Non-pitting edema and rating

[clearblue3]

Hi all!

I am a first semester nursing student and in my first clinical. From my understanding "non-pitting" edema was not rated. Is that correct? My instructor has taken points off twice for not rating my "non-pitting" edema. At first I thought she just didn't see the NON part, but when I mentioned it she said that there is 1-4 for non-pitting and 1-4 for pitting. No one I talk to seems to know what she is talking about. I thought the 1-4 stood for how much time it took for the pitting to go away after the skin was pressed on?? I just don't want to keep getting it wrong! Thanks much!!

Marisa

[ObtundedRN, BSN, RN]

Non-pitting edema has no rating to it. Although, it seems to me that there are sooo many nurses our there that think it can be rated. I've had patients that I'm charting on, and see a previous nurse charted "2+ non-pitting edema." Your instructor has it wrong.

If you can find it explained well in a book, I'd show it to her. Otherwise, just rate your non-pitting edema for her so you can get your grade. lol

[CrazierThanYou]

We only rate pitting edema. My patient at clinical last week had edema but non-pitting. I charted "Patient has non-pitting edema bilaterally in lower extremities".

[kids_play2]

Pitting Edema: Pitting edema is not only about the depth of the pitting. It's also about how long the pitting takes to return to normal. Facilities may have their own grading scale that they use to determine the difference between a 1+, 2+, and so on.

Method #1 is this: +1 pitting edema = slight pitting, no visible distortion, rebounds quickly. +2 = somewhat deeper pit (2-4mm indent), no readably detectable distortion, rebounds in 10-15 seconds. 3+ = pit is noticeably deep (4-6mm), may last more than 1 minute, dependent extremity looks full and swollen. 4+ = pit is very deep (6-8mm), lasts as long as 2-5 minutes, dependent extremity is grossly distorted.

Method #2 is this: 1+ = Barely detectable depression up to 2mm, rebounds immediately. 2+ = 4mm indentation, takes a few seconds to rebound. 3+ = 6mm depression, takes 10-12 seconds to rebound.

An example of these types of grading would look like this: Pt. has 3+ pitting edema bilateral feet, ankles, lower legs, and 2+ pitting edema bilateral hands.

Non-Pitting Edema: When there is no pitting, or you wish to indicate the overall severity, the edema is graded based on that severity and how extensive it is. 1+ = mild: Both ankles and feet. 2+ = Moderate: Both feet, hands, lower arms and lower legs. And 3+ = Severe: Generalized bilateral pitting edema, which includes both legs, arms, feet and face.

An example of this type of grading would look like this: Pt. has 2+ non-pitting edema bilateral ankles and feet.

[shellyscorner]

...Although, it seems to me that there are sooo many nurses our there that think it can be rated...

I don't understand HOW you can rate something that you can't OBJECTIVELY measure ... (I've never heard of rating NONpitting edema... which of course does NOT mean that it can't be or isn't done... It just means that I've never heard of it. )

Now, theoretically, if you knew the circumference of the edematous area PRIOR TO becoming edematous, then, yes... I could see how you could rate it. But otherwise? It seems to me that it would be pretty much a useless value. Am I wrong?