Where the fluid backs up, and the swollen leg that is not heart failure
A standing figure split down the center, the left half tagged at the lungs and the right half tagged at neck, liver, abdomen, and sacrum, with a detached inset of two lower legs, one swollen and warm, one pale and pulseless.
| LEFT-SIDED BACKUP | RIGHT-SIDED BACKUP | THE LEG THAT IS NOT HEART FAILURE | |
|---|---|---|---|
| Where it collects | Pulmonary circulation | Systemic venous circulation | One limb only |
| What you see | Orthopnea, paroxysmal nocturnal dyspnea, crackles, dry cough, pink frothy sputum in the acute form | Jugular venous distention, hepatomegaly with right upper quadrant tenderness, ascites, dependent and sacral edema, weight gain | Unilateral calf swelling, warmth and redness for thrombosis; medial ankle staining with weeping shallow ulcers for venous insufficiency; cool hairless skin with absent pulses and painful punched-out toe ulcers for arterial disease |
| What makes it worse | Lying flat, fluid load, uncontrolled rate | Salt and volume, missed diuretic doses | Immobility for venous disease; walking for arterial claudication |
| First nursing action | Sit the patient upright with legs dependent, then reassess breathing and saturation | Daily weight on the same scale at the same time in the same clothing, reporting a gain of two to three pounds overnight or five pounds in a week | Measure and compare calf circumference at a marked point, keep the limb still, and do not massage |
| What you must not do | Do not lay a breathless patient flat | Do not withhold the weight because the patient looks stable | Do not apply compression to an arterial limb, and do not elevate one |
Sorting the limb in three questions. One leg or two? Two legs point at the right heart or at systemic volume. One leg points at a clot or at a limb problem. Warm or cold? Warm, swollen, and tender is venous. Cold, pale, and hairless is arterial. Better with elevation or worse with it? Venous pain eases when the leg comes up. Arterial pain eases when the leg hangs down, which is why these patients sleep in a chair.
Deep vein thrombosis specifics. Ask about recent surgery, immobility, and travel. Report new unilateral swelling with a measured difference, and anticipate venous ultrasound. Sudden dyspnea, pleuritic pain, tachycardia, or anxiety in a patient with a known or suspected clot is treated as pulmonary embolism and reported immediately.
Watch outa cold, pale, pulseless limb with new pain and numbness is an acute arterial occlusion. Keep it flat and dependent, protect it, and call now. Elevation and compression make it worse.
Memory hookARTERIAL DANGLES. VENOUS ELEVATES. Registered as B8-DANGLE-ELEV.
Margin noteone leg or two legs is the whole question.
Any laboratory value named in these columns belongs to → BOOK 07 · P4.
Takeawaybilateral edema asks about the right heart, one swollen leg asks about a clot, and a cold pulseless leg asks for a phone call now.