Additional Questions and Rationale
I will ask about pain in the leg as swelling of the leg is often associated with pain. However, about the onset of the swelling, I will ask when it began, what made the swelling worse, and what alleviated it. These questions help determine the causes of the limb swelling and the factors that aggravate the swelling (Slivnick & Lampert, 2019). They also will evaluate the associated symptoms like pain that often denotes other causes of lower leg swelling.
What the questions reveal about patient’s health
These questions tend to reveal a lot about the patient’s health. They will reveal what types of disease the patient is exposed to, the risk factors to his health, and the current stage of his health condition (Slivnick & Lampert, 2019).
Domain: Physical Assessment
Reasons for systemic examination and abnormal findings
The systemic examination is done systematically to evaluate the patient’s other systems. This gives a chance to assess those systems and find out if they have been affected. Leg swelling can involve a lot of systems. It is a presentation of other diseases in the body and denotes that there are organs that are not healthy, like the heart, kidneys or even the blood vessels (Slivnick & Lampert, 2019). It is essential to undertake a systemic examination in a patient with leg swelling as other health issues, or organ damages can cause leg swelling. According to the patient’s age, the abnormal findings include pitting non-tender oedema with additional heart sounds. Also, high blood pressure and increased heart rate can be denoted in physical exam findings.
Normal systemic findings
CVS: Capillary refill immediate, S1S2 denotable with normally placed apex beat.
RS: Reveals bilateral air entry to the lungs, no use of accessory muscles of respiration, no rhonchi and normal chest expansion.
GIT: Moves with respiration, normal bowel sounds, no organomegaly denoted nor tenderness.
MSK: ROM in all extremities is normal, and there are no reduced sensations.
NS: Normal sensations, average balance and intact cranial nerves.
This patient will need an immediate electrocardiogram and echocardiogram to help diagnose heart failure. However, additional Doppler ultrasound of the affected limb will help rule out deep venous thrombosis (Boorsma et al., 2020). Different full hemograms and UECs will be done to rule out any other diseases like kidney damage.
Pathophysiology of diagnosis and differential diagnosis
The diagnosis of the patient is heart failure. Heart failure is common in patients aged 58 years and above. It develops due to the increased inefficiency of the cardiac muscles to pump blood efficiently to all body parts (Boorsma et al., 2020). As a result, the cardiac muscles wear out, resulting in reduced cardiac activity, causing a backlog of blood on the affected side and presenting with leg oedema. Deep venous thrombosis is a significant differential diagnosis that affects the lower limbs. It develops due to the long-term accumulation of fats or platelets in the inner muscle blood vessels causing thrombi that clogs the blood vessels (Boorsma et al., 2020). Kidney failure can also cause leg oedema due to increased fluid retention due to a reduced glomerular filtration rate. The other differential diagnosis is cellulitis, which develops due to infection of the lower limbs presenting with leg swelling.