B10 · Swollen legs or feet
Actual Breathing and circulation
Definition
Fluid builds up in the lower limbs, causing puffiness, tightness, or heaviness.- Heart failure
- kidney problems
- long sitting
- low protein
- vein problems
- Puffy or tight skin
- a dent that stays when pressed
- shoes feel tight
- heavy legs
📋 Scenario
An older woman's ankles are swollen and leave a dent when pressed.
Subjective (S): "My shoes don't fit and my legs feel heavy."
Objective (O): Both ankles swollen with pitting 2+; weight up 1.5 kg in a week; skin tight and shiny; blood pressure 140/85.
Assessment tools for this scenario: CP-BREATH Breathing & Circulation Check CP-SKIN Skin & Wound Score CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: NEWS2, SpO₂, ECG, Braden Scale, TIME wound chart, MUST, fluid chart, glucose
**CarePath diagnosis:** Swollen legs or feet related to fluid retention, as evidenced by 2+ pitting swelling of both ankles, weight up 1.5 kg in a week, and tight, shiny skin.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Raise legs when sitting. | Raising the legs uses gravity to help fluid drain back toward the heart, which lowers swelling. |
| Weigh daily. | Daily weight is a reliable way to see fluid gain or loss, since about 1 kg of weight is roughly 1 liter of fluid. |
| Follow salt and fluid advice. | Less salt and controlled fluids reduce the water held in the body and so the swelling. |
| Check skin for breakdown. | Swollen, tight skin is fragile and has less blood supply, so it breaks down easily. Checking finds early damage. |
| Give diuretics as ordered. | Diuretics help the kidneys remove extra fluid and salt, which reduces swelling. |
**Expected outcomes**
- Within 3 days: swelling reduced and weight moving toward target.
- Skin stays intact.
- Patient raises legs correctly and states salt and fluid advice.
**Linking the data to the diagnosis**
The older woman has both ankles swollen with 2+ pitting, tight shiny skin, weight up 1.5 kg in a week and blood pressure 140/85. She says her shoes do not fit and her legs feel heavy. This is an actual problem because the swelling is already present and leaves a dent when pressed. Fluid build-up in the body is a wider statement about total body fluid, while this one is limited to the legs and feet and so fits the local findings. The plan aims for less swelling and weight moving toward target within 3 days, intact skin, and the patient raising her legs correctly and stating the salt and fluid advice.
CarePath diagnosis
Swollen legs or feet related to fluid retention, as evidenced by 2+ pitting swelling of both ankles, weight up 1.5 kg in a week, and tight, shiny skin.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Raise legs when sitting. | Raising the legs uses gravity to help fluid drain back toward the heart, which lowers swelling. |
| 2. Weigh daily. | Daily weight is a reliable way to see fluid gain or loss, since about 1 kg of weight is roughly 1 liter of fluid. |
| 3. Follow salt and fluid advice. | Less salt and controlled fluids reduce the water held in the body and so the swelling. |
| 4. Check skin for breakdown. | Swollen, tight skin is fragile and has less blood supply, so it breaks down easily. Checking finds early damage. |
| 5. Give diuretics as ordered. | Diuretics help the kidneys remove extra fluid and salt, which reduces swelling. |
Expected outcomes
- Within 3 days: swelling reduced and weight moving toward target.
- Skin stays intact.
- Patient raises legs correctly and states salt and fluid advice.
Linking the data to the diagnosis
The older woman has both ankles swollen with 2+ pitting, tight shiny skin, weight up 1.5 kg in a week and blood pressure 140/85. She says her shoes do not fit and her legs feel heavy. This is an actual problem because the swelling is already present and leaves a dent when pressed. Fluid build-up in the body is a wider statement about total body fluid, while this one is limited to the legs and feet and so fits the local findings. The plan aims for less swelling and weight moving toward target within 3 days, intact skin, and the patient raising her legs correctly and stating the salt and fluid advice.