Blood Vessels

Question 1

pulse amplitude

Answer 1

force - created 0 (absent) to 4 (bounding)

Question 2

Seven locations for palpation of arterial pulses

Answer 2

• Carotid: below mandible; best for evaluating heart function
o Can have patient turn head to side begin examined to relax sternocleidomastoid muscle
• Brachial: medial side of inner elbow
• Radial: radial side of wrist
• Femoral: inguinal area
• Popliteal: behind knee
• Dorsalis pedis: top of foot b/t 1st and 2nd metatarsals
• Posterior tibial: inner ankle inferior and posterior to ankle bone

Question 3

bruit

Answer 3

murmur or unexpected sound; use bell since low-pitched

• Locations: carotid, subclavian, abdominal aorta, renal, iliac, and femoral arteries
• during carotid, ask patient to hold breath to distinguish breath and pulse sounds

Question 4

audible bruit lt of umbilicus

Answer 4

abdominal aortic aneurysm

Question 5

claudication

Answer 5

pain that results from muscle ischemia (loss of blood flow); can indicate peripheral artery disease; subsides with stop in activity

Question 6

ways to assess arterial insufficiency

Answer 6

o Elevation of limb (suspected slight pallor) followed by lowering below heart (expected blood return within seconds)
o Capillary refill time: occluding blood flow by putting pressure on capillary beds in fingernail or toenail
- normal - less than 2 seconds

Question 7

jugular venous pressure

Answer 7

vertical distance of the meniscus above the level of the heart (cm of water)
o Value less than 9 cm H2O = expected

Question 8

jugular pulse

Answer 8

can only be visualized; not palpated

Question 9

taking JVP

Answer 9

• Need two pocket rulers, patient lies supine, tangential light over rt side of neck

Question 10

ways to confirm JVP

Answer 10

hepatojugular reflux (JVP observed in neck elevated with abdominal pressure) and venous engorgement of hands at levels above heart

Question 11

signs of venous obstruction

Answer 11

pain with
o Swelling and tenderness over muscles
o Engorgement of superficial veins
o Erythema and / or cyanosis

NOTE: can only confirm thrombosis (clot) with ultrasound!!

Question 12

signs of venous insufficiency

Answer 12

thrombosis, varicose veins, edema

Question 13

Homan Sign

Answer 13

flex patient’s knee slightly with 1 hand and dorsiflex the foot = pain is a positive sign of venous thrombosis

Question 14

pitting edema

Answer 14

sign of venous obstruction and insufficiency
NOTE: cannot be used to determine!!

o Severity measured by grading 1+ (slight pitting, disappears rapidly) to 4+ (very deep; lasts 2-5 minutes)

Question 15

pulses in infants

Answer 15

Infants: brachial, radial, and femoral pulses easily palpated
• Bounding pulse = patent ductus ateriosus
• Difference in amplitude b/t upper extremity pulses or b/t femoral and radial or lack of femoral = coarctation (narrowing) of aorta
• Capillary refill time rapid – expect less than 1 second

Question 16

venous hum

Answer 16

typical finding when osculating over jugular views in kids

Question 17

Allen test

Answer 17

test for adequate circulation by ulnar artery before radial artery puncture for invasion for arterial line

Question 18

3 P’s of arterial occlusion

Answer 18

pain, pallor, pulselessness, (polar = cold)