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632 Advanced Anesthesia Health Assessment > Cardiovascular and Peripheral Vascular Assessment > Flashcards

Cardiovascular and Peripheral Vascular Assessment Flashcards

1
Q

What is contained within the mediastinum

A
  • Heart
  • Great Vessels: aorta, pulmonary artery, & superior/inferior vena cava
  • Esophagus
  • Trachea
  • Thoracic duct
  • Thoracic lymph nodes
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2
Q

What chamber of the heart is the most anterior ?

A

Right ventricle

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3
Q

Where can the RV and pulmonary artery be found?

A

To the left of the sternum @ the level of the sternal angle (base of the heart)

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4
Q

What intercostal space represents the level of the base of the heart

A

2nd intercostal space

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5
Q

Point of maximal impulse (PMI)

A

LV behind the RV & to the Left forms the L lateral margin
5th ICS @ left midclavicular line
- 1 to 2.5 cm in supine
- PMI > 2.5 cm = LVH

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6
Q

Where is the PMI in right & left hypertrophy?

A

RVH - PMI @ xiphoid or epigastric area

LVH- PMI > 2.5 cm

  • PMI displaced laterally to MCL
  • PMI > 10 cm from midsternal line
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7
Q

What are the atrioventricular valves

A

Tricuspid & Mitral

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8
Q

What are the semilunar valves

A

Aortic & Pulmonic

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9
Q

Which valves closing cause S1? vs S2?

A 
S1 = AV closure
S2 = SL closure
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10
Q

Where is the aortic valve located?

A

Right sternal border 2nd ICS

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11
Q

Where is the pulmonic valve located?

A

Left sternal border 2nd ICS

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12
Q

Where is the tricuspid valve located?

A

Right sternal border 5th ICS

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13
Q

Where is the mitral valve located?

A

Left midclavicular 4th ICS

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14
Q

What is an S3 murmur

A

Mitral valve opens, allowing abrupt blood flow, filling the left ventricle (compliant/ dilated)

  • right after S2 (early diastole)
  • during LV PASSIVE filling
  • can be normal in kids & teens
  • heard best at the cardiac apex
  • In older adults it represents pathology
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15
Q

What is the pathology of an S3 in an older adult?

A

the myocardium is usually overly compliant, resulting in a dilated LV
- CHF (systolic)

  • Mitral regurg
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16
Q

What is an S4

A

Increased LV end diastolic stiffness which decreases compliance

  • right before S1 (late diastole)
  • during LV active filling
  • Pathological ventricular stiffness
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17
Q

What is the pathology of an S4?

A

Non-compliant heart trying to fill but meeting resistance

  • HTN
  • MI
  • Diastolic HF (problem w/ end diastolic filling)
  • Worse d/t not feeding coronary arteries
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18
Q

What causes a heart murmur?

A

Turbulent blood flow

  • distinguished by their pitch and longer duration
  • indicate valvular heart disease in the older adult
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19
Q

What is the difference between a stenotic valve and a regurgitant valve?

A

Stenotic = narrowed orifice that obstructs blood flow

Regurgitant = close abnormally and allows backward flow

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20
Q

Murmurs detected during pregnancy should be immediately evaluated especially ________ & ________.

A

Aortic stenosis & pulmonary hypertension

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21
Q

Where is the SA node located and what is the intrinsic rate?

A

In the RA at the junction of vena cava inferior & superior)
- Pacemaker rate 60-100

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22
Q

Where is the AV node located and what is the intrinsic rate?

A

In the distal atrial septum.
- Pacemaker rate 40-60

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23
Q

HR x SV =

A

Cardiac output

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24
Q

What is a normal EF

A

60%

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25
Q

What are the 3 components of SV

A
  1. Preload
  2. Afterload
  3. Contractility
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26
Q

What are causes for decreased RV preload:

A
  • Exhalation (increase intrathoracic pressure in end exhalation in negative press. breathing)
  • Dehydration
  • Blood pooling
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27
Q

What are causes for increased preload/afterload:

A

Volume or pressure overload

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28
Q

Pulse pressure =

A

Systolic - Diastolic

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29
Q

Name 4 factors affecting Blood pressure:

A
  1. LV stroke volume
  2. Distensibility of the aorta & large arteries
  3. PVR (particularly at arteriolar level, medium size vessel level)
  4. Volume of blood in the system
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30
Q

Jugular veins can be used to assess what?

A

Index of right heart pressures & cardiac function

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31
Q

Right Jugular venous pressure (JVP) =

A

right atrial pressure = CVP & RV-end-diastolic pressure

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32
Q

Jugular venous pulsations

A

Changing pressures in the right atrium during diastole & systole produce oscillations of filling & emptying in jugular veins

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33
Q

Retrograde blood flow from the atrial contraction just before S1 and systole =

A

a wave followed by the x descent of continued atrial relaxation

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34
Q

As right atrial pressure begins to rise during right ventricular systole there is a second elevation in the CVP wave form______.

A

v wave followed by the y descent as blood passively empties from the right atrium into the RV during early & mid-diastole

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35
Q

3 Questions related to the most common manifestations of cardiac disease:

A
  1. Is the blood supply to the heart adequate?
  2. Is the electrical system of the heart functioning normally?
  3. Is the heart adequately moving blood through the circulation & supplying the organs?
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36
Q

What are the most common or concerning symptoms found in a cardiac health history?

A
  • Chest pain
  • Palpitations
  • Shortness of breath: dyspnea, orthopnea, or paroxysmal nocturnal dyspnea
  • Edema
  • Syncope
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37
Q

What is the most common symptom of coronary heart disease (CHD)?

A

Chest pain

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38
Q

What is classic exertional pain?

A

Pressure or discomfort in the chest, shoulder, back, neck, or arm in angina pectoris is seen in 18% of patients with acute MI

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39
Q

What is atypical descriptors of chest pain?

A
  • Cramping
  • Grinding
  • Pricking
  • Tooth or jaw pain (rarely)
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40
Q

Anterior chest pain descriptions

A
  • Tearing or ripping
  • Radiating into the back or neck
  • Occurs in acute aortic dissection (won’t ever be comfortable, look gray, feeling of impending doom, mottled chest)
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41
Q

Acute coronary syndrome is used to describe what?

A

The clinical syndromes caused by acute myocardial ischemia = unstable angina, non-ST & ST elevation MI
- Considered life threatening diagnoses such as angina pectoris, MI, dissecting aortic aneurysm, & PE

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42
Q

Women over 65 yo commonly report what type of chest pain?

A

Atypical.
- Upper back, neck or jaw pain, SOB, paroxysmal nocturnal dyspnea, N/V, & fatigue

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43
Q

What are palpitations?

A

Unpleasant awareness of the heartbeat.

  • Not necessarily a heart disease
  • The most serious, VTach, do not produce palpitations
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44
Q

Name 3 ways shortness of breath can present?

A
  1. Dyspnea
  2. Orthopnea
  3. Paroxysmal nocturnal dyspnea (PND)
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45
Q

What are clinical considerations if a patient has sudden dyspnea

A
  • Pulmonary embolus
  • Spontaneous pneumothorax
  • Anxiety
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46
Q

Your patient presents with orthopnea and PND what cardiac pathology do you suspect?

A
  • Left ventricular heart failure
  • Mitral stenosis
  • Obstructive lung disease
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47
Q

Edema

A

The accumulation of excessive fluid in the extravascular interstitial space.
- the interstitial tissue can absorb up to 5 L of fluid (10% weight gain) before pitting

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48
Q

What are some causes of edema?

A
  • Cardiac: R or L ventricular dysfunction; pulmonary HTN
  • Pulmonary: obstructive lung disease
  • Nutritional: hypoalbuminemia
  • Positional: dependent edema in feet and lower legs when sitting, or the sacrum when bedridden.
  • Renal: periorbital puffiness & tight rings of nephrotic syndrome
  • Liver failure enlarged waistline from ascites
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49
Q

Anasarca

A

Severe generalized edema extending to the sacrum & abdomen

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50
Q

Syncope

A

A transient loss of consciousness followed by recovery
- Usually caused by vasovagal syncope (most common)

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51
Q

What is the most concerning cause of syncope?

A

The heart not providing adequate blood flow to the brain, as occurs in end-stage heart failure & arrhythmias

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52
Q

Orthostatic hypotension

A
  • Gravitational redistribution of 300-800 mL of blood
  • Due to decreased venous return, inadequate adrenals (norepi) or hypovolemia
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53
Q

Cough syncope (episode of vigorous coughing)

A
  • Reflex vaso-depressor- bradycardia, cerebral hypoperfusion, increased CSF pressure
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54
Q

Micturition syncope

A

Vasovagal response from emptying bladder
- usually in the elderly when urinating at night

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55
Q

Arrhythmias and syncope are caused from what?

A

From decreased CO

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56
Q

How does Aortic stenosis or hypertrophic cardiomyopathy cause syncope?

A

Vascular resistance falls with exercise but CO does not rise due to outflow obstruction - not meeting demand

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57
Q

How does an MI cause syncope?

A

From decreased CO

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58
Q

What are common disorders that can resemble syncope?

A
  • Hyperventilation: hypocapnia & constriction of cerebral blood vessels & passout
  • Hypoglycemia: Unable to maintain cerebral metabolism, epinephrine released
  • Fainting from conversion disorder: unknown
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59
Q

General cardiac exam includes:

A
  • BP & HR
  • JVP
  • Carotid bruit
  • Carotid pulse/ upstroke & presence of a thrill
  • Anterior chest wall inspection
  • Palpate & locate PMI or apical impulse
  • Auscultate S1 & S2 in 6 positions from the base to the apex
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60
Q

When listening for murmurs what should you try and distinguish?

A
  • Identify their timing
  • Shape
  • Grade
  • Location
  • Radiation
  • Pitch
  • Quality
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61
Q

When should you use the diaphragm ?

A

To detect higher frequency sounds

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62
Q

When should you use the bell?

A

To detect lower frequency sounds: higher grades of stenosis

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63
Q

Where should you place the stethoscope to auscultate a carotid bruits

A

At the upper edge, level of the thyroid cartilage (on either side)

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64
Q

What usually causes a bruits

A

CAD or atherosclerosis but can also be:

  • tortuous artery
  • aortic stenosis
  • hypervascularity of hyperthyroid
  • external compression from thoracic outlet syndrome
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65
Q

What are the risks of Carotid Stenosis

A
  • 10% risk of ischemic stroke
  • Doubles risk of CAD
  • 50-69% stenosed = stroke rate is 22% at 5 years
    70% stenosed = stroke rate is 24% at 1.5 years
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66
Q

Where do you palpate the carotid?

A

Palpate the lower 1/3 of the neck
- Avoid pressing on the carotid sinus (@ the top of the thyroid cartilage) = reflex brady & decrease BP

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67
Q

What causes a decreased pulsation in the carotid?

A
  • Low SV
  • Local narrowing
  • Occlusion from CAD
68
Q

Carotid pulse characteristics:

A

Timing = upstroke follows S1 and before S2

  • Delayed in aortic stenosis
  • Thready in cardiogenic shock
  • Bounding in aortic regurgitation
69
Q

Pulsus Alternans

A

the rhythm of the pulse remains regular
- the force of the arterial pulse alternates because of alternating strong & weak ventricular contractions
- Almost always indicates severe left ventricular dysfunction
(might hear S4)

70
Q

Where is pulsus alternans best felt?

A

By applying light pressure on the radial or femoral arteries

71
Q

What is Paradoxical pulse?

A

A greater than normal drop in systolic blood pressure during inspiration
- normally no greater than 3 or 4 mmHg

72
Q

What symptoms should you look for if your patient has an unstable paradoxical pulse ?

A

Suspect cardiac tamponade b/c of:

  • JVD
  • Dyspnea
  • Tachycardia
  • Muffled heart tones
  • Hypotension
73
Q

Paradoxical pulse is commonly found in what diagnoses?

A
  • Acute asthma
  • Obstructive pulmonary disease
  • Constrictive pericarditis
  • Acute pulmonary embolism
74
Q

The apical pulse location changes in what conditions?

A
  • Pregnancy = up and to the left
  • Ventricular dilation (HF, cardiomyopathy) & mediastinal shift = displaced to anterior axillary line (L of MCL)
  • Pericardial effusion = no detection, fluid does not allow sound to be transmitted
75
Q

Midsystolic murmur

A
  • Between S1 & S2
  • Turbulent flow across semilunar valves
  • Crescendo is in the middle of systole
76
Q

Pansystolic murmur

A

Regurgitant flow across the AV valves
- Heard evenly through systole (no crescendo in the middle)

77
Q

Late systolic murmur

A

Usually Mitral valve prolapse proceeded by a click OR
- MV regurgitation

78
Q

Early diastolic murmur

A

Regurgitant flow over incompetent SL valves

79
Q

Mid-diastolic murmur

A

Turbulent flow across AV valves

80
Q

Late diastolic murmur

A

Turbulent flow across AV valves

81
Q

What are causes of continuous murmurs?

A
  • Congenital patent ductus arteriosus
  • AV fistulas
  • Venous hums
  • Pericardial friction rubs
82
Q

Grading of systolic murmurs

A

The CRNA does not grade but should know the scale 1-6:
1 - Softer than S1&S2, very faint
2 - Equal to S1&S2, hear immediately
3 - Louder than S1&S2
4 - Louder than S1&S2 w/ palpable thrill
5 - Louder than S1&S2 w/ thrill, may be hear w/ stethoscope partially off chest
6 - Louder than S1&S2, w/ thrill, may be heard w/ stethoscope entirely off the chest

83
Q

Grading of Diastolic murmurs

A

1-4:
1 - Barely audible
2 - Faint but immediately audible
3 - Easily heard
4 - Very loud

84
Q

Your patient’s JVP is 5 cm above the sternal angle, carotid upstroke is brisk w/ a bruit over the L carotid artery. PMI is diffuse, 3 cm in diameter, palpated at the anterior axillary line in the 5th & 6th ICS. S1 & S2 are soft w/ S3 present at the apex. High pitched harsh 2/6 holosystolic murmur best heard at the apex, radiating to the axilla. What does this suggest?

A
  • PMI = increased in size & displaced
  • JVP normal = 4 cm above sternal angle
  • HF
  • Volume overload (JVP/edema)
  • Left carotid occlusion
  • MV disease

Holostolic murmur = begin with S1 & continue throughout systole. - often regurgitant; a common cause is mitral regurgitation

85
Q

If your patient presents with MV regurgitation do you want a fast or slow heart rate ?

A

Normal to fast = keep a forward flow

  • if you slow the heart rate down w/ regurg you give the blood more time to backflow
86
Q

AHA concepts of ideal cardiovascular health?

A
  • BMI < 25 kg/m2
  • Non-smoker
  • Physically active
  • Follows a healthy diet
  • Untreated cholesterol < 200 mg/dL
  • BP < 120/<80 mmHg
  • Fasting BG < 100 mg/dL

(only 4% of Americans meet all 6 criteria)

87
Q

What is the leading cause of death in women?

A

Cardiovascular disease

  • about 2/3 of all US women are overweight or obese
  • contributes to epidemic of type 2 DM, & increasing risks for MI and stroke (60%)
88
Q

What are some unique factors that predispose women to having a stroke ?

A
  • Pregnancy
  • Hormone therapy
  • Early menopause
  • Preeclampsia
89
Q

Risk factors for Cardiovascular health (8):

A
  1. Family hx of premature CVD
  2. Smoking
  3. Unhealthy diet
  4. Physical inactivity
  5. Obesity
  6. HTN
  7. Diabetes
  8. Increased lipids
90
Q

Risk factors for primary (essential) HTN (7):

A
  1. Age
  2. Genetics
  3. Black race
  4. Obesity & wt. gain
  5. Excessive salt intake
  6. Physical inactivity
  7. Excessive alcohol use
91
Q

Causes for secondary HTN (10):

A
  1. OSA
  2. CKD
  3. Renal artery stenosis
  4. Medications
  5. Thyroid disease
  6. Parathyroid disease
  7. Cushing syndrome
  8. Hyperaldosteronism
  9. Pheochromocytoma
  10. Coarctation of the aorta
92
Q

What is the American College of Cardiology (ACC) and AHA recommendations for BP

A
  • Existing CVD = 130/80 mmHg
  • Patients who have had a stroke or TIA = 140/90 mmHg
93
Q

What are the 3 layers of issue in an artery

A
  1. Intima
  2. Media
  3. Adventitia
94
Q

What is Atherosclerosis?

A

Chronic inflammatory disease initiated by injury (i.e., smoking or HTN) to vascular endothelial cells

95
Q

Where does atherosclerotic plaque begin to form?

A

In the Intima
- circulating cholesterol particles, especially LDLs, are exposed to proteoglycans from the extracellular matrix, undergo, oxidative modification, & trigger a local inflammatory response

96
Q

Where do you assess the arterial pulses?

A

Arms & Hands:
- Brachial, radial, & ulnar
Abdomen:
- Superior mesenteric, celiac, inferior mesenteric arteries
Legs:
- Femoral, popliteal, posterior tibial, dorsalis pedis arteries

97
Q

How does the venous intima prevent clots from forming?

A

Consists of nonthrombogenic endothelium

98
Q

Where does the abdominal visceral veins drain?

A

Drain into the portal vein
- Supplies ~75% of the blood flow to the liver

99
Q

Which veins are more susceptible to irregular dilation?

A

Due to weaker wall structures, the leg veins are susceptible to irregular dilation, compression, ulceration, & evasion by tumors

100
Q

Most filtered fluid returns to circulation as _______.

A

Lymph

101
Q

Any alteration in what 3 things can cause edema

A
  1. Venous capillary pressure
  2. Capillary osmotic pressure
  3. Abnormal fluid balance (exogenous administration or by resorption by the kidney)
102
Q

What characterizes pitting edema?

A

Edema that is compressible, or lessens when external pressure is applied

103
Q

What characterizes lymphedema?

A

Obstructed lymphatic drainage, usually not compressible
- initially soft and pitting then changes to hard non-pitting
skin thickened
ULCERs are RARE
> 3 cm swelling

104
Q

Lymphadenopathy

A

Enlarged lymph nodes, with or without tenderness

105
Q

What is the difference between local or generalized lymphadenopathy

A

Local = a causative lesion in the drainage area (unilateral)

Generalized = enlarged nodes in at least two other non-contiguous lymph node regions

106
Q

What is it called when your patient presents with cramping in the legs on exertion but relief with rest?

A

Intermittent claudication

107
Q

Peripheral arterial disease

A

Atherosclerotic disease distal to the aortic bifurcation
- marker for CV morbidity & mortality
= functional decline

108
Q

What are the presenting symptoms of PAD

A

Almost always involve:
- pain
- swelling
- discoloration in the area of arterial distribution
(same risk factors as CAD)

109
Q

What is it called when your patient presents with pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet?

A

Neurogenic claudication

110
Q

Most PAD has minimal symptoms. 2 types of atypical leg pain occur prior to critical limb ischemia, what are they?

A

Leg pain on exertion & rest
- this pain can begin at rest & carry on (exertional pain that does not stop when the patient stops walking)

111
Q

PAD warning signs (6):

A
  1. Fatigue, aching, numbness, or pain that limits walking or exertion
  2. Erectile dysfunction
  3. Poor healing/non-healing wounds of the feet or legs
  4. Pain present at rest in the lower leg/foot & changes when standing or supine
  5. Abdominal pain after meals (food fear/ wt. loss)
  6. 1st degree relative w/ ABD aortic aneurysm
112
Q

Your patient with a hx of PAD states they are having pain in the buttock/hip, what artery is affected ?

A

Aortoiliac artery

113
Q

Your patient with a hx of PAD states they are having pain in the Genitalia, what artery is affected ? What other symptom might they have?

A

Aortoiliac-pudendal artery
- Erectile dysfunction

114
Q

Your patient with a hx of PAD states they are having pain in the thigh, what artery is affected ?

A

Common femoral or aortoiliac artery

115
Q

Your patient with a hx of PAD states they are having pain in the upper calf, what artery is affected ?

A

Superficial femoral artery

116
Q

Your patient with a hx of PAD states they are having pain in the lower calf, what artery is affected ?

A

Popliteal artery

117
Q

Your patient with a hx of PAD states they are having pain in the foot, what artery is affected ?

A

Tibial or peroneal artery

118
Q

Your patient presents w/ PAD and Abdominal, flank, back pain. What is your primary concern?

A

Abdominal aortic aneurysm (AAA)

119
Q

Abdominal aortic aneurysm (AAA) may cause symptoms by compressing on what 3 things:

A
  1. Bowel
  2. Aortic branch arteries
  3. Ureters
120
Q

Acute onset of abdominal, flank or back pain suggest what diagnoses?

A

Mesenteric ischemia from:

  1. arterial embolism
  2. arterial or venous thrombosis
  3. bowel volvulus or strangulation
  4. hypoperfusion

Failure to detect acute symptoms can result in necrosis or death

121
Q

If abdominal, flank, or back pain is relieved by sitting or bending forward what might this suggest?

A

Spinal stenosis

  • may also present as bilateral buttock or leg pain
122
Q

Food fear and weight loss with a patient w/ a hx of PAD suggest?

A

Abdominal pain after meals related to oxygen supply-demand mismatch
= CHRONIC intestinal ischemia of the Celiac or superior/ inferior mesenteric arteries

123
Q

DVTs usually present as

A

unilateral or asymmetric swelling of the extremities
- individual clinical features have poor diagnostic value

124
Q

If you suspect a DVT in a patient with a CVC what questions should you ask?

A
  • Arm discomfort
  • Pain
  • Paresthesia
  • Weakness
125
Q

If you suspect a DVT in a patient you understand the individual clinical features are a poor diagnostic value and you should use what?

A

A well validated formal clinical scoring system like the:
Wells Clinical Score
&
the Geneva Score

126
Q

PAD physical exam of the arms should include?

A
  • Inspect the upper extremities:
  • size, symmetry, swelling, venous pattern, color
  • Palpate the upper extremities:
  • radial pulse, brachial pulse, epitrochlear lymph nodes (elbow)
127
Q

PAD physical exam of the abdomen should include?

A
  • Auscultate the abdomen: aortic, renal & femoral bruits
  • Inspect & palpate the aortic width & pulsatation
  • Palpate the inguinal lymph nodes size, consistency, discreteness, & any tenderness
128
Q

PAD physical exam of the legs should include?

A
  • Inspect the lower extremities: size, symmetry, swelling, venous pattern, skin color, temperature (cooler d/t weak walls), ulcers, hair loss
  • Palpate the femoral, popliteal, dorsalis pedis, posterior tibial pulses, temperature, swelling, & edema
129
Q

Physical exam of the vasculature should include ?

A
  • Measure the BP in both arms
  • Palpate the carotid upstroke
  • Auscultate for bruits
  • Palpate the aorta & assess its maximal diameter
  • Ankle brachial index to check for insufficiency
130
Q

What is the Grading of pulses ?

A 
0 = absent, unable to palpate 
1+ = Diminished, weaker than expected 
2+ = Brisk, expected (normal) 
3+ = Bounding
131
Q

Your patient presents with bounding carotid, radial & femoral pulses what is your differential diagnosis?

A

Aortic regurgitation

132
Q

Your patient presents with pulsus parvus (weak pulses) what is your differential diagnosis?

A

Atherosclerotic PVD

133
Q

Your patient presents with pulsus tardus (sluggish pulses) what is your differential diagnosis?

A

Aortic stenosis or low cardiac output

134
Q

How does Raynaud disease clinically present?

A

Wrist pulses are typically normal, but spasm of the more distal arteries causes episodes of sharply demarcated pallor of the fingers
- can present in the feet as well (distal to the ankle)

135
Q

If you suspect a DVT in the lower leg what will you see clinically?

A

Calf asymmetry > 3 cm (increases the likelihood ratio >2.20)
- Have to r/o muscle tear/trauma, baker cyst, and muscular atrophy

136
Q

Superficial thrombophlebitis =

A

Local swelling, redness, warmth, & a subcutaneous cord

137
Q

Cellulitis

A

Asymmetric warmth & redness over the calf

138
Q

Venous thromboembolism

A

Chronic venous insufficiency from prior DVT, incompetent venous valves; or lymphedema

= Unilateral calf & ankle swelling & edema

139
Q

If you patient has bilateral lower leg edema, what should you suspect?

A
  • HF
  • Cirrhosis
  • Nephrotic syndrome
140
Q

Patient presents with ulcers or sores on the feet, what is your differential diagnosis?

A

Peripheral vascular disease

141
Q

Varicose veins

A

Dilated & tortuous veins, may feel somewhat thickened walls

142
Q

Chronic venous insufficiency

A

Brownish discoloration or ulcers just above the malleolus
- may be bilateral w/ soft and pitting

143
Q

Lymphedema & advanced venous insufficiency will present with?

A

thickened, brawny skin (non-acute)

144
Q

Where should you measure the calves if you notice unilateral swelling or edema in the legs?

A

10 cm below the tibial tuberosity

145
Q

If you suspect an occlusion in the lower extremity what clinical signs will you see?

A
  • All pulses distal will be affected
  • Postural color change from supine to standing
146
Q

If your patient has an aneurysm how will this affect the pulses?

A

Exaggerated & widened pulses

147
Q

What are the clinical signs of an acute arterial occlusion from embolism or thrombosis?

A

Pain, numbness, or tingling.

The limb distal to the occlusion becomes cold, pale, and pulseless = EMERGENCY

148
Q

Poikilothermia

A

Relative hypothermia of one extremity as compared with another

149
Q

1+ scoring of pitting edema

A

Barely detectable impression when finger is pressed into skin

150
Q

2+ scoring of pitting edema

A

Slight indentation; 15 seconds to rebound

151
Q

3+ scoring of pitting edema

A

Deeper indentation; 30 seconds to rebound

152
Q

4+ scoring of pitting edema

A

> 30 seconds to rebound

153
Q

A painful, pale, swollen leg, w/ tenderness in the groin over the femoral vein suggests?

A

Deep iliofemoral thrombosis

154
Q

How should you palpate the veins in the calf?

A

With the patient’s leg flexed at the knee & relaxed:
- gently compress the calf muscles against the tibia and search for any tenderness or cords

155
Q

Homan sign

A

Discomfort behind the knee with forced dorsiflexion on the foot
- Not a reliable test for DVT

156
Q

How to perform an ankle-brachial index?

A
  1. Patient supine for 10 min
  2. Measure SBP of brachial pulse w/ doppler (avg. 2 readings)
  3. Measure SBP of dorsalis pedis pulse w/ doppler (BP around calf)(avg. 2 readings)
157
Q

How do you calculate an ABI

A

The ratio of blood pressure measurements in the foot and arm
- should be recorded to two decimal places

Right ABI = highest pressure in Right foot/ highest pressure in BOTH arms

Left ABI = highest pressure in Left foot/ highest pressure in BOTH arms

158
Q

What is a normal ABI?

A

Normal range = 0.90 to 1.40
- pressure is normally higher in the ankle than the arm

>1.40 = noncompressible calcified vessel
< 0.90 = diagnostic of PAD
< 0.5 = severe PAD

159
Q

What are the AHA/ACC practice guidelines for ABI screening for PAD?

A

Screen when only risk factors present

  • sensitivity of an abnormal ABI is low
  • specificity is 99%
  • the test has high positive & negative predictive values (both > 80%)
160
Q

What are the USPSTF recommendations for AAA screenings?

A

Grade B recommendation for 1-time ABD US screening of men ages 65-75 yr who have smoked more than 100 cigarettes in a lifetime

  • Women are inconclusive
161
Q

Thromboangiitis Obliterans (Buerger Disease)

A

Inflammatory process
- non-atherosclerotic occlusive ds. of sm-med. arteries & veins (not plaque related)
- usually digits or toes on two limbs
Progress from sm. ulcerations to gangrene
- Migratory phlebitis

162
Q

Compartment Syndrome

A

Increased pressure in a fascial compartment

  • collapses arterial supply causing nerve damage = tingling, burning, numbness
  • Dusky red skin, shiny
  • Does not have to be trauma related can result from an athlete w/ a muscle tear
  • EMERGENCY!
163
Q

Acute Lymphangitis

A

Acute infection

  • usually strep or staph from portal of entry
  • Red streak on skin with tenderness (follows a demarcated line)
  • Enlarged lymph nodes
  • Seen in IV drug abuse
  • FEVER
164
Q

Acute Cellulitis

A

Bacterial infection of skin

  • usually strep or staph
  • red, edema, warm
  • lesion can be demarcated from skin
  • enlarged lymph nodes
  • FEVER
165
Q

Erythema Nodosum

A

Painful raised bilateral lesions from the inflammation of subQ fat

  • autoimmune
  • pretibial lower legs, extensor arms, buttocks, & thighs
  • red initially then fade to violet/red-brown
  • NO ulcerations
  • FEVER, malaise

632 Advanced Anesthesia Health Assessment (12 decks)

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