a little help

[vuphan86]

I am working as a CNA in nursing home. Yesterday, when i took care one of my resident who is paralyzed right side ( cant move right arm (RA) and Right foot (RF)), i found out RF was swollen (+4) and LF was normal. it was excruciated when i moved it. it was not red but warm ( because previous CNA put the sock and cover him with blanket). I reported to the nurse and the nurse told me to elevate the affected leg with pillow. Can anyone explain why did he have edema in the paralyzed foot (not for unaffected foot)?

[IVRUS, BSN, RN]

The limb with hemiparesis has diminished movement. In order to have appropriate venous return one needs the action of the muscle. If flaccid, that action is not occurring and edema results. Therefore, circulation is impaired in that affected extremity.

[vuphan86]

he has hemoparesis for long time. why does it happen now? if it is edema, why would it cause excruciated pain?

[203bravo, MSN, APRN]

could be trauma, could be gout, could be cellulitis, could be any number of things..

[vuphan86]

could be trauma, could be gout, could be cellulitis, could be any number of things..

Thank you for your info. In my opinion, it could not be any of them. First, he has been in the nursing when i worked in the facility (almost a year) and he never has any edema. Second, gout usually occur at the fingers (swollen, red and painful compared to his sign which is foot edemaous and painful). Moreover, he never has gout in the past. Last one, from what i know, cellulitis signs are red, swollen, and painful. It usually occurs at lower leg, not foot.

[OrganizedChaos, LVN]

Thank you for your info. In my opinion, it could not be any of them. First, he has been in the nursing when i worked in the facility (almost a year) and he never has any edema. Second, gout usually occur at the fingers (swollen, red and painful compared to his sign which is foot edemaous and painful). Moreover, he never has gout in the past. Last one, from what i know, cellulitis signs are red, swollen, and painful. It usually occurs at lower leg, not foot.

Gout can occur at any joint. Just because the resident wasn't diagnosed with gout before doesn't mean he can't have it now. With cellulitis you can also get it anywhere.

Gout - Mayo Clinic

Cellulitis - Mayo Clinic

[JustBeachyNurse, LPN]

Gout most common in the great toe or foot not the finger/hand. A previous diagnosis is not necessary for a new onset

Edema can result from poor vascular return in a paralyzed limb if a sock is even marginally snug.

Cellulitis is not more common in the lower leg, it can incur in any site there is tissue it's a cellular inflammation often bacterial but can be environmental reaction, viral infection, allergic reaction. Yes it can occur in a foot or a finger or an ear

[JustBeachyNurse, LPN]

The edema if due to poor vascular return secondary to paralysis and limited mobility can be reduced by range of motion, elevation, repositioning.

[vuphan86]

Gout, cellulitis' sign is red in the affected area but he did not have redness on the right foot and his temperature was 98.7 F. One thing is cellulitis only occur if he has a cut right? but his foot's skin was intact.

[OrganizedChaos, LVN]

Gout, cellulitis' sign is red in the affected area but he did not have redness on the right foot and his temperature was 98.7 F. One thing is cellulitis only occur if he has a cut right? but his foot's skin was intact.

Not everything is always textbook & clear cut. Also, the PP that listed the reasons for the possibility of the redness. We are not the residents nurse, we cannot asses him or read his chart so we don't know what is really wrong with him. It could be anything.

Are you his nurse or CNA?

[JustBeachyNurse, LPN]

Gout, cellulitis' sign is red in the affected area but he did not have redness on the right foot and his temperature was 98.7 F. One thing is cellulitis only occur if he has a cut right? but his foot's skin was intact.

Not all cellulitis initiates in a cut or obvious broken skin. Not all cellulitis or gout cause systemic reactions like an elevated body temperature. Redness is one sign but not always. Warmth and edema are others. It could be painful edema due to poor circulation/vascular return that will be relieved by elevation.

Are you a nurse or CNA? Patients don't like to follow the text book rules. Without knowing the full history, current assessment anything we post here is pure speculation.

[vuphan86]

i am in the BSN program and work as a CNA in nursing home facility