Assessment of the Peripheral Vascular System

Question 1

the ____ carry oxygenated, nutrient-rich blood to capillaries

Answer 1

arteries

Question 2

the arteries have a ____ pressure system and ___ walls

Answer 2

high; thick,layered walls

Question 3

____ = force of blood against arterial walls felt with heart beat

Answer 3

pulse

Question 4

name the major arteries of the arm

Answer 4

brachial, radial, ulnar

Question 5

name the major arteries of the leg

Answer 5

femoral, popliteal, posterior tibial, dorsalis pedis

Question 6

______ carry deoxygenated, nutrient-depleted, waste-laden blood from the tissues back to the heart

Answer 6

veins

Question 7

name the major veins of the arm

Answer 7

cephalic, basilic, median cubital

Question 7

veins have a ___ pressure system

Answer 7

low

(have no force that propels blood flow)

Question 8

name the major veins of the leg

Answer 8

femoral, great saphenous, popliteal, small saphenous

Question 9

what are the 3 mechanisms that propel blood back to the heart

Answer 9

valves, muscular contraction, pressure gradient

(failure in mechanisms results in impeded venous return; venous stasis)

Question 10

when inspecting the arms what should you observe

Answer 10

arm size, venous patterning, edema

Question 11

normal findings when inspecting the arm

Answer 11

• arms are bilaterally symmetric with minimal variation in size and shape
  no edema or prominent venous patterning

Question 12

________ results from blocked lymphatic circulation, which may be caused by breast surgery

Answer 12

lymphedema

Question 13

lymphedema usually affects ONE extremity and causes what

Answer 13

induration and nonpitting edema

Question 14

what are precautions to take when someone has lymphedema

Answer 14

no blood pressure or blood draws can be done on the affected arm

Question 15

prominent venous patterning with edema may indicate _____

Answer 15

venous obstruction

Question 16

when inspecting the hands what should be observed

Answer 16

coloration

Question 17

normal finding when inspecting hands for color

Answer 17

equal bilaterally

Question 18

abnormal finding when inspecting hands for coloration

Answer 18

Raynaud’s disease -vascular disorder caused by vasoconstriction or vasospasm of fingers or toes

Question 19

what is a normal finding when palpating a patient’s fingers, hands, and arms for temperature

Answer 19

skin should be warm bilaterally from fingertips to upper arms

Question 20

what is an abnormal finding when palpating for temp

Answer 20

• a cool extremity (can be a sign of atrial insufficiency)
• cold fingers are common with Raynaud’s disease

Question 21

normal findings when palpating the radial pulse

Answer 21

-equal strength bilaterally (2+)
-resilient/elastic quality

Question 22

abnormal findings when palpating the radial pulse

Answer 22

diminished or absent pulse (suggests partial or complete arterial occlusion)

Question 23

when should you palpate the ulnar pulse

Answer 23

when you suspect arterial insufficiency

Question 24

normal finding when palpating the ulnar pulses

Answer 24

non-detectable (or normal pulse findings)

Question 25

abnormal findings when palpating the ulnar pulse

Answer 25

lack of resilience (can indicate arteriosclerosis)

Question 26

normal findings when palpating the brachial pulse

Answer 26

equal strength bilaterally

Question 27

abnormal finding when palpating the brachial pulse

Answer 27

increased, diminished, absent

Question 28

where should you check capillary refill and what is brisk and sluggish capillary refill

Answer 28

- check at base of nail at fingers/toes - brisk < 2sec - sluggish > 2sec

Question 29

the ____ test evaluates the patency of the radial or ulnar arteries

Answer 29

Allens (implemented when patency is questionable)

Question 30

how do you perform Allens test

Answer 30

- 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

Question 31

normal findings when inspecting the legs for color

Answer 31

pink color for lighter-skinned clients and pink or red undertones visible under darker-pigmented skin (no pigmentation changes)

Question 32

abnormal findings when inspecting the legs for color

Answer 32

- 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)

Question 33

normal findings when inspecting the legs for hair distribution

Answer 33

- hair covers legs and appears on the dorsal surface of toes

Question 34

abnormal finding when inspecting the legs for hair distribution

Answer 34

hair loss (can indicate arterial insufficiency) - hair loss occurs with age so it is not always abnormal

Question 35

normal findings when inspecting the legs for ulcers

Answer 35

free of lesions or ulcerations

Question 36

abnormal findings when inspecting the legs for lesions or ulcers

Answer 36

- 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)

Question 37

normal findings when inspecting legs for edema

Answer 37

equal in size and shape bilaterally; no swelling or atrophy

Question 38

abnormal findings when inspecting lgs for edema

Answer 38

bilateral edema (can indicate a systemic problem - CHF, lymphedema)

Question 39

when measuring legs what is unilateral edema characterized by

Answer 39

a 1cm difference in measurement at the ankles or a 2cm difference at the calf

Question 40

if edema is noted during inspection you should palpate the area to determine if it is ____ or ____

Answer 40

pitting or nonpitting

Question 41

how do you palpate to determine pitting or nonpitting edema

Answer 41

- 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

Question 42

pitting edema is associated with _____ problems

Answer 42

systemic (SHF, hepatic cirrhosis) (local problems such as venous stasis due to insufficiency, obstruction, prolonged standing/sitting)

Question 43

normal findings when palpating the legs for temperature

Answer 43

equally warm temperature bilaterally

Question 44

abnormal findings when palpating the legs for temperature

Answer 44

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)

Question 45

how should a patient position their knee when one is palpating the femoral pulse

Answer 45

bend the knee and move it out and to the side

Question 46

normal findings when palpating the femoral pulse

Answer 46

strong and equal bilaterally

Question 47

abnormal finding when palpating the femoral pulse

Answer 47

weak or absent pulse (indicated partial or complete arterial occlusion)

Question 48

how should a patients leg be positioned when palpating the popliteal pulse

Answer 48

raise the knee partially

Question 49

is it unusual to not be able to palpate the popliteal pulse

Answer 49

no - it can be difficult to detect and circulation can still be normal

Question 50

abnormal findings when palpating the popliteal pulse

Answer 50

absent pulse can be the result of an occluded artery

Question 51

normal findings when palpating the tibial pulse

Answer 51

strong bilaterally

Question 52

abnormal finding when palpating the tibial pulse

Answer 52

weak or absent pulse (can indicate partial or complete occlusion)

Question 53

normal finding when palpating the dorsalis pedis pulse

Answer 53

strong bilaterally

Question 54

abnormal finding when palpating the dorsalis pedis pulse

Answer 54

weak or absent pulse can indicate impaired arterial circulation

Question 55

how do you assess for DVT (Homan's sign)

Answer 55

- 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

Question 56

when no pain or tenderness is elicited when assessing for DVT what type of Homan's sign is this

Answer 56

negative Homan's sign