Answer :
Based on the information provided about the nursing assistant, the most likely diagnosis is chronic venous insufficiency. Here's a step-by-step explanation:
Patient Demographics: The patient is a 55-year-old woman who works long hours (16-hour shifts) standing or sitting, which is common in professions such as nursing. This lifestyle can predispose her to venous insufficiency, especially if there are no other underlying medical conditions mentioned.
Symptoms of Pitting Edema: The clinical finding of 2+ pitting edema bilaterally (in both legs) is significant. This type of edema is often indicative of venous insufficiency, where blood pools in the legs due to ineffective venous return to the heart. Other potential causes like orthostatic edema are less common and typically involve situations where edema resolves upon lying down.
Exclusion of Other Options:
- Orthostatic Edema: Usually caused by prolonged standing but often resolves with rest or elevation of the legs. There is no indication that the edema improves with rest.
- Lymphedema: Typically presents with non-pitting edema and is associated with lymphatic system blockages, previous surgeries, or infections, which do not apply here.
- Lipedema: Characterized by fat deposits that cause swelling and often occurs alongside hormonal issues. It typically doesn't cause significant pitting like seen in venous insufficiency and also usually does not affect the feet.
Additional Clinical Findings: The absence of skin changes such as rashes, thickening, or ulceration, and the normal cardiovascular exam further support chronic venous insufficiency without severe complications.
In conclusion, chronic venous insufficiency is the most likely diagnosis due to the patient's occupation, the nature of her edema, and the ruling out of other conditions. Further assessment and management might include leg elevation, compression stockings, and potentially referral to a specialist for venous studies.
