Elevation is the fork in the road. Elevating a venous leg drains it and relieves the ache; elevating an arterial leg removes what little gravity-assisted perfusion the foot had and can turn ischemia into necrosis. Sort the findings, settle the elevation question, then put real numbers on the limb — pulse grade, capillary refill, ankle-brachial index, edema depth and rebound — and chart them the way the next nurse can use.
Every finding below belongs to one of the two. Assign it, and the bench will tell you what the assignment changes at the bedside.
The elevation decision
Before you prop a swollen leg on pillows or apply a compression stocking, answer one question.
Palpate with the pads of two or three fingers — never the thumb, which has its own pulse strong enough to fool you. Assess rate, rhythm, amplitude, contour and symmetry, and always compare sides.
Ankle-brachial index
Press firmly with your thumb for at least five seconds over a bony prominence — the dorsum of the foot, behind the medial malleolus, or over the tibia. In a patient on bed rest, also press over the sacrum.