for educational purposes only. Please consult with a qualified healthcare provider for any specific medical concerns.
Option 2: J.P., 45-Year-Old Man with Swollen Toes
Additional Assessments:
- History: Obtain a more detailed history of the edema, including onset, duration, any worsening factors, and any recent injuries or medical conditions.
- Palpation: Palpate the affected area for tenderness, warmth, and fluctuance (fluid-filled).
- Temperature: Take the patient's temperature to rule out infection.
- Lymphatic system: Assess lymph nodes in the groin and inguinal area for swelling or tenderness.
Probable Cause of Edema:
Based on the limited information, the most likely cause of J.P.'s edema is acute lymphedema due to an unknown cause. Other possibilities include cellulitis, gout, or a deep vein thrombosis (DVT). Further assessment is needed to confirm the diagnosis.
Nursing Diagnoses:
- Acute pain related to inflammation in the right foot.
- Risk for impaired skin integrity related to edema in the right foot.
Nursing Care Plan:
The care plan would focus on pain management, edema reduction, and preventing skin complications. It may include:
- Elevation: Elevate the affected foot above heart level to promote lymphatic drainage.
- Compression: Use compression stockings or wraps to reduce swelling.
- Cold therapy: Apply ice packs to the affected area to reduce inflammation and pain.
- Pain medication: Administer pain medication as prescribed by the doctor.
- Skin care: Maintain good skin hygiene and moisturize the affected area to prevent dryness and cracking.
- Monitoring: Monitor the edema for any worsening or changes in skin color or temperature.
- Referral: Refer J.P. to a doctor for further investigation and treatment.
Interventions:
- Implement the elements of the care plan mentioned above.
- Educate J.P. about the importance of elevating his foot, wearing compression stockings, and maintaining proper skin care.
- Encourage J.P. to report any worsening of symptoms or development of new symptoms.
- Monitor vital signs and assess the effectiveness of interventions.