By Patty Kunze, BSN, RNC and Roberta Palmer, RN 

The nurses writing for The Rollin’ RNs decide on topics based on our own findings. This topic is no different. You all know the story of my husband passing and how difficult it became to create meals and eat alone. Because of this, I decided to fill my fridge with frozen fast-fix meals. After several days of consuming that frozen food, I noticed my legs and feet were extremely edematous. Swollen to the point I was unable to put shoes on, “Flintstoes” you might call them. Upon investigating the sodium contents of some of those choices, I found one potato skin appetizer had 440 mg sodium in one skin. You can do the math in a portion and the other foods were no different. So, this Rollin’ RN is back to reading labels on food and eating plenty of fruits and vegetables. We will discuss dependent edema and what we can do to prevent them while sitting in our chairs.

Dependent edema is a condition in which there is an accumulation of fluid underneath the skin that causes abnormal swelling. This usually happens in areas of the body that are lower than the heart. Alright, that’s the official definition and it happens to all of us who live life in the sitting position for hours during the day, but why and how do you prevent it?


Dependent edema is caused by the effects of gravity and occurs when fluid pools in the lower parts of the body, including the feet, legs, or hands. Rereading that last sentence, GRAVITY is the cause. GRAVITY. Simple as that. GRAVITY. So now we know the cause but why? The blood is pumped back from feet toward the heart by the veins and the motion of the muscles. When this system malfunctions, the lower body parts begin to fill up with excess fluid, causing the swelling and puffiness of edema. OK, breaking that down, blood is pumped BACK from the feet toward the heart by the motion of the MUSCLES. There you go, our lower muscles forgot how to function as they once did. Because they don’t work as they once did prior to our spinal cord injury, the fluid that is caused by gravity to accumulate in our lower extremities doesn’t pump fluid back towards the heart.
Symptoms of dependent edema:

· difficulty putting on shoes and socks due to swelling

· shiny skin

· stretched-looking skin

To differentiate between dependent edema and one of the other types of edema, apply gentle pressure to the affected area. If dents appear on the skin, which is known as pitting, it suggests dependent edema.

Treatment for dependent edema: These treatment options are self-explanatory to all of us but I am using them as a reminder.

· Elevate the affected body parts –elevation needs to be above the level of the heart to be truly beneficial but if that is not an option, then any elevation will aid in decreasing edema.

· Use compression stockings (TEDS)

· Manually move body parts effected

·
-Reduce salt intake. This is a huge culprit of our edema. Sodium is necessary for the body to function but 186 mg is all that is actually necessary. The Institute of Medicine (IOM) recommends that healthy adults consume 1,500 mg (1.5 grams) of sodium per day. Read food labels before consumption. Don’t omit fluids, sodas are a culprit too. Add up your total sodium daily content. You may be surprised and you may be able to delete some when you are aware of the numbers.

· Massage extremities. This one was new to me, really. Nurses can be receptive to new ideas. I tried massaging my feet while watching TV in the evening. My feet were swollen from the day, I exercised them, massaged, and rubbed in some lotion. Next morning my bladder was full and my feet were decreased in size.

THE MAJOR WARNING HERE IS BE CERTAIN THERE IS NO HISTORY OF BLOOD CLOTS, REDNESS OR WARMTH IN EXTREMITY. IF ANY OF THE SYMPTOMS OCCUR, DO NOT MASSAGE YOUR EXTREMITIES. IMMEDIATELY GO TO THE EMERGENCY ROOM FOR EVALUATION.

· Skin hygiene – Once our feet get edematous and shoes are difficult to place on our feet, skin hygiene is so necessary.

· Foot protection – wear shoes to avoid injury. I know some prefer to be barefoot but that’s not really a good idea because we can easily run into cabinets with sharp edges and we are totally unaware until we look down and oops.

Foot and leg edema are difficult to avoid with daily hours sitting in a chair.

Give your feet a little LOVE in the evening before bedtime. They will thank you in the morning. It’s all good, so keep on rollin’.

Patty, BSN, RNC and Roberta, RN

The ROLLIN’ RNs™

References

Official dietary recommendations. Obtained February 19, 2019 from https://www.healthline.com/nutrition/sodium-per-day#recommendations.

What is dependent edema? Medical News Today. Obtained February 13, 2019 from https://www.medicalnewstoday.com/articles/320986.php.