How to chart a cardiovascular assessment

1. Compare right and left. Dependent areas first: ankles, pretibial, then sacral if the patient has been in bed.
2. Press firmly with a finger over bony prominence for about five seconds; release; look first at how deep the dent is. Depth is the main grade on most school scales (+1 mild/shallow → +4 very deep). Learning depth takes practice — you get better after seeing many patients.
3. Refill time (how long the dent stays) is often listed alongside depth in textbooks, but schools vary — match your instructor’s scale. True pitting means an indentation remains after you release; deeper pits usually stay longer, and mild pits often spring back fast. Do not grade on refill time alone.
4. Grade each side separately on this app’s scale. If one side differs, chart the difference — do not average.
5. Note whether swelling is dependent, unilateral (think DVT / infection / injury teaching differentials — escalate; don’t diagnose), or generalized.
6. Use Additional edema location for sacrum, face, hands, scrotum, or other sites not captured by R/L extremity rows.
7. Pair with weight, shoes/rings tighter, and respiratory findings when volume overload is suspected.

Bedside pearl: Sacral edema hides in patients who mostly sit or lie — roll and check the sacrum on bedbound adults.

• Edema is excess fluid in the tissues (interstitial fluid).
• Dependent edema follows gravity — legs when standing/sitting; sacrum when lying.
• Right-sided heart failure classically emphasizes dependent edema; left-sided emphasizes lung congestion — real patients often show a mix.
• Lymphatic blockage, venous insufficiency, low albumin, kidney disease, and meds also cause swelling.
• Both legs (or the dependent side of the body) usually swell together with systemic fluid overload.
• One limb clearly more swollen points to that limb’s veins, lymphatics, soft tissue, or recent injury/surgery — which is why the chart grades R and L separately.
• Describe, weigh, and report — don’t name the cause.