Symptom: Swelling/Puffiness (Edema)

Initial Grading Reminder

CTCAE grading of edema:

Grade 1 (Mild): Swelling or obscuration of anatomic architecture on close inspection
Grade 2 (Moderate): Readily apparent obscuration of anatomic architecture; obliteration of skin folds; limiting instrumental ADLs
Grade 3 (Severe): Gross deviation from normal anatomic contour; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had issues with swelling in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How bad is the swelling? Can you see your ankles, etc? Is the skin tense? Are you able to carry out your normal activities?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you having any changes in urination? Are you swollen elsewhere? Do you have any nausea, vomiting? Are you confused? Is it difficult to breathe? Are you very fatigued? Do you have any chest pain? Does your heart feel like it is racing or skipping a beat?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    If the patient has new-onset moderate or worse (or worsening) edema should be seen.

    If any of the red-flag symptoms are present, the patient should be seen immediately.

    Patients with severe shortness of breath or any chest pain should go to the ED.

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    Nursing Assessment of Potential Causes

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    Differential Diagnosis

    What do you suspect is the cause of the swelling?