The nurse notes edema in the hands and legs of an older client who appears undernourished. What should the nurse consider as being the reason for this client's edema?

Question

a. Thyroid hormones are out of balance
b. The kidneys are failing, causing fluid retention
c. Lack of adequate protein is causing a fluid shift
d. The client has been drinking large amounts of water to prevent feelings of hunger

Answer 1

c. Lack of adequate protein is causing a fluid shift

Oncotic pressure results in fluid balance between the tissue and the capillaries. When there is inadequate protein, the change in oncotic pressure causes fluid to shift from the blood into the tissue, resulting in edema. If the kidneys are functioning normally, drinking large amounts of fluid results in more urine. The nurse has no reason to suspect kidney failure by appearance only. Proteins are responsible for hormone synthesis, but thyroid hormone imbalance does not cause edema.