Edema.

[megananne7]

I'm a new nurse and I've seen a lot of nurses chart the pt has edema (usually "mild" generalized of LE non pitting edema) when, to me, they seem to be just overweight. How exactly can you tell if someone who is overweight really has edema? I have pts who have moderate to severe edema and are obese (You're typical obese CHF-er) and I can definitely tell then, but what about an obese pt with mild edema?

Also, I've seen pts (and been told that even myself) who have the "sock ring" around their ankles/lower legs and described as having edema. Just b/c the sock leaves a ring around their ankles, does that mean the pt is edematous or just a normal "side effect" of wearing socks?! Maybe a dumb question, but even my nurse-friend told me I have LE edema b/c of this.

[chenoaspirit, ASN, RN]

Well, I press my finger on the skin and if it leaves pitting, then its edema. Its measured from +1 - +4. Although there is nonpitting edema, which I dont understand. But sock marks, in my opinion, doesnt mean edema. My socks leave marks and I definitely dont have edema.

[traumaRUs, MSN, APRN]

Edema feels like a different quality than fat. I assess renal pts all day and see real edema versus fat daily. I like to feel pre-tibial (just above the ankle on the front of the leg). This is a much more reliable area to assess I've found. The pitting part is where it gets difficult. Much is a judgement call and you get better at it with experience. It is measured as 1+ to 4+ not as mild, moderate, severe. And...edema can be in other places too. For a bed-bound pt, roll them over and look at the pre-sacral area (kinda like right below the love handles) - you will often find edema there before the ankles in someone who is not mobile. Other places to check: wrists, hands, face.

[megananne7]

I understand what pitting versus nonpitting look like, but what exactly is the difference? I'm assuming pitting edema is much worse?

[Boston-RN, RN]

Pitting edema is just that, when you press against the tibia (or other boney area) it pits and doesn't return immediately. The rating of +1-+4 is how long it takes to return to normal.

[diveRN]

Lymphedema often doesn't pit.

[jessiern, BSN, RN]

On the note about the socks: If I notice a patient has a "sock ring", and I am not familiar with that patient, I ask the patient or family if their socks usually make a ring. I do that because when I was young, I can remember my granddaddy had CHF, and Grandma could tell his was "holding water" when he socks made a ring around his ankle.

But also, we get used to the feel of edema. You can't always just "look" and see it. Many times, unless it is severe, it does just look like a "fat ankle", but it does have a different feel from regular fat. I started when I was a tech getting the nurses to help me with my assessment skills by watching them assess patients, and looking at the same things they did. So, maybe you could let your more experienced nurses know this is a problem for you. Let me help you get more comfortable.

[RNperdiem, RN]

I look under the SCD's. An obese person's legs without edema will maintain their shape. Edema will clearly show the pattern of the SCDs on edematous legs.

[megananne7]

Pitting edema is just that, when you press against the tibia (or other boney area) it pits and doesn't return immediately. The rating of +1-+4 is how long it takes to return to normal.

Yea, I know what it looks like, I just didnt know the process which causes edema to pit whereas some edema doesn't.

[Virgo_RN, BSN, RN]

At my facility, +1-+4 refers to the depth of the edema in millimeters. Capillary refill is measured in time.

[arynberg]

I have pitting edema caused by cushings. I wouldnt say mine is severe but if you press above the ankle on the bone it will leave a mark for nearly an hour. The reason I say this, is because of the "sock ring" remark. Im wondering if they are talking about if it stays there for a long time being and indicator? When I take my ankle socks off I will have the marks for 2-4 hours depending on how bad the swelling is. The same with wearing a hair tie around my wrist.

[mystcnurse, MSN, APRN, NP]

I have pitting edema caused by cushings. I wouldnt say mine is severe but if you press above the ankle on the bone it will leave a mark for nearly an hour. The reason I say this, is because of the "sock ring" remark. Im wondering if they are talking about if it stays there for a long time being and indicator? When I take my ankle socks off I will have the marks for 2-4 hours depending on how bad the swelling is. The same with wearing a hair tie around my wrist.

This may be a very old post, but I was doing a search on it. If "pitting edema" is measured by length of time and depth, then I would say, that is VERY severe. :)