Advanced Clinical Practitioner, Northampton General Hospital NHS Trust.
Senior House Officer, Northampton General Hospital NHS Trust.
Br J Nurs. 2024 Nov 7;33(20):S8-S14. doi: 10.12968/bjon.2024.0210.
Lower limb oedema is a common condition in clinical practice, frequently affecting the distal lower limbs. Whereas benign causes such as prolonged sitting or standing are typical, oedema can also indicate serious systemic diseases such as cardiac failure, liver disease, or renal impairment. Identifying the cause is crucial to prevent irreversible skin and tissue changes. This clinical review aims to increase the knowledge of advanced clinical practitioners (ACPs) and generalist practitioners, including practice and community nurses, by providing an overview of how to approach patients with lower limb oedema, encompassing history-taking, examinations, investigations, and management plans. The main focus is on lymphoedema, which can be primary or secondary. Primary lymphoedema results from genetic abnormalities, while secondary lymphoedema arises from acquired defects due to factors such as obesity, infections, neoplasms, and trauma. Effective management includes addressing the underlying cause, ensuring proper skin care, recommending appropriate exercises, and the use of compression garments. Referral to a lymphoedema specialist is recommended for patient education on managing and treating the condition when required. Additionally, the article discusses the importance of regular skin inspections, minor injury management, environmental considerations, and the critical role of compression garments in lymphoedema management. This comprehensive approach aims to enhance patient outcomes and provide a thorough strategy for ACPs and generalist practitioners.
下肢水肿是临床实践中的一种常见病症,常影响下肢远端。良性病因,如长时间坐立或站立,较为典型,但水肿也可能表明严重的系统性疾病,如心力衰竭、肝病或肾功能损害。确定病因对于预防不可逆的皮肤和组织变化至关重要。本临床综述旨在通过提供有关如何处理下肢水肿患者的概述,包括病史采集、检查、检查和管理计划,提高高级临床医生(ACPs)和全科医生的知识,包括实践和社区护士。主要重点是淋巴水肿,可分为原发性和继发性。原发性淋巴水肿是由遗传异常引起的,而继发性淋巴水肿则是由于肥胖、感染、肿瘤和创伤等获得性缺陷引起的。有效的管理包括解决根本原因、确保适当的皮肤护理、推荐适当的运动以及使用压缩服装。当需要时,建议向淋巴水肿专家转介,以对患者进行有关管理和治疗病情的教育。此外,文章还讨论了定期皮肤检查、小伤处理、环境因素以及压缩服装在淋巴水肿管理中的重要作用。这种综合方法旨在改善患者的预后,并为 ACPs 和全科医生提供全面的策略。