So first of all- I am a nurse that has recently transferred into home care (UK) and there are no doctors whose brain I can just pick when they are around. However, I am still curious about the pathophysiology of why my patient's are poorly.
So…. PMH: 85 y/o male, smoker, COPD, TIIDM, hypertension, recently diagnosed with hepatocellular carcinoma and has undergone TACE for extension of life.
We go in this man's home every day for bilateral leg dressings. We put on every dressing possible, but it is not enough because the exudate is overwhelming. It looks like trench foot with the addition of necrotic toes. Without knowing any details about him I assumed that he has the typical kidney/heart failure combo as he had swollen legs, complained of swollen testicles, wasn't passing a lot of urine and well… just looked it (sorry).
Later on, through nursing assessment I figured out that he had a medication mixup and was taking up to 600mg of codeine a day. That resulted in a call to the GP and me accessing his medical notes.
His eGFR is 90 and he had an echocardiogram last month(because the GP though he had HF too) but that was absolutely fine!!! The cardio consultant in his letter said that the symptoms are probably from HCC and existing co-morbidities.
here is my question Can someone please explain to my nursing brain in relatively simple terms, what pathophysiological processes can be happening for oedema to form secondary to liver cancer? He was taken to a hospital next day with new onset of chest pain, so I also know that his potassium and sodium were on the low side, but albumin, CRP were normal.
Much appreciate if anyone can come back to me with an answer and I hope me wanting to learn more doesn't break this subs rules 🙂
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