otherwise DM pt w/ pitting edema

  1. I was doing a practice assessment on a friend, who is for the most part healthy. Long term IDDM (30+ yrs), on an insulin pump and a low dose "HTN" med to protect kidneys. So, I'm going along doing my thing, not really expecting to find anything abnormal when I discover that she has trace pitting edema on RLE and 1+ on her LLE. (Not ankles though, just distal tibial area -about half way up). I'm surprised, ask her if this is something that she knew about (no) and advise her to talk to her primary, elevate her feet and consider compression stockings. Beyond that I was at a loss to explain it. Anybody have any thoughts about what was/ is going on? Thanks!

    Wave
  2. Visit Wave profile page

    About Wave

    Joined: Nov '06; Posts: 64; Likes: 4

    17 Comments

  3. by   augigi
    Don't have enough info to say.
  4. by   Daytonite
    edema occurs because of trauma to an area, vascular compromise or pump (heart) problems/failure. diabetics are known to develop peripheral vascular problems, heart complications and renal failure. other things where there can be edema in the legs are blood clots in the leg, cellulitis, liver/kidney/heart failure or even some side effect of medications, including insulin. with a 30-year history of diabetes, i wouldn't find it surprising for a diabetic to be developing some sort of complications to their disease. is this person, by any chance, obese? that will also compromise the circulation to the lower extremities and result in some pitting edema. damage to heart, kidney or peripheral vessels is not uncommon in diabetes despite having excellent care and control of their blood sugars.
  5. by   Wave
    Thanks for your reply, Augigi! What else should I have asked/assessed? (what info is missing? -aside from a complete medical record lol.)
    Wave
    Last edit by Wave on Nov 7, '06
  6. by   Wave
    Thanks also for your reply, Daytonite. (Any relation to Kryptonite?) Yes, I'm sure my "patient" is above her ideal weight by a fair amount. I'd hazard a guess 180-190Lbs (5' 4"). In addition, I believe she has a ptosis related to her DM as well as h/o surgery for a blocked ureter. Beyond that I'm not aware of other complications that she's had. She denies any peripheral neuropathy or h/o any DM foot ulcers. Just want to make sure thatI'm giving good advice/pt care. (Besides recommending that she talk to her PCP) Thanks again.

    Wave

    P.S. Apparently it's been "20-something" years, not 30. My Bad
    Last edit by Wave on Nov 7, '06
  7. by   augigi
    I'd want to know the cardiovascular status - overloaded? JVP? Crackles on ausculation? Blood pressure? Distal pulses? Sensation? Warmth? Capillary refill? Basic info for a peripheral vascular assessment.
  8. by   Wave
    Quote from augigi
    I'd want to know the cardiovascular status - overloaded? JVP? Crackles on ausculation? Blood pressure? Distal pulses? Sensation? Warmth? Capillary refill? Basic info for a peripheral vascular assessment.
    Let's see, bp was 130/80 & 120/70 R/L respectively. Capillary refill was <3 seconds (fingernails though, not sure if that makes a difference.) skin was warm w/o being excessive (i.e. wnl). I'm not sure how lung sounds fit into the picture, but anterior and laterel lung sounds were normal. Posterior lung sounds: superior, R mid normal. It was kinda funny but at the time,it seemed that the lower posterior and L mid sounds were adventicious (?sp) but they actually sounded louder? maybe some consolidation? I didn't think much of it at the time. Egophony and tactile fremitus seemed nl but I'm still so new at this that I wouldn't put much stock in that. I was just playing around when I had a willing subject. No clubbed fingers. I'm sorry but I don't know what a JVP is. That's all that I can think of at the moment. Oh, probably non-contributary, but she also has a nodule on her thyroid or parathyroid.

    Wave
  9. by   canoehead
    I get 4+ pitting edema from the calves down after work, and I think that is normal for most (OK maybe just half) of the nurses I work with. So 1+ edema would strike me as a variation of normal unless accompanied by other symptoms.
  10. by   Lisa CCU RN
    Sorry to bust in on the thread, but how do you tell edema from fat ankles?

    I have a lot of patients who have no pitting, but it looks like their ankles are swollen, but I suspect it is just like I said, fat ankles. I know their is a term called brawny edema, where the area is so edematous that it doesn't pit, yet there is edema present.

    Yes, I have asked the patient if their ankles are normally like that and it seems a lot obese can't see nor do they look at their ankles, so that doesn't help any. I really hate looking to see what the prevous shift charted because I want to know for myself. It's sometimes frustrating when my own perception differs from the others charting.
  11. by   augigi
    I'm talking about the cap refill, warmth, sensation etc of the foot distal to the oedema (to see if circulation was ok).

    Lung sounds fit into the picture to see if the patient is generally fluid overloaded - if you have enough for pitting oedema, you often have enough on board to have crackly lungs.

    JVP is jugular venous pressure - can you see a swollen neck vein, which is an indication of fluid overload. Normally you cannot.

    It's all a bit too close to normal to be able to give you many answers apart from sending her to the doc for a full assessment.
  12. by   sephinroth
    yey, i successfully deciphered at least 80% of the subject matter here. jvp is jugular vein pressure btw, and its adventitious sounds. anyway, i didn't get to decipher all the abbreviations, so would anyone mind telling me what rle and lle (i know its right lower and left lower, whats the e?), htn, egophony, peripheral neuropathy(vessel pain???), h/o, dm, pcp?

    @crnasomeday25

    you should check for the patients' skin turgor. if you stretch the skin of a patient with edema, the skin returns pretty slow. and the skin should be glistening. i've never seen edema in my life, so, if i'm wrong, forgive me. i'm just sharing what i was told. =) they said edema is mostly found in pregnant women. next time, i should check thier calves instead of staring at their bellies
  13. by   Curious1alwys
    Quote from sephinroth
    yey, i successfully deciphered at least 80% of the subject matter here. jvp is jugular vein pressure btw, and its adventitious sounds. anyway, i didn't get to decipher all the abbreviations, so would anyone mind telling me what rle and lle (i know its right lower and left lower, whats the e?), htn, egophony, peripheral neuropathy(vessel pain???), h/o, dm, pcp?

    @crnasomeday25

    you should check for the patients' skin turgor. if you stretch the skin of a patient with edema, the skin returns pretty slow. and the skin should be glistening. i've never seen edema in my life, so, if i'm wrong, forgive me. i'm just sharing what i was told. =) they said edema is mostly found in pregnant women. next time, i should check thier calves instead of staring at their bellies

    never seen edema??? you must not be far in ns!

    "e" stands for extremity
    dm diabetes mellitus
    h/0 history of
    htn hypertension
    pcp primary care physician

    the rest can be adequetely researched on the net.
  14. by   Curious1alwys
    I am also thinkin' 1+ edema....what's the big deal.....

close