Question about localized peripheral edema..please help?!

[andreabenetrn]

Question about localized peripheral edema?

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Hello,
this is my first post ever, so please correct me if I am doing anything wrong. My patient is 11 years old, he has Lennox-Gastaut Syndrome (a rare form of epilepsy), chronic lung disease, and he is mentally and physically disabled. He is completely dependent for ADL's, can't walk, talk,etc.. My question is this.. He has developed swelling in his left arm from his wrist to his shoulder. Lungs and heart sounds are clear. NO pitting, the arm is not warm , and the color is the same as the other arm. Could there be a blockage Blood or lymphedema perhaps? I am stumped by the cause of this swelling. I am a new nurse with little experience, and would be very grateful if you could give me some ideas of what could be happening here. This is the second time this has happened to him in the past two weeks, and before this it has never occurred according to his parents. please give me some insights.?? Thank you.

I also had this thread posted in a different forum, so disregard that if you see it there until I get it deleted thanks.

[cassioo]

what does the doctor say? what tests have been done? does it go away with positioning? is that arm dependent? I would think if it goes away it's not blockage.

[kimmiejs]

Originally Posted by andreabenetrn

Question about localized peripheral edema?

--------------------------------------------------------------------------------

Hello,
this is my first post ever, so please correct me if I am doing anything wrong. My patient is 11 years old, he has Lennox-Gastaut Syndrome (a rare form of epilepsy), chronic lung disease, and he is mentally and physically disabled. He is completely dependent for ADL's, can't walk, talk,etc.. My question is this.. He has developed swelling in his left arm from his wrist to his shoulder. Lungs and heart sounds are clear. NO pitting, the arm is not warm , and the color is the same as the other arm. Could there be a blockage Blood or lymphedema perhaps? I am stumped by the cause of this swelling. I am a new nurse with little experience, and would be very grateful if you could give me some ideas of what could be happening here. This is the second time this has happened to him in the past two weeks, and before this it has never occurred according to his parents. please give me some insights.?? Thank you.

I also had this thread posted in a different forum, so disregard that if you see it there until I get it deleted thanks.

Has the MD checked any labs recently. I would wonder about his Albumin and Total Protein Level is. A severe loss of protein from the bloodstream into the urine (proteinuria) results, lowering the protein content of the blood and resulting in fluid retention, or edema. An US might give some answers as well.
I hope this helps

[andreabenetrn]

The Doctors say it could be lymph blockage, or his VNS,(Vagal Nerve Stimulator) which is implanted in his left upper chest area, could be inflamed. He saw his neurologist, pulmonologist, and his pediatrician today, and they are not sure of the cause. They all had a different guess, and did not seem concerned enough to order further tests or blooxdwork; just an x-ray, which showed us that his arm is not "fractured or broken". It could be his heart, or his lungs, or lymph, they say...do you think the lack of concern is because of his recent commencement of Hospice care? I guess my concern could be unwarranted, but I see no need for unnecessary suffering if a simple bloodtest or U/A may be able to help? Do you think that I am wrong for thinking this way? He is just 11 years old! It is very hard for me to see him suffer, I am working on my "healthy detatchment skills", but as a new, inexperienced nurse, it is quite a difficult situation for me. Let me know what you think....Thank you......Andrea