19 Peripheral Vascular System

Question 1

greatest incidence of HTN is amonghts

Answer 1

blacks

Question 2

risk of HTN

Answer 2

• black
• obese
• diabetes
• smoking (native amercn)

Question 3

highest risk for varicose veins

Answer 3

irish/german

• fam Hx
• desk job
• standing job

Question 4

PT

Answer 4

10-12 sec

Question 5

platelets

Answer 5

150k-300k

Question 6

thrombin time

Answer 6

15-23 sec

Question 7

ACT

Answer 7

90-130sec

Question 8

aPTT

Answer 8

28-38 sec

Question 9

INR

Answer 9

0.8-1.2

Question 10

shiny skin + swelling

Answer 10

caused by fluid leaking into tissues bc of incompetent valves in veins

Question 11

hair loss or skin changes

Answer 11

peripheral arterial insufficiency

Question 12

leg ulcers

Answer 12

chronic arterial or venous problems

Question 13

extreme coolness

Answer 13

arterial insufficiency

Question 14

impotence

Answer 14

periph vasc disease

-diminished arterial flow to pelvic

Question 15

arterial insufficiency pain

Answer 15

• gnawing, sharp, stabbing pain
• incr w exercise
• relieved w cessationof mvmt + dangling legs

Question 16

venous insufficiency pain

Answer 16

• aching
• feeling of fullness
• intensified w prolonged standing or sitting in one position
• swelling/varicose veins may be present
• relieved by elevating legs or by walking

Question 17

nicotine

Answer 17

vasoconstrictor

-aggravates periph vasc disease

Question 18

anxiety/emo

Answer 18

impact SNS> produce hormone response that affect vascular

Question 19

difference of more than ______ mmHg may indicate _____

Answer 19

5-10, obstruction of arterial flow to one arm

Question 20

systolic reading below 90 or diastolic below 60 may indicate…

Answer 20

early shock

Question 21

norm BP in adult

Answer 21

<14/60-90

Question 22

norm BP in older adult

Answer 22

<150/60-90

Question 23

standard position for BP

Answer 23

sitting

-supine has lower reading

Question 24

absence of pulsation

Answer 24

internal/external obstruction

Question 25

pt’s head should face __ when palpating the carotid

Answer 25

towards the hand

Question 26

abnormal carotid readings + exceptions

Answer 26

> 90 unless anxious, smoking, recently exercising
<60
50 sometimes athletes
-bruits (obstruction causing turbulance)

Question 27

carotid landmarks

Answer 27

• inferior to angle of jaw

- medial to sternoclaidomastoid muscle

Question 28

carotid instructions

Answer 28

• pt face hand
• ask to hold breath for several secs to decr tracheal sounds
• use diaphragm + bell

Question 29

edema

Answer 29

• obstruction of lymph system
• right sided HF
• if only in 1 leg, may indicate occlusion of large vein

Question 30

ulnar pulses

Answer 30

NOT necessary to palpate bs so deep

Question 31

radial pulse landmark

Answer 31

above thumb

Question 32

brachial pulse landmark

Answer 32

medial to bicep tendon

Question 33

epitrochlear lymph node landmark

Answer 33

sides of elbow

-grooves bw biceps + triceps

Question 34

dilated/constricted vessel on legs

Answer 34

D: red
C: pale

Question 35

rusty discoloration over anterior tibial w skinintact

Answer 35

venous disease

Question 36

how to check lower extremity temp

Answer 36

move fr feet + upward

cool: constric
warm: dilated

Question 37

vaicosities

Answer 37

distended veins

• freq occur in anterolateral aspect of thigh +lower leg
• calf

Question 38

tenderness + inflammation in lower legs

Answer 38

phlebitis esp if redness + swelling is present

Question 39

how to test for length of varicose vein + competency of valves

Answer 39

manual compression test

• pt stand
• palpate lower part of varicose vein w 2 fingers
• at same time, compress vein atleast 15-20cm higher w fingers of other hand

Question 40

manual compression test readigns

Answer 40

competent valves: absent pulsation beneath lower fingers

Question 41

lymph nodes larger than __ are abnormal

Answer 41

1cm

Question 42

leg sites for pulse

Answer 42

femoral (hip)
popliteal (behind knee)
dorsalis pedis (dosum of foot)
posterior tibial (outer ankle)

Question 43

how to assess for arterial supply of legs + feet

Answer 43

• pt remains supine
• lift legs 12 in above HR
• pt point + flex feet for 60 sec to drain venous blood
• skin will be blanched bc only arterial blood is present
• pt sits + dangles feet
• color should return in 10 seconds
• superficial veins hsould return 15 seconds
• if no color return, may indicate arterial insufficiencty

Question 44

leg sites for pitting edema check

Answer 44

• tibia
• behind medial malleolus
• over dorsum