Clinicals: How to tell edema from fat?

[northmississippi]

I have started trying to pay more attention to how to assess feet/legs in an initial morning assessment, but its hard to tell if someone just has fat feet or if its edema? any tips?

[manusko]

I have started trying to pay more attention to how to assess feet/legs in an initial morning assessment but its hard to tell if someone just has fat feet or if its edema? any tips?[/quote']

Is it the same bilaterally? Pitting edema is easier to tell because it will indent and slowly come back to normal. You can also ask the pt if they have noticed any swelling.

[nurseprnRN, BSN, RN]

I have started trying to pay more attention to how to assess feet/legs in an initial morning assessment, but its hard to tell if someone just has fat feet or if its edema? any tips?

Good question. If you see this patient over the course of the day and s/he is up in a chair or ambulatory, you will see whether the feet/ankles swell up. You can also learn to check for dependent edema in other places, like over the sacrum in someone who is lying down all the time.

But the easiest way to tell is to squeeze and hold the area in question. Fat feet and ankles are springy-- squeeze your own (or someone else's near and dear to you :) ) upper arm where there's subq fat and you'll see how that feels. However, your fingers will leave dents in edema, and they will gradually fill back up over a few minutes.

[HappyWife77, BSN, RN]

You can also ask your patient if they are with it- they will know if they are swelling. After some time and experience you will be able to recognize it. It is usually measured by trace,1,2,3,4 + pitting, as it will hold an indentation after you press into it.

[krisiepoo]

If the overall body habitus is large, then it's more difficult for sure. If there is pitting edema (of if you THINK there is but aren't sure), I say to the patient, it looks like you have some swelling, is this normal?

[Esme12, ASN, BSN, RN]

check on the tibial crest...if your thumb print stays...it's edema.

[Caitlin23]

Just like everyone else said, pitting is the way to test. Press your finger into their skin. Does the indenation stay or does the skin bounce back right away?

[tsm007]

I actually came here looking for some ideas on assessing edema as well. I hate to hijack this thread, but I think my further questions might help. I can tell localized edema and am getting better at rating it 1,2,3,4 + pitting, but have more trouble rating generalized edema. Usually there are sections in charting for both. I think the hospital I'm at has mild, moderate, severe for ratings and I really have a hard time with assessing that. I'll have to go look next time I'm there what the exact wording is, but any input on assessing generalized edema would be helpful to me as well.

[meanmaryjean, DNP, RN]

If the overall body habitus is large, then it's more difficult for sure. If there is pitting edema (of if you THINK there is but aren't sure), I say to the patient, it looks like you have some swelling, is this normal?

That's it! I'm not fat- my 'overall body habitus is large'!! Thanks

[truckinusa, BSN, LPN, RN]

Doesn't fat float really well in water? If they are really fat they should never sink lol.

[nurseprnRN, BSN, RN]

Doesn't fat float really well in water? If they are really fat they should never sink lol.

Interesting you should mention that, because it's actually true. I actually had Scouts at camp who were small and wiry, all muscle and bone, and they had really tough times passing swim tests and skills like diving to the bottom and swimming back up because they had to work so much harder to stay afloat. Me, I'm like the manatee-- a nice gentle floaty style, easy-peasy.

Other fat-float-related trivia: fatty stools float in the bowl, a useful quick-and-dirty measure of whether fat digestion is occurring properly.