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Sharlene and MB's PT party > Cardiovascular- The Exam: Peripheral Vascular System > Flashcards

Cardiovascular- The Exam: Peripheral Vascular System Flashcards

1
Q

Examine Extremities: why check for diaphoresis

A

excess sweating can be associated with decreased cardiac output

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2
Q

Examine Extremities: why check arterial pulses

A

decreased or absent pulses associated with peripheral artery disease (PAD)

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3
Q

Examine Extremities: how to check arterial pulses

A

Must check bilaterally and start distal
For LE: check in supine- dorsalis pedic, posterior tibial, popliteal, femoral
For UE: radial, brachial, carotid

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4
Q

Examine Extremities: check skin- what is cyanosis

A

blueish color
decreased cardiac output or cold
very visible at lips, fingers, nail beds

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5
Q

Examine Extremities: check skin- what is pallor

A

absence of rosy color in light skin
associated with decrease blood flow
common in PAD

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6
Q

Examine Extremities: check skin- when does rubor occur

A

dependent redness with PAD

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7
Q

Examine Extremities: check skin- besides color what should you check

A

temperature changes

decrease in superficial skin associated with poor arterial perfusion

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8
Q

Examine Extremities: check skin- clubbing

A

curvature of finger nails with soft tissue enlargement at base of nail
associated with chronic O2 deficiency, chronic pulmonary disease, or heart failure

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9
Q

Examine Extremities: check skin- trophic changes

A

pale, shiny, dry skin

hair loss associated w/ PAD

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10
Q

Examine Extremities: check skin- fibrosis

A

tissues that are thick, firm, and unyielding

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11
Q

Examine Extremities: check skin- Stemmer’s sign

A

dorsal skin folds of the toe or fingers are resistant to lifting
indicative of fibrotic changes and lymphedema

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12
Q

Examine Extremities: check skin- abnormal qualities of skin

A

abnormal pigmentation
ulceraton
dermatitis
gangrene

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13
Q

Examine Extremities: Intermittent claudication (IC)

A
  • IC is pain, cramping, and LE fatigue occurring during exercise and relieved by rest
  • Associated w/ PAD
  • pain is typical in calf, but may be in thigh or butt
  • pain at rest will occur with severe decreased in arterial blood supply, typically in forefoot, and worse at night
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14
Q

Examine Extremities: check edema- measuring edema

A
  • girth measurements using tape measure at regular intervals
  • volumetric measurements using a volumeter (useful for irregular body parts such as hand or foot
  • pitting edema grades 1+ through 4+ (depression made when pressuing firmly into skin)
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15
Q

Examine Extremities: check edema- 1+

A

mild, barely perceptible indentation

<1/4 inch pitting

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16
Q

Examine Extremities: check edema- 2+

A

moderate
easily identified depression
returns to normal w/in 15 sec
1/4-1/2 inch pitting

17
Q

Examine Extremities: check edema- 3+

A

Severe depression
takes 15-30 sec to rebound
1/2-1 inch pitting

18
Q

Examine Extremities: check edema- 4+

A

very severe
depression lasts for > 30 seconds or more
> 1 inch pitting

19
Q

Examine Extremities: check edema- causes of peripheral edema

A
  • include chronic venous insufficiency and lymphedema

- BIL edema associated with CHF

20
Q

Peripheral venous circulation: what to do first

A

examine venous system before arterial; venous insufficiency can invalidate some arterial test.

21
Q

Peripheral venous circulation: what is the percussion test

A
  • determines competence of greater saphenous vein
  • in standing, palpate one segment of vein while percussing vein app. 20 cm. higher
  • if pulse wave is felt in lower hand, the intervening valves are incompetent
22
Q

Peripheral venous circulation:what is the trendelenburg test (retrograde filling test)

A
  • determines competence of communicating veins and saphenous system
  • pt. is supine, LE elevated 60 degrees (empties venous blood)
  • tourniquet put on upper thigh (occludes venous flow in superficial veins
  • ask pt. to stand
  • note if veins fill in normal pattern. should take app. 30 sec.

**I’m never doing this to a patient

23
Q

Peripheral venous circulation: venous filling time

A
  • examines time needed for veins to refill
  • put pt. supine and passively elevate LE to 45 degrees for 1 min; place in dependent position; note how long to refill
  • delayed filling (>15 sec) is indicative of venous insufficiency
24
Q

Peripheral venous circulation: doppler ultrasound

A
  • examine using an ultrasonic oscillator connected to ear phones
  • determines blood flow in a vessel; good for venous and arterial
  • probe goes over large vessel, US signal given transcutaneously
  • movement of blood causes audible shift in frequency
  • good for locating nonpalpable pulses and measuring systolic BP in extremities
25
Q

Peripheral venous circulation: air plethysmography (APG)

A

pneumatic device calibrated to measure patency of venous system; volume

  • cuff inflated around calf, attached to pressure transducer and microprocessor
  • occludes venous return, permits arterial inflow, recorder registers increasing volume with cuff, time to return to baseline with cuff deflation
  • comparison tests performed in sitting, standing, and up on toes
26
Q

Peripheral arterial circulation: Ankle Brachial index (ABI)

A
  • the ratio in LE pressure divided by UE pressure
  • pt. rests in supine for 5 min
  • BP cuff inflated to occlude arterial blood flow
  • Performed at in UE at brachial artery and LE at post tib artery and dorsalis pedis
  • assiss with risk stratification of CV disease
27
Q

Peripheral arterial circulation: ABI index and meaning of values

A

<0.9 = associated with 2-4x increased risk for CV events or death
< 0.5 = increased risk of progression tosevere or critical limb ischemia in one year
1 = normal
> 1.4 non-compliant arteries

28
Q

Peripheral arterial circulation: changes in color with LE positional changes

A
  • with insifficiency, pallor develops in elevation; reactive hyperemia (rubor) develops in dependent position
  • changes taking more than 30 sec are also indicative of arterial insufficiency
29
Q

Peripheral arterial circulation: intermittent claudication (IC)

A
  • exercise induced pain or cramping in LE, most typically in calf, that goes away with rest
  • have pt. walk on level grade, 1 mile/hour
  • test is stopped with claudicatory pain
  • note time fo test and usesubjective ratings of pain scale to classify degree of claudification
  • examine LE for cold, numbness, pallor, and loss of hair over ant. tib. area
  • leg cramps may also result from diuretic use with hypokalemia
30
Q

Peripheral arterial circulation: Subjective ratings of pain with IC scale

A

Grade 1- min discomfort or pain
Grade 2- mod discomfort or pain; pt.’s attention can be diverted
Grade 3- intense pain; pt.’s attention cannot be diverted
Grade 4- excruciating and unbearable pain

Sharlene and MB's PT party (35 decks)

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