Edema

Edema refers to the swelling of tissues that result from excessive accumulation of fluid within the tissue. Edema can be highly localized as occurs in a small region of the skin subjected to a bee sting. Edema, however, can also comprise an entire limb, specific organs such as the lungs (e.g., pulmonary edema) or the whole body.
General principles
To understand how edema occurs, it is first necessary to explain the concept of tissue compartments. There are two primary fluid compartments in the body between which fluid is exchanged - the intravascular and extravascular compartments. The intravascular compartment contains fluid (i.e., blood) within the cardiac chambers and vascular system of the body. The extravascular system is everything outside of the intravascular compartment. Fluid and electrolytes readily move between these two compartments. The extravascular compartment is made up of many subcompartments such as the cellular, interstitial, and lymphatic subcompartments, and a specialized system containing cerebrospinal fluid.
The movement of fluid and accompanying solutes between compartments (mostly water, electrolytes, and smaller molecular weight solutes) is governed by physical factors such as hydrostatic and oncotic forces. These forces are normally balanced in such a manner the fluid volume remains relatively constant between the compartments. If the physical forces or barriers to fluid movement are altered, the volume of fluid may increase in one compartment and decrease in another. In some cases, total fluid volume increases in the body so that both intravascular and extravascular compartments increase in volume. This can occur, for example, when the kidneys fail to excrete sufficient amounts of sodium and water. When the fluid volume within the interstitial compartment increases, this compartment will increase in size leading to tissue swelling (i.e., edema). When excess fluid accumulates within the peritoneal space (space between the abdominal wall and organs), this is termed "ascites." Pulmonary congestion, which can occur in heart failure as the left atrial pressure increases and blood backs up in the pulmonary circuit, causes pulmonary edema.

A model that helps us to understand what causes edema is shown to the right. Filtration is the movement of fluid out of the capillary and reabsorption is the movement of fluid back into the distal end of the capillary and small venules. In most capillary systems of the body, there is a small net filtration (typically about 1% of plasma) of fluid from the intravascular to the extravascular compartment. In other words, capillary fluid filtration exceeds reabsorption. This would cause fluid to accumulate within the interstitium over time if it were not for the lymphatic system that removes excess fluid from the interstitium and returns it back to the intravascular compartment. Circumstances, however, can arise where net capillary filtration exceeds the capacity of the lymphatics to carry away the fluid (i.e., net filtration > lymph flow). When this occurs, the interstitium will swell with fluid, thereby become edematous.

Factors Precipitating Edema
• capillary hydrostatic pressure (as occurs when venous pressures become elevated by gravitational forces, in heart failure or with venous obstruction)
• Decreased plasma oncotic pressure (as occurs with hypoproteinemia during malnutrition)
• Increased capillary permeability caused by proinflammatory mediators (e.g., histamine, bradykinin) or by damage to the structural integrity of capillaries so that they become more "leaky" (as occurs in tissue trauma, burns, and severe inflammation)
• Lymphatic obstruction (as occurs in filariasis or with tissue injury)

Prevention and Treatment of Edema
The treatment for edema involves altering one or more of the physical factors that regulate fluid movement. For example, in edema (pulmonary or systemic) secondary to heart failure, diuretic drugs are given to reduce blood volume and venous pressure. In heart failure patients, improving cardiac output by using cardiostimulatory or vasodilators drugs reduces venous and capillary pressures, thereby decreasing filtration and promoting reabsorption of fluid within tissues (click here to see why increasing cardiac output decreases venous pressure). If a patient suffers from ankle edema, that person will be instructed to keep their feet elevated whenever possible (to diminish the effects of gravity on capillary pressure), use tight fitting elastic hose (to increase tissue hydrostatic pressure), and possibly be prescribed a diuretic drug to enhance fluid removal by the kidneys.

PELUANG KERJA DI AMERIKA

From: magdalenasuryandari
Subject: [Nursingline] Peluang Kerja di America
To: Nursingline@ yahoogroups. com
Date: Monday, June 8, 2009, 9:01 PM

Dear Bapak/Ibu ,

Perkenalkan nama saya Nastiti.
Saya pemimpin PT KETS (Kaynos Education and Training Services), alamat kami di Matraman Jakarta.

Saya mau menawarkan peluang kerja di Amerika.

Saat ini saya kerja sama dengan agent resmi di US (Texas dan Houston), untuk melatih para perawat dengan materi NCLEX dengan menggunakan pengajar yang berkualitas (RN).
Lama training 4 bulan (2x seminggu) dan 2 bulan intensif. Dalam waktu 4 bulan tersebut setiap siswa diperbolehkan untuk belajar setiap hari dan menggunakan fasilitas kami (internet, ruangan, materi NCLEX) dari jam 10.00 - 21.00. Dan sisanya 2 bulan, para perawat diwajibkan mengikuti review intensif program NCLEX.

Proses aplikasi ke US dan imigrasi akan ditangani langsung oleh partner saya, sehingga para kandidat perawat hanya bertugas belajar saja untuk mempersiapkan diri mengikuti test NCLEX di Filipina atau HOngkong. Semua masalah administrasi akan kami handle. Tingkat keberhasilan lulus test NCLEX adalah 80%.

Setelah lulus NCLEX, partner kami tsb juga yang akan MENJAMIN penempatan anda di US Hospital. Keberangkatan dari Indonesia ke US juga akan didampingi oleh partner kami.

Kami memberikan jaminan bahwa dalam waktu maximal 18 bulan dari anda pertama aplikasi/mengikuti training, anda sudah ditempatkan di US hospital. 18 bulan == 6 bulan training, 2 masa tunggu test, dan sisanya proses administrasi pengurusan visa.

DI US anda akan mendapatkan fasilitas gratis tempat tinggal ( 2 bulan) dan transportasi selama 1 bulan, dengan asumsi dalam waktu tersebut anda sudah settle dan sudah mengenai lingkungan dengan baik sehingga sudah bisa me -manage gajinya dengan baik.

Jika anda tertarik, atau ada teman anda yang tertarik, bisa response email ini atau telp saya/partner ke

- Nastiti: HP 08128278234 (tolong sms dulu), email: magdalenasuryandari @yahoo.com
- Jusran: HP 08129731265 (sms dulu), email: jusranamp@cbn. net.id

kami memberikan reward menarik untuk setiap orang yang memperkenalkan perusahaan kami ke teman-temannya dan bergabung dengan kami.

Tolong dicatat bahwa, kami sebagai agent TIDAK MELAKUKAN PEMOTONGAN GAJI anda sebesar seperti yang agent lain lakukan.
Hanya ada pemotongan sebesar 250 USD/bulan untuk partner kami di US, dibandingkan dengan gaji anda (4500 - 7500 USD/bulan minimal), tidak ada artinya bukan?



Salam
Nastiti