3: Examination Flashcards
Describe the technique of assessing pallor with elevation?
Position the pt in supine and note the color of the soles of the feet. Elevate the legs above 45 degrees for one minute and observe color
What is a positive pallor with elevation test indicative of?
Ischemia
How long does it take to see pallor with elevation if there is moderate arterial insufficiency?
30-45 seconds
How long does it take to see pallor with elevation if there is mild arterial insufficiency?
45-60 seconds
How long does it take to see pallor with elevation if there is no arterial insufficiency?
Greater than one minute
Describe the rubor of dependency test
Upon completion of the pallor of elevation test, bring the pt into sitting and observe the color of the feet
If the feet turn bright red during the rubor of dependency test, what is it indicative of?
Ischemia - causes significant vasodilation
How fast should normal color return during rubor of dependency if there is normal blood flow?
15-20 seconds
How will a pt respond to the rubor of dependency test if they have severe arterial insufficiency?
Pallor with elevation in less than 25 seconds that is followed by a bright red appearance
Describe how to assess venous filling time
Observe LE and veins to establish baseline, then elevate LE for 1 minute or until vein collapses. Bring pt to sitting and record time it takes vein to refill
What is considered normal venous filling time?
5-15 seconds
How long will it take for the veins to refill if the pt has arterial insufficiency?
Greater than 20 seconds
If a pt’s venous filling time is greater than 20 seconds, what is it indicative of?
Arterial insufficiency
What is indicated if a pt’s venous filling time is immediate?
Venous insufficiency
Describe how to assess capillary refill
Apply pressure to distal extremity and observe refill
What timeframe is appropriate for capillary refill?
Immediately
How is pitting edema scored?
0-4+ based on rebound time
What is considered to be a 0 on the pitting edema scale?
No pitting observed
What is considered to be a 1+ on the pitting edema scale?
Barely perceptible
What is considered to be a 2+ on the pitting edema scale?
Skin rebound less than 15 seconds
What is considered to be a 3+ on the pitting edema scale?
Skin rebound in 15-30 seconds
What is considered to be a 4+ on the pitting edema scale?
Skin rebound in 30 seconds or more
What two scales can be used to assess pulses?
0-4+ or 0-2
If you are assessing pulses with the 0-4+ scale, what does 0 indicate?
Unable to palpate pulse
If you are assessing pulses with the 0-4+ scale, what does 1+ indicate?
Barely perceptible
If you are assessing pulses with the 0-4+ scale, what does 2+ indicate?
Weak
If you are assessing pulses with the 0-4+ scale, what does 3+ indicate?
Normal
If you are assessing pulses with the 0-4+ scale, what does 4+ indicate?
Bounding pulse, possible charcot joint or aneurysm
If you are assessing pulses with the 0-2 scale, what does 0 indicate?
Absent
If you are assessing pulses with the 0-2 scale, what does D indicate?
Doppler
If you are assessing pulses with the 0-2 scale, what does 1+ indicate?
Normal
If you are assessing pulses with the 0-2 scale, what does 2 indicate?
Increased
What is the ABI?
Ankle brachial index is a noninvasive test to diagnose peripheral artery disease
What is the equation for the ABI?
Systolic at the ankle / systolic at the brachium
What is the gold standard for assessing peripheral artery disease?
ABI
What is a normal ABI value?
1.0 - 1.29
What ABI value is considered to be borderline?
0.91 - 0.99
What ABI value is considered to be mild PAD?
0.71 - 0.90
What ABI value is considered to be medium severe PAD?
0.41 - 0.70
What ABI value is considered to be severe PAD?
< 0.40
What is the leading cause of foot ulceration?
Loss of protection sensation
What are the two methods of conducting a sensory assessment?
Semmes-Weinstein monofilament and tuning fork
What size monofilament is used to assess sensation?
5.07 monofilament
How much force is applied with 5.07 monofilament?
10 g of perpendicular force
What level tuning fork can be used to assess sensation?
128 Hz
Which is a more sensitive assessment, tuning fork or monofilament?
Tuning fork
What are 4 characteristics of an ideal residual limb?
- Durable
- Well-vascularized
- Tolerates pressure in weight bearing areas
- Tolerates friction in areas covered by prosthetic socket
What is the name of this residual limb shape?
Bulbous
What is the name of this residual limb shape?
Conical
What is the name of this residual limb shape?
Cylindrical
What is the name of this residual limb shape?
Dog ears
What is the name of this residual limb shape?
Complicated
What limb shape is ideal?
Cylindrical
What is required prior to assessing strength?
MD clearance to add any resistance beyond gravity
How long after an amputation until a pt will typically receive MD clearance?
7-10 days once drains and staples are removed and the wound is closed
What are 10 methods for preventative foot care?
- Wash daily and dry
- Apply thin coat of moisturized daily but avoid between toes
- Trim nails after washing and trying feet
- Cut nails straight across
- Have podiatrist assist with thick or ingrown nails
- Gently use pumice stone for corns or calluses
- Check water temp with thermometer
- Wear socks at night for cold feet
- Sunscreen on tops of feet
- Health care screen
How often should pt’s be inspecting their feet?
Daily
Should pt’s walk bearfoot?
No - use slippers at night and special shoes on the beach
Should pt’s wear sandals with thongs between the toes?
No
