Ch. 22 Assessing the Peripheral Vascular System Flashcards
arteries
carry oxygen/nutrient blood to body
Arterial pulse
each heartbeat forces blood through arterial vessels under pressure
Peripheral arteries
major arteries of arms and legs
Major arm arteries
brachial, radial, ulnar
Major leg arteries
femoral, popliteal, dorsalis pedis, posterior tibial
Veins
carry deoxygenated blood to heart, lower pressure than arteries
Three types of leg veins
deep, superficial, perforator. most susceptible to dysfunction
Two specific veins in the legs
deep veins - femoral, popliteal. account for 90% of venous return
What is it called when venous return is impeded?
venous stasis
Capillaries
small blood vessels, connection between arterioles/venules, equilibrium between vascular and interstitial space, helps prevent edema
Lymphatic system
complex vascular system, drains extra fluid/plasma from bodily tissues/returns to vascular system. lymph nodes
Lymph nodes
filter lymph - microorganisms, dead cells, foreign material, abnormal cells.
What do we get if the lymphatic system is not working right?
edema or swelling (lymphedema)
History of health concern
changes in skin color/temp/texture, pain/cramping in legs (COLDSPA), heaviness/aching in legs, bulging/contorted/ropelike veins, open wounds/sores on legs, edema, swollen lymph nodes, changes in male sexual activity
Personal history
past problems w/ circulation in arms/legs? PVD? heart/blood vessel surgeries?
Family history
DVT, diabetes, hypertension, coronary heart disease, intermittent claudication, elevated cholesterol levels
Lifestyle/health practices
smoke, exercise, transdermal contraceptives (female), new stress, circulation problems, leg ulcers/varicose veins, support hose, medication to improve circulation
What are risks of using transdermal contraceptives and smoking?
DVTs, Raynaud disease, hypertension, edema
Raynaud disease
feel numb/cold in response to cold temp/stress
Equipment
cm tape, stethoscope, doppler ultrasound, conductivity gel, tourniquet, gauze/tissues, waterproof pen, bp cuff
Arm inspection
size, venous pattern, edema, symmetry, color of arms/hands. usually lymphedema only one extremity (no pigment change/ulceration)
Leg inspection
color (toes to groin), hair distribution, lesions/ulcers, edema, varicosities/thrombophlebitis
What could loss of hair indicate?
arterial insufficiency. older adults may have less
Arm palpation
fingers/hands/arms - note temp, cap refill <2sec, palpate radial pulse, ulnar pulses, brachial pulses if suspect arterial insufficiency, epitrochlear lymph nodes
What could cool arms indicate?
arterial insufficiency
Rating pulse
normal 2+, bounding 3+, less 1+
Which pulse do you start with?
farthest from heart
Allen test is for
evaluates patency of radial or ulnar arteries, essential before abg, used when patency questionable
Performing Allen test
palm side up on exam table, make fist, occlude ulnar artery w/ thumb, while applying pressure release fist, palm remains pale, release thumb and watch for color return. same for radial
Leg palpation
edema, bilaterally for temp (feet/legs), superficial inguinal lymph nodes, femoral, popliteal, dorsalis pedis, posterior tibial pulses.
Popliteal pulse
can be hard to detect
Posterior tibial pulse is absent in how many healthy clients?
15%
Auscultate femoral pulses
if suspect arterial occlusion in femoral, position stethoscope over femoral artery/listen for bruits. normal = not hearing sounds
Arterial insufficiency
sharp pain, pulses low, dry/shiny skin, thick toenails, no edema, deep wounds but circular - wound base black/dry/gangrene, less pain when dangling
Venous insufficiency
insufficiency
aching, pulses noted but hard to find through edema, skin thick/tough, edema, wounds superficial/irregular - beefy red wound base, less edema/pain w/ legs elevated
Special tests for arterial or venous insufficiency
position change test, ankle-brachial index (ABI), manual compression test, trendelenburg test
Position change test is for
arterial insufficiency
Position change test
supine, put forearms under knees and ankles/raise 12 inches above heart, pump feet up and down for a minute (drains venous blood), sit up/dangle legs, note color/time it takes to return
Ankle brachial index is for
arterial insufficiency
Determining ABI (ankle brachial index)
supine at least 5 min, bp cuff on one arm then other to determine brachial pressure using doppler - record highest reading between arms. bp on right ankle, use doppler to record posterior tibial and dorsalis pedis systolic pressures, do left ankle. right ABI = highest pressure in right ankle/highest pressure in both arms. left vice versa
Manual compression test is for
venous insufficiency, varicose veins
Manual compression test
stand, compress lower portion of varicose, put other hand 6-8 inches above, feel for pulsation to fingers in upper hand. repeat on other leg if varicose veins present
Trendelenburg test is for
varicose veins. determines competence of saphenous vein valves/retrograde filling of superficial veins
Trendelenburg test
supine, elevate legs 90 degrees for 15 seconds, apply tourniquet to upper thigh, stand up/observe venous filling, remove tourniquet after 30 second standing/watch for sudden filling of varicose veins from above
