Comprehensive Care for the Anasarca Patient

Clinical Problem

Anasarca is massive swelling or edema of the soft tissue and may cause pain in the swollen areas.¹    This 65 year old female patient with anasarca was challenged to manage lower extremity (LE) elevation and skin care as she was alone much of the day.

Past Management

The patient had frequent hospital admissions and skilled care facility (SNF) stays.  The plan of care was bed rest with LE elevation.  Once home the anasarca exacerbated with weeping of both LE and ultimately ulcerations.

Current Clinical Approach

The physician requested an evaluation by the WOCN nurse who manages a telemedicine program at a home health care agency (HHCA).  Photos were obtained and shared with the physician.  Recommendations were discussed with the physician who supported the plan of care.  The wound care protocol was established with a 100% sodium carboxymethylcellulose with ionic silver dressing to the right LE wound and gelling foam cover dressing to bilateral LE wounds with compression.  Baseline lab work, cultures, nutrition, and glucose control were initiated.  The patient was evaluated for sequential pressure pumps (SCPs) and compression garments.  The patient was taught to record daily intake and output, weights and measurements of LEs and abdominal girth.  Parameters were established for contacting the physician.  The husband was taught to manage her care.  HHCA visits decreased to twice weekly as the edema was controlled and healing progressed.

Patient Outcomes

Six weeks later all wounds were healed.  SCPs continue twice per day, and the patient became independent in LE and foot skin care.  No further acute care admissions were needed.

Conclusions

This large rural home care agency services approximately 2000 patients and frequently encounters a patient population requiring extensive teaching and management. This team approach and the protocol prepared the patient for long term management independently.

References

1. Get the Details on Anasarca  page.  Anasarca Web site.  http://www.anasarca.org/ .  Accessed 10/20/09.

SC-000086-US