I know I use to know this but now I have forgotten How do you tell if someone has 1+ or 2+ or 3 + edema in their legs? Thanks

Pitting Edema

Pitting vs Unpitting Edema

Best Answer (provided by Daytonite)...

Edema is evaluated on it's ability to pit. The examiner's fingers are pressed into a dependent area of the patient's skin for 5 seconds. Areas used to check for pitting are the sacrum if the patient is bedridden, or the lower leg. If pitting edema is present, the fingers will sink into the tissue and leave an impression of the fingers when they are removed. This pitting is graded on a scale of +1 to +4 as follows:

pitting-edema-examples.jpg.3dfdc76513c89ff6711877abd5716f78.jpg
 
  Definition
Grade +1 (Trace) Mild pitting, 2mm indent, slight indentation, rapid return to normal
Grade +2 (Mild) Moderate pitting, 4mm indent, rebounds in a few seconds
Grade +3 (Moderate) Deep pitting, 6mm indent, 30 seconds
Grade +4 (Severe) Very deep pitting, 8mm indent, > 30 seconds to return to normal

1-2-3-Edema-rating-scale (1).pdf

Specializes in LDRP.
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but typically most MD's and RN's don't go by that strict of scale...it is a eye thing.

Yeah, I just eyeball it. I'll say "none" or "trace" then 1+, 2+, etc.

How do you measure and document edema,lets say when a patient has a swollen toe.How do you measure edema?? I find it very hard to measure and document the size edema

Look back in your nursing books for pitting edema scale. Use your tape measure for circumference. Note skin color, texture, integrity, size of area (from where to where). Always doc data for L and R extremities.

Oops I forgot your pulses, skin temp, pain.

There are 2 schools of thought on this and never the twain shall meet:

1. Make a dent in the flesh with a finger and rate by seconds it takes for the dent to go away from nonpitting (self-explanatory), trace (it pits but it's a very shallow dent that goes away fast--exception: if the skin is too hard to dent, it's gotta be +4, actually more), then +1 to +4 (seconds dent persists).

2. Rate +1 to +4 based on how bad it looks relative to other stuff you've seen (I hate this but there are more folks who use this than the first method).

Specializes in Endoscopy.

One teacher taught us that the pitting edema ratings of +1 through +4 correspond to puddle, pond, lake, ocean. :rolleyes:

Specializes in MPCU.

nessajune21's post in the above thread is excellent.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
2ndwind said:
Oops I forgot your pulses, skin temp, pain.

and capillary refill!!

So in my understanding pitting edema is less serious than non-pitting? And MOST patients have pitting edema? So brawny edema is like the most serious edema and it is non-pitting?

No, it depends on the pathyphys. Of course if you are getting to the point where it's obvious compartment you have what amounts to an emergent situation. That's why perfusion can be so important. You need to really doc well and be up on change or no change, things can get clotty and necrotic fast. Is it infection? is it a clot, is it overload/cardiac failure, or is it BP meds, etc.

Woodenpug said:

nessajune21's post in the above thread is excellent.

I found this particular thread very helpful,I copied everything down for future references.Thanks!

2ndwind said:
No, it depends on the pathyphys. Of course if you are getting to the point where it's obvious compartment you have what amounts to an emergent situation. That's why perfusion can be so important. You need to really doc well and be up on change or no change, things can get clotty and necrotic fast. Is it infection? is it a clot, is it overload/cardiac failure, or is it BP meds, etc.

So basically for the non-pitting edema the size would be zero and/or none. On my charting sheet I have a space that says edema :location____(fill in the blank size),size________(fill in the blank space) then type {non-pitting,pitting (circle)}.I never know how to fill the size.If lets say I have a patient that does have an edema but has no identation (non-pitting) should I just fill in 0 or none for the size.One of the nurses I work with told me to put trace for the size instead of zero or none,but it doesnt make sense to me since there is no pitting.

Ps.I found some nice article about edema

https://www.medicinenet.com/edema/article.htm

The article clearly states that PITTING edema is the most common edema.

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