{"id":1227,"date":"2022-12-01T14:35:50","date_gmt":"2022-12-01T19:35:50","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/assessment-of-lymphedema\/"},"modified":"2024-05-03T15:48:05","modified_gmt":"2024-05-03T19:48:05","slug":"assessment-of-lymphedema","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/assessment-of-lymphedema\/","title":{"raw":"Assessment of Lymphedema","rendered":"Assessment of Lymphedema"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the lymphatic system includes inspecting the skin for signs of lymphedema (<strong>Figure 5 <\/strong>shows signs of severe edema). The most common sign is swelling, but other signs may be present when the condition is severe or not well managed.\u00a0<\/span><\/p>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms.jpg\" alt=\"A severely swollen left arm in comparison to the right arm.\" width=\"263\" height=\"400\" class=\"alignnone wp-image-1225\" \/>\u00a0<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs-199x300.jpg\" alt=\"A left leg that is severely edematous in comparison to the right leg.\" width=\"265\" height=\"400\" class=\"alignnone wp-image-1226\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 5<\/strong>: Lymphedema.<\/span>\r\n\r\n<span style=\"color: #000000\">(Attribution: Photo of legs by Medical doctors -\u00a0<a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=37663127\" target=\"_blank\" rel=\"noopener\" style=\"color: #000000\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=37663127<\/a>\u00a0and photo of arms has been cropped. Photo by DocHealer -\u00a0<a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=64120555\" target=\"_blank\" rel=\"noopener\" style=\"color: #000000\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=64120555<\/a>, both own work, CC-BY SA 4.0)<\/span>\r\n\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\">Clients with lymphedema will usually report that they are experiencing swelling or that their clothes or jewelry appear to be fitting tighter. This will help you to determine where to begin your assessment. If you are doing a general assessment, it is appropriate to observe the face, neck, arms and legs in a sitting or supine position. Observe the client\u2019s bare skin and compare bilaterally.<\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Assessment for lymphedema<\/strong> involves the following steps:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\">Inspect for <strong>swelling<\/strong> and <strong>symmetry<\/strong> over the face, neck, arms, and legs.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, no swelling is present on the face, neck, arms, and legs, and limb circumference is equal bilaterally.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">If swelling or asymmetry is present, describe the location. If you observe asymmetrical limbs in terms of circumference, measure with a flat\/flexible tape measure around the largest area of swelling on the affected limb and measure at the same location on the other limb.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<span style=\"color: #000000\">If you note swelling,<strong> assess for pitting edema<\/strong>: an indentation that remains after applying pressure over the location (see <strong>Figure 6<\/strong>). Apply pressure with the pad of your finger on a distal location (feet and medial malleolus) for about 3-5 seconds and then release. If you observe an indentation (a \u201cpit\u201d), note the location and how long the indentation remains. Then, assess a proximal location to assess how high the edema goes (e.g., over the tibia). Always check with the unit you work on about the scale used to evaluate pitting edema. Scales are usually 1\u20134 as shown in <strong>Figure 7<\/strong> and are used to record the pit depth and rebound time (the time for the indentation to disappear). Often, 1 is classified as mild, 2 as moderate, 3 as severe, and 4 as very severe. <\/span>\r\n\r\n<span style=\"color: #000000\"><img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/IMG_0709-1-scaled-1.jpg\" alt=\"Indent showing pitting edema on medial\/dorsal side of foot.\" width=\"391\" height=\"521\" class=\"alignnone wp-image-901\" \/><\/span>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 6<\/strong>: Example of pitting edema<\/span>\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed-300x232.png\" alt=\"A table showing what grade 1-4 pitting edema is with a visual representation of the size of the indent.\" width=\"519\" height=\"401\" class=\"alignnone wp-image-1199\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 7<\/strong>: Pitting edema scale. (Attribution: <a href=\"https:\/\/wtcs.pressbooks.pub\/nursingskills\/\" style=\"color: #000000\">https:\/\/wtcs.pressbooks.pub\/nursingskills\/<\/a> CC-BY 4.0).<\/span>\r\n<ol start=\"2\">\r\n \t<li><span style=\"color: #000000\">Inspect for <strong>skin discolouration<\/strong>, <strong>skin breakdown<\/strong> (cuts, cracks), and <strong>ulcers<\/strong> over the face, neck, arms, and legs. Inspect anterior and posterior sides, in between skin folds and toes, and on the bottom of the feet.\u00a0<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, skin colour is even throughout the body and skin is intact.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">If you observe any skin discoloration from the client\u2019s baseline, identify the location and colour. If skin is not intact or ulcers are present, note the location and record a description. If applicable, describe the colour, odour, [pb_glossary id=\"1380\"]consistency[\/pb_glossary] and colour and quantity of discharge.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Palpate for temperature<\/strong> using the dorsa of your hands from the top of the client's limb (e.g., shoulder\/upper leg) to their extremities (hand\/fingers and feet\/toes).<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the temperature is equal bilaterally. The distal portions of the limbs (hands and feet) may be slightly cooler, but should be equal bilaterally.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">If you note any asymmetry in temperature or extreme temperatures, identify the location and temperature (i.e., cold or hot).<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\"><strong>Palpate skin texture<\/strong> and <strong>consistency<\/strong> with your first two or three fingers and thumb over the limbs or any areas where lymphedema is suspected.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the skin texture is smooth and soft with no lumps.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Describe the quality and note the location of any dry, moist, dimpled, or firm areas on the skin.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">If you suspect lymphedema, assess the client\u2019s <strong>mobility<\/strong> of the affected limb and <strong>range of motion<\/strong>.\u00a0<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, clients should have no difficulty moving their arms and legs, with full range of motion and no pain.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note any difficulty moving, limited range of motion, or pain.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:\u00a0<\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo swelling or discolouration present on the face, neck, arms, and legs, and limb circumference is equal bilaterally. Temperature is warm to touch and equal bilaterally, and skin texture is smooth with no lumps on arms and legs.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cRedness and swelling noted on left arm, left upper arm circumference 19 inches and forearm circumference 12 inches. Right upper arm circumference 14 inches and forearm circumference 10 in inches. Full range of motion of both arms. Client describes slowness and difficulty moving arm.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><span style=\"color: #000000\"><strong>Priorities of Care<\/strong><\/span><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"color: #000000\">A main priority of care is to <strong>prevent and\/or treat infection<\/strong>. Clients with lymphedema are at risk for skin breakdown, ulcers, and infection. Skin should be kept clean, dry, and moisturized. Clients should also be careful to prevent any scratches or cuts that could lead to infection. Assess and monitor any areas of the skin that are not intact and\/or show potential infection. It is important to observe if any areas of concern worsen (e.g., get bigger). Report to the physician or nurse practitioner if you observe any ulcers or signs of infection.<\/span>\r\n\r\n<span style=\"color: #000000\">Clients with lymphedema may be referred to a physiotherapist and encouraged to perform light exercises to assist with <strong>lymphatic fluid transportation<\/strong>. For similar reasons, compression stockings are often prescribed: these are fitted elastic stockings that apply a certain amount of pressure to the limb. It is also often recommended to elevate limbs with lymphedema.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n[h5p id=\"99\"]","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the lymphatic system includes inspecting the skin for signs of lymphedema (<strong>Figure 5 <\/strong>shows signs of severe edema). The most common sign is swelling, but other signs may be present when the condition is severe or not well managed.\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms.jpg\" alt=\"A severely swollen left arm in comparison to the right arm.\" width=\"263\" height=\"400\" class=\"alignnone wp-image-1225\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms.jpg 393w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms-197x300.jpg 197w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms-65x99.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms-225x342.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Stage-4-arms-350x532.jpg 350w\" sizes=\"auto, (max-width: 263px) 100vw, 263px\" \/>\u00a0<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs-199x300.jpg\" alt=\"A left leg that is severely edematous in comparison to the right leg.\" width=\"265\" height=\"400\" class=\"alignnone wp-image-1226\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs-199x300.jpg 199w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs-65x98.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs-225x339.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs-350x528.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Lymphedema_limbs.jpg 370w\" sizes=\"auto, (max-width: 265px) 100vw, 265px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 5<\/strong>: Lymphedema.<\/span><\/p>\n<p><span style=\"color: #000000\">(Attribution: Photo of legs by Medical doctors &#8211;\u00a0<a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=37663127\" target=\"_blank\" rel=\"noopener\" style=\"color: #000000\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=37663127<\/a>\u00a0and photo of arms has been cropped. Photo by DocHealer &#8211;\u00a0<a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=64120555\" target=\"_blank\" rel=\"noopener\" style=\"color: #000000\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=64120555<\/a>, both own work, CC-BY SA 4.0)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\">Clients with lymphedema will usually report that they are experiencing swelling or that their clothes or jewelry appear to be fitting tighter. This will help you to determine where to begin your assessment. If you are doing a general assessment, it is appropriate to observe the face, neck, arms and legs in a sitting or supine position. Observe the client\u2019s bare skin and compare bilaterally.<\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Assessment for lymphedema<\/strong> involves the following steps:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\">Inspect for <strong>swelling<\/strong> and <strong>symmetry<\/strong> over the face, neck, arms, and legs.<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, no swelling is present on the face, neck, arms, and legs, and limb circumference is equal bilaterally.<\/span><\/li>\n<li><span style=\"color: #000000\">If swelling or asymmetry is present, describe the location. If you observe asymmetrical limbs in terms of circumference, measure with a flat\/flexible tape measure around the largest area of swelling on the affected limb and measure at the same location on the other limb.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><span style=\"color: #000000\">If you note swelling,<strong> assess for pitting edema<\/strong>: an indentation that remains after applying pressure over the location (see <strong>Figure 6<\/strong>). Apply pressure with the pad of your finger on a distal location (feet and medial malleolus) for about 3-5 seconds and then release. If you observe an indentation (a \u201cpit\u201d), note the location and how long the indentation remains. Then, assess a proximal location to assess how high the edema goes (e.g., over the tibia). Always check with the unit you work on about the scale used to evaluate pitting edema. Scales are usually 1\u20134 as shown in <strong>Figure 7<\/strong> and are used to record the pit depth and rebound time (the time for the indentation to disappear). Often, 1 is classified as mild, 2 as moderate, 3 as severe, and 4 as very severe. <\/span><\/p>\n<p><span style=\"color: #000000\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/IMG_0709-1-scaled-1.jpg\" alt=\"Indent showing pitting edema on medial\/dorsal side of foot.\" width=\"391\" height=\"521\" class=\"alignnone wp-image-901\" \/><\/span><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 6<\/strong>: Example of pitting edema<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed-300x232.png\" alt=\"A table showing what grade 1-4 pitting edema is with a visual representation of the size of the indent.\" width=\"519\" height=\"401\" class=\"alignnone wp-image-1199\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed-300x232.png 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed-65x50.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed-225x174.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed-350x271.png 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/11\/unnamed.png 512w\" sizes=\"auto, (max-width: 519px) 100vw, 519px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 7<\/strong>: Pitting edema scale. (Attribution: <a href=\"https:\/\/wtcs.pressbooks.pub\/nursingskills\/\" style=\"color: #000000\">https:\/\/wtcs.pressbooks.pub\/nursingskills\/<\/a> CC-BY 4.0).<\/span><\/p>\n<ol start=\"2\">\n<li><span style=\"color: #000000\">Inspect for <strong>skin discolouration<\/strong>, <strong>skin breakdown<\/strong> (cuts, cracks), and <strong>ulcers<\/strong> over the face, neck, arms, and legs. Inspect anterior and posterior sides, in between skin folds and toes, and on the bottom of the feet.\u00a0<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, skin colour is even throughout the body and skin is intact.<\/span><\/li>\n<li><span style=\"color: #000000\">If you observe any skin discoloration from the client\u2019s baseline, identify the location and colour. If skin is not intact or ulcers are present, note the location and record a description. If applicable, describe the colour, odour, <button class=\"glossary-term\" aria-describedby=\"1227-1380\">consistency<\/button> and colour and quantity of discharge.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\"><strong>Palpate for temperature<\/strong> using the dorsa of your hands from the top of the client&#8217;s limb (e.g., shoulder\/upper leg) to their extremities (hand\/fingers and feet\/toes).<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, the temperature is equal bilaterally. The distal portions of the limbs (hands and feet) may be slightly cooler, but should be equal bilaterally.<\/span><\/li>\n<li><span style=\"color: #000000\">If you note any asymmetry in temperature or extreme temperatures, identify the location and temperature (i.e., cold or hot).<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\"><strong>Palpate skin texture<\/strong> and <strong>consistency<\/strong> with your first two or three fingers and thumb over the limbs or any areas where lymphedema is suspected.<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, the skin texture is smooth and soft with no lumps.<\/span><\/li>\n<li><span style=\"color: #000000\">Describe the quality and note the location of any dry, moist, dimpled, or firm areas on the skin.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">If you suspect lymphedema, assess the client\u2019s <strong>mobility<\/strong> of the affected limb and <strong>range of motion<\/strong>.\u00a0<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, clients should have no difficulty moving their arms and legs, with full range of motion and no pain.<\/span><\/li>\n<li><span style=\"color: #000000\">Note any difficulty moving, limited range of motion, or pain.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:\u00a0<\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo swelling or discolouration present on the face, neck, arms, and legs, and limb circumference is equal bilaterally. Temperature is warm to touch and equal bilaterally, and skin texture is smooth with no lumps on arms and legs.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cRedness and swelling noted on left arm, left upper arm circumference 19 inches and forearm circumference 12 inches. Right upper arm circumference 14 inches and forearm circumference 10 in inches. Full range of motion of both arms. Client describes slowness and difficulty moving arm.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><span style=\"color: #000000\"><strong>Priorities of Care<\/strong><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"color: #000000\">A main priority of care is to <strong>prevent and\/or treat infection<\/strong>. Clients with lymphedema are at risk for skin breakdown, ulcers, and infection. Skin should be kept clean, dry, and moisturized. Clients should also be careful to prevent any scratches or cuts that could lead to infection. Assess and monitor any areas of the skin that are not intact and\/or show potential infection. It is important to observe if any areas of concern worsen (e.g., get bigger). Report to the physician or nurse practitioner if you observe any ulcers or signs of infection.<\/span><\/p>\n<p><span style=\"color: #000000\">Clients with lymphedema may be referred to a physiotherapist and encouraged to perform light exercises to assist with <strong>lymphatic fluid transportation<\/strong>. For similar reasons, compression stockings are often prescribed: these are fitted elastic stockings that apply a certain amount of pressure to the limb. It is also often recommended to elevate limbs with lymphedema.<\/span><\/p>\n<\/div>\n<\/div>\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<div id=\"h5p-99\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-99\" class=\"h5p-iframe\" data-content-id=\"99\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Lymphatics: Assessment of Lymphedema\"><\/iframe><\/div>\n<\/div>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"1227-1380\" hidden><p>refers to the degree of density or firmness.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[85],"license":[56],"class_list":["post-1227","chapter","type-chapter","status-publish","hentry","contributor-january-2023","license-cc-by-nc"],"part":1211,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1227","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":4,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1227\/revisions"}],"predecessor-version":[{"id":1921,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1227\/revisions\/1921"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1211"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1227\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=1227"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=1227"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=1227"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=1227"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}