Case Study Chapter 8: Disorders Of Fluid, Electrolyte 060305

Casestudy Chapter 8 Disorders Of Fluid Electrolyte And Acid Base

Amanda is an 18-year-old patient diagnosed with anorexia nervosa, presenting with a dangerously low body mass index (BMI) of 13.9. Her reluctance to accept treatment and her perception that she is overweight, despite feeling tight in her clothes and experiencing swelling in her hands and feet, suggest significant fluid and electrolyte imbalances. Her nurse pointed out a low blood protein level, which is crucial in understanding her condition. In this context, the protein most likely referred to is albumin, a vital plasma protein responsible for maintaining oncotic pressure within blood vessels (Brunton et al., 2018). A deficiency in albumin impairs the colloid osmotic pressure that draws water into the bloodstream from the interstitial spaces, leading to decreased plasma volume and the development of edema. Without sufficient albumin, fluid tends to accumulate in the interstitial tissues, causing swelling and the characteristic pitting edema that Amanda exhibits, particularly visible in her extremities and face (Glen, 2020). This compromised oncotic pressure contributes significantly to her overall fluid imbalance and worsens her clinical condition.

The difference between pitting and no pitting edema lies primarily in the pattern of fluid accumulation and its response to pressure. Pitting edema is characterized by an indentation that persists after pressing the swollen area with a finger for about 5 seconds, indicating the presence of fluid in the interstitial space that is displaced temporarily (Dains et al., 2018). This type of edema often results from increased hydrostatic pressure, such as in congestive heart failure or severe protein deficiency, which allows excess fluid to leak into the interstitium. Conversely, non-pitting edema does not leave an indentation and occurs when fluid accumulates in the subcutaneous tissue in a way that prevents the tissue from compressing, often due to inflammatory conditions or lymphatic obstruction (Glen, 2020). Understanding this distinction helps clinicians determine the underlying pathology and guide appropriate treatment strategies for edema management in patients like Amanda.

Amanda’s weakened state necessitates restricted mobility, often requiring her to be moved using a wheelchair when not on bed rest. This reduced activity level further influences her edematous tissues. Immobilization decreases the muscle pump activity, which normally aids in the return of venous blood and lymph from the extremities to the central circulation (Brunton et al., 2018). When muscles are inactive, the propulsion of blood and lymph diminishes, exacerbating venous stasis and increasing hydrostatic pressure in the lower limbs. This elevated pressure encourages more fluid to shift into the interstitial space, intensifying the edema (Glen, 2020). Moreover, immobility reduces lymphatic drainage, which is vital for removing excess interstitial fluid, thereby worsening swelling. Therefore, Amanda’s decreased mobility not only contributes to the persistence of edema but also complicates her overall clinical picture, emphasizing the importance of gentle mobilization and supportive measures to reduce fluid accumulation.

References

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