Assessment of the Peripheral Vascular System Flashcards
the ____ carry oxygenated, nutrient-rich blood to capillaries
arteries
the arteries have a ____ pressure system and ___ walls
high; thick,layered walls
____ = force of blood against arterial walls felt with heart beat
pulse
name the major arteries of the arm
brachial, radial, ulnar
name the major arteries of the leg
femoral, popliteal, posterior tibial, dorsalis pedis
______ carry deoxygenated, nutrient-depleted, waste-laden blood from the tissues back to the heart
veins
name the major veins of the arm
cephalic, basilic, median cubital
veins have a ___ pressure system
low
(have no force that propels blood flow)
name the major veins of the leg
femoral, great saphenous, popliteal, small saphenous
what are the 3 mechanisms that propel blood back to the heart
valves, muscular contraction, pressure gradient
(failure in mechanisms results in impeded venous return; venous stasis)
when inspecting the arms what should you observe
arm size, venous patterning, edema
normal findings when inspecting the arm
- arms are bilaterally symmetric with minimal variation in size and shape
no edema or prominent venous patterning
________ results from blocked lymphatic circulation, which may be caused by breast surgery
lymphedema
lymphedema usually affects ONE extremity and causes what
induration and nonpitting edema
what are precautions to take when someone has lymphedema
no blood pressure or blood draws can be done on the affected arm
prominent venous patterning with edema may indicate _____
venous obstruction
when inspecting the hands what should be observed
coloration
normal finding when inspecting hands for color
equal bilaterally
abnormal finding when inspecting hands for coloration
Raynaud’s disease -vascular disorder caused by vasoconstriction or vasospasm of fingers or toes
what is a normal finding when palpating a patient’s fingers, hands, and arms for temperature
skin should be warm bilaterally from fingertips to upper arms
what is an abnormal finding when palpating for temp
- a cool extremity (can be a sign of atrial insufficiency)
- cold fingers are common with Raynaud’s disease
normal findings when palpating the radial pulse
-equal strength bilaterally (2+)
-resilient/elastic quality
abnormal findings when palpating the radial pulse
diminished or absent pulse (suggests partial or complete arterial occlusion)
when should you palpate the ulnar pulse
when you suspect arterial insufficiency
normal finding when palpating the ulnar pulses
non-detectable (or normal pulse findings)
abnormal findings when palpating the ulnar pulse
lack of resilience (can indicate arteriosclerosis)
normal findings when palpating the brachial pulse
equal strength bilaterally
abnormal finding when palpating the brachial pulse
increased, diminished, absent
where should you check capillary refill and what is brisk and sluggish capillary refill
- check at base of nail at fingers/toes
- brisk < 2sec
- sluggish > 2sec
the ____ test evaluates the patency of the radial or ulnar arteries
Allens
(implemented when patency is questionable)
how do you perform Allens test
- assess ulnar patency
-Have client rest hand palm side up and make a fist - Use your thumbs to occlude the radial and ulnar arteries
- Continue pressing to keep both arteries occluded and have client release fist
- Note that the palm remains pale
- Release the pressure on the ulnar artery, watch for color to return
- To assess radial patency, repeat the last step, release pressure on the radial artery
normal findings when inspecting the legs for color
pink color for lighter-skinned clients and pink or red undertones visible under darker-pigmented skin
(no pigmentation changes)
abnormal findings when inspecting the legs for color
- pallor (especially when elevated)
- rubor (suggests arterial insufficiency when dependent)
- cyanosis (when dependent suggests venous insufficiency)
_ rush or brownish pigmentation around ankles (suggests venous insufficiency)
normal findings when inspecting the legs for hair distribution
- hair covers legs and appears on the dorsal surface of toes
abnormal finding when inspecting the legs for hair distribution
hair loss (can indicate arterial insufficiency)
- hair loss occurs with age so it is not always abnormal
normal findings when inspecting the legs for ulcers
free of lesions or ulcerations
abnormal findings when inspecting the legs for lesions or ulcers
- ulcers with smooth, even margins that occur are pressure areas (result from arterial insufficiency)
- ulcers with irregular edges, bleeding, and possible bacterial infection (result from venous insufficiency)
normal findings when inspecting legs for edema
equal in size and shape bilaterally; no swelling or atrophy
abnormal findings when inspecting lgs for edema
bilateral edema (can indicate a systemic problem - CHF, lymphedema)
when measuring legs what is unilateral edema characterized by
a 1cm difference in measurement at the ankles or a 2cm difference at the calf
if edema is noted during inspection you should palpate the area to determine if it is ____ or ____
pitting or nonpitting
how do you palpate to determine pitting or nonpitting edema
- Press the edematous area with the tips of your fingers, hold for a few seconds, then release
- If depression does not rapidly refill and the skin remains indented on release, pitting edema is present
pitting edema is associated with _____ problems
systemic (SHF, hepatic cirrhosis)
(local problems such as venous stasis due to insufficiency, obstruction, prolonged standing/sitting)
normal findings when palpating the legs for temperature
equally warm temperature bilaterally
abnormal findings when palpating the legs for temperature
generalized coolness in one leg or a change in temperature from warm to cool as you move down the leg (suggests arterial insufficiency)
(increased warmth can be caused by superficial thrombophlebitis)
how should a patient position their knee when one is palpating the femoral pulse
bend the knee and move it out and to the side
normal findings when palpating the femoral pulse
strong and equal bilaterally
abnormal finding when palpating the femoral pulse
weak or absent pulse (indicated partial or complete arterial occlusion)
how should a patients leg be positioned when palpating the popliteal pulse
raise the knee partially
is it unusual to not be able to palpate the popliteal pulse
no - it can be difficult to detect and circulation can still be normal
abnormal findings when palpating the popliteal pulse
absent pulse can be the result of an occluded artery
normal findings when palpating the tibial pulse
strong bilaterally
abnormal finding when palpating the tibial pulse
weak or absent pulse (can indicate partial or complete occlusion)
normal finding when palpating the dorsalis pedis pulse
strong bilaterally
abnormal finding when palpating the dorsalis pedis pulse
weak or absent pulse can indicate impaired arterial circulation
how do you assess for DVT (Homan’s sign)
- Client should be supine
- Flex client’s knee about 5 degrees
- Place your hand under the client’s calf muscle, and dorsiflex the foot
- Ask the client to report pain or tenderness
- Repeat on the opposite leg
when no pain or tenderness is elicited when assessing for DVT what type of Homan’s sign is this
negative Homan’s sign
