1+ 2+ 3+ Edema rating scale?

  1. 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
    Last edit by Joe V on Nov 29, '16
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    About Blackcat99

    Joined: Jan '04; Posts: 3,159; Likes: 1,142
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  3. by   happystudent
    when you press your finger into the skin. it makes a pit. Then you decied how deep it is by how far down the indentation is. +1+2+3

    personally, any edema is bad....
  4. by   Antikigirl
    I rate it on the pitting by how many seconds it takes to return to normal after an indent. If it takes 1-3 seconds I rate it a one, 4-6 seconds a two, more a three and after that I tell them how many seconds and say beyond a three.

    Now I push down till a good blanch happens, then count...and I do it on multiple sites. I also take the time since I am there to feel for pedal pulses and let my MD know if I was able to find them easily or not...and I get lucky here because I know my patients well...if I can find them normally...if not I say that I don't know if they normally have easy to find pedal pulses.

    Rating edema becomes natural to tell after a while I think...and with non pitting...well that is enough for me just to tell my MD's..."hey we have non pitting" and I describe skin tone, color, nailbeds, hair placement (that tells you volumes actually about circulation!), nail condition, temp of the extremity, any numbness/tingling, pain, changes in mobility...you name it (well I tell that for pitting too)! AND especially if there is skin damage r/t this! I have been told I am overly efficient by my other nurses..but the docs..they love me!!!!

    But edema is my game really...I work at an assisted living facility where everyone seems to have a degree of CHF, or diabetes, or other conditions where edema is just fairly normal. SO is lasix..LOL! OH those poor folks...they may not know most of their meds..but they know that one..they call it the "pee like a race horse pill"...or "little, white, peeing all night" (my humor has been transfered to my clients..can you tell? LOL).

    Did you know that lasix was actually made for race horses? Yeppers! It was produced to encourage lower water weight in horses so they were lighter...then a smart doc said..hmmmm fluid regulation..and the rest is history . So when a client says "I am peeing like a race horse" tell them "yep...you are!!!!"...LOL!
  5. by   Energizer Bunny
    This is what my Health Assessment text says:

    1+ Mild pitting, slight indentation, no perceptable swelling of the leg
    2+ Moderate pitting, indentation subsides rapidly
    3+ Deep pitting, indentation remains for a short time, leg looks swollen
    4+ Very deep pitting, indentation lasts a long time, leg is very swollen

  6. by   Antikigirl
    That is what I learned originally too! BUT, you may not get a doc responding to a +1 as much as not only giving your percieved scale, but the other s/sx I mentioned. So I always tend to discribe more than just the edema scale...

    I have had patients with acute onset that have never had edema before...and when I say +1 to a doc, they may not be as concerned as I am...so I always mention: change of condition, new onset of pitting pedal edema, bilateral lower extemities within normal color and temp, with good blanch at 1 second, ppx4 (pedal pulses), and normal hair placement bilateral legs, resident states "my ankels are very stiff...I have never had this before", and has increased anxiety for fall. No hx of edema mentioned in chart. Please advise.

    See...a little more writing sure, but gives a bit more than "acute onset of +1 pitting edema bilateral extremities". (thank goodness I write fast and clearly...or at least I think clearly..LOL!).
  7. by   Energizer Bunny
    I see what you mean, Triage....something that will come with experience, I'm sure. It makes perfect sense, though...I'm glad you mentioned it!
  8. by   Antikigirl
    Well I learned this pretty quick being harrassed by paramedics all the time..LOL! Oh boy they really drilled in how to do a 'report' to them so that I would make even a burned out doc listen! LOL! So I have to thank them big time...it isn't just what you know..or what you relay...it is whom you are having to work with and sometimes...around! That comes with experience

    To this day if I don't do a good report to the paramedics..they tell my hubby and boy do I get it..LOL!!!!!
  9. by   Blackcat99
    Thanks all for your great information. I suffer from CRS. Can't remember s###. :imbar :imbar