Anasarca

Definition

Anasarca is massive, generalized edema affecting subcutaneous tissue and body cavities. It results from severe fluid overload or oncotic pressure loss and indicates advanced systemic disease.

Underlying Causes

• End-stage heart failure
• Cirrhosis with hypoalbuminemia
• Nephrotic syndrome (severe proteinuria)
• Severe malnutrition (kwashiorkor)
• Capillary leak syndrome and severe sepsis

Assessment

Pitting edema beyond +3, facial puffiness, periorbital edema, scrotal/vulvar edema, ascites, pleural effusion, and weight gain of several kilograms per day. Skin becomes taut, shiny, and fragile.

Nursing Interventions

Daily weights (most accurate fluid measure), strict I&Os, elevate extremities, restrict sodium and fluids per order, administer diuretics and albumin as prescribed. Protect skin integrity with careful repositioning, pressure redistribution, and meticulous skin care. Monitor for worsening respiratory status.

NCLEX Relevance

Recognize anasarca as a late-stage fluid overload cue, such as commonly tested in CHF, cirrhosis, and nephrotic syndrome scenarios.