Swelling of the legs, a form of dependent edema, is a frequent complaint of patients. Ask the following questions:
''When was the swelling first noted?''
''Are both legs swollen equally?''
''Did the swelling appear suddenly?''
''Is the swelling worse at any time of the day?''
''Does it disappear after a night's sleep?''
''Does elevation of your feet reduce the swelling?''
''What kind of medications are you taking?''
''Is there a history of kidney, heart, or liver disease?''
''Do you have shortness of breath?'' If so, ' 'Which came first, the edema or the shortness of breath?''
''Do you have pain in the legs?'' ''Do you have any ulcers on your legs?''
If the patient is a woman, ask the following questions:
Are you taking oral contraceptives?'' ''Is the edema associated with menstrual changes?''
The patient with congestive heart failure has symmetric edema of the lower extremities that worsens as the day progresses. It is least in the morning after sleeping with the legs elevated in bed. If the patient also complains of dyspnea, it is helpful to determine which symptom came first. In patients with dyspnea and edema secondary to cardiac causes, the dyspnea usually precedes the edema. Bedridden patients may have dependent edema in the sacral area.
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