You are getting handoff report from the previous night shift RN. When she is going over the assessment of the patient, she tells you that the patient has anasarca. What do you expect to see in this patient based on this information?

Choice A rationale Anasarca is defined as severe, generalized edema involving the subcutaneous tissues throughout the entire body. It occurs when there is a significant shift of fluid from the intravascular space into the interstitial space. This is often caused by a decrease in plasma oncotic pressure, typically from low albumin levels, or an increase in capillary permeability and hydrostatic pressure. In critically ill patients, this massive swelling indicates profound fluid overload or systemic inflammatory damage. Choice B rationale Itching and hives are manifestations of an allergic reaction or pruritus, typically mediated by histamine release from mast cells. While systemic inflammation can sometimes involve skin changes, these are not the defining characteristics of anasarca. Hives represent localized areas of edema in the dermis, known as urticaria, whereas anasarca is a much more massive and global accumulation of fluid in the extravascular compartments that compromises skin integrity and organ function significantly. Choice C rationale Increased thirst and urination, or polydipsia and polyuria, are classic symptoms of diabetes mellitus or diabetes insipidus. Anasarca actually often presents with decreased urine output because fluid is being lost to the third space rather than being processed by the kidneys for excretion. In states of profound edema, the circulating volume may be low despite the total body water being high, leading the body to trigger thirst mechanisms and conserve water via antidiuretic hormone. Choice D rationale Erythema refers to redness of the skin caused by increased blood flow in the superficial capillaries, often seen in inflammation, infection, or burns. While the skin in anasarca may be taut and shiny, erythema is not the hallmark of this condition. Anasarca focuses on the volume of fluid in the tissue rather than the vascular tone or color. Patients with anasarca may actually appear pale if the edema is so severe that it compresses small cutaneous blood vessels.