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Pt has severe pain when legs elevated

Im a fairly new nurse, working in homecare. I have an elderly patient with dx of DMII, HTN, debility and recent toe amputation. Her DM and HTN are well controlled/wnl.

She sits and sleeps in her chair, she has 3+ to 4+ pitting edema BLE and rarely gets up except to use the bathroom 2-3 times a day. She stopped taking her hctz because it caused her to use the bathroom more which causes her pain.

I instructed she start sleeping in her bed and elevate her feet to reduce edema and encourage wound healing but she said she cant because it causes severe pain when she does. I researched this and found that it could be PAD and claudication which does indeed cause increased pain when feet are elevated compared to when they are dangling.

Will elevating her feet do more damage than good?

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown.

I'm not a cardiac nurse (my heart is in trauma-surgical) but I would be worried about the edema in her legs causing her heart to overload with them being elevated which is probably why she's got leg edema in the first place...it would be a trip to the PCP if I had my way! Good luck and hope she gets better and not worse by not taking her diuretic anymore...:nailbiting: :scrying:

This often happens with PAD and it's generally a precursor to wounds in the lower extremities. Could your patient stand some compression to her lower extremities? Maybe start off with TED stockings or mild compression. Of course, you will want MD orders, and possibly a vascular consult.

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

I wouldn't do anything until the patient goes to see her doctor, especially with regards to stopping the HCTZ. The other poster is right, if she suddenly starts sleeping flat in bed with her legs up her heart could become overloaded with fluid and she could go into severe CHF, in which she may not recover from if she cannot call a boo boo bus quick enough and/or ends up on a vent! Thankfully in my area we are now carrying CPAP pre-hospital and we carry IV NTG, but it doesn't always work in time to avoid intubation.

I can't count the number of times I have had a mild CHF patient go from not so bad to frothing at the mouth, and not from rabies, after putting them on the ambulance stretcher when they have been sitting in a chair for sometime.

HPRN

Edited by AnnieOaklyRN

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health.

Is the leg pain a new symptom? Does she have pain on ambulation too? Definitely need to consult with her MD about this, and you should make sure they know she stopped her diuretic. Compression stockings might help, and I agree that a vascular consult might be in order here.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes.

I have many pts w/PAD and it feels better to dangle than to elevate. we let them dangle.

I should have left more information, I apologize. She has not been dx with CHF, denies SOB when she lays down either, HTN very well controlled, just leg pain and edema. She is seeing her PCP today as a matter of fact, I had called and left him a message with my concerns and recommendation for compression stockings and referral to cardiologist and/or vascular surgeon.

My concern was that with edema, elevation usually helps, however with her pain she described, it sounded like it could be PAD so elevation isn't an option either as it hurts, I just wondered if she did elevate if it would cause damage in any way.

Update: her dr office just called me back, I guess she just saw a vascular surgeon 2 months ago and they said everything is fine. This doesn't make sense though, she has had 2 amputations of the same toe (one at the first joint, then the 2nd joint, and may require more as its not healing well). This doesn't imply she has good circulation to me. She has pain when her feet are dangling but hurt when up, these are signs of PAD... anyway, he prescribed her compression stockings and was told she stopped her hctz.

If I had a dime for every time medical personnel told me there is really nothing wrong with me, I could probably pay someone to eliminate my symptoms! Just saying. Commendable that you are following up with this, too many would just let the situation continue without intervention of any type.

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