Chapter 13: Blood Vessels Flashcards
BV: Physical exam
Palpate the arterial pulses in distal extremities, comparing characteristics bilaterally for rate, rhythm, contour, amplitude.
Auscultate the carotid, abdominal aorta, renal, iliac, and femoral arteries for bruits.
With the patient reclining at a 45-degree angle, inspect for jugular venous pulsations and distention; differentiate jugular and carotid pulse waves, and measure jugular venous pressure.
Inspect the extremities for sufficiency of arteries and veins for color, skin texture, and nail changes; presence of hair; muscular atrophy; edema or swelling; varicose veins.
Palpate the extremities for warmth, pulse quality, tenderness along any superficial vein, pitting edema
Grading of pitting edema
1+ 2mm depression
2+ 4mm depression
3+ 6mm depression
4+ 8mm depression
HPI: BV
Leg pain or cramps
-Onset and duration; character; continuous burning in toes, pain in thighs or buttocks; skin changes; swelling of leg; limping; waking at night with leg pain
Swollen ankles
-Onset and duration, related circumstances ,associated symptoms, treatment attempted, medication
HPI children
Hemophilia
Sickle cell disease
Thalassemias
Renal disease
Coarctation of the aorta: Femoral pulses stronger than brachial
Leg cramps during exercise
HPI: preg
BP
Legs
HPI: older adults
Leg edema
Impact on ADL
Coping abilities
Claudication
Medications
PMH: BV
Cardiac surgery or hospitalization; chronic illness
Blood cancers
FMH
Family member risk factors; morbidity/mortality; cardiac; metabolic disorders; blood cancers
PMH/SMH
Employment, tobacco, nutritional status/diet/weight; exercise; alcohol/recreational drugs
Peripheral art. Physical exam
Palpation of arteries
-Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial
Palpate for artery characteristics
-Rate and rhythm, pulse contour (waveform), amplitude (force),symmetry, obstructions, variations
Amplitude scale
-4: Bounding, aneurysmal
-3: Full, increased
-2: Expected
-1: Diminished, barely palpable
-0: Absent, not palpable
Auscultation over arteries for bruits
-Carotid, Subclavian, Abdominal aorta, Renal, Iliac, Femoral
Pulse abnormalities
Alternating pulse (pulsus alternans)
-alt of a pulsation of small amp with the pulsation of large amp while the rhythm is regular
-poss cause: L vent failure (more sig if pulse slow)
Pulsus Bistriens
-best detected by palpation of the carotid artery. 2 main peaks. 1st percussion wave (pulse pressure), 2nd tidal wave (reverberation from periphery)
-poss cause- aortic stenosis combined with aortic insufficiency
Bigenminal pulse
-normal pulsation followed by a premature contraction
- the amp of the pulsation of the premature contraction is less than that of the normal
-poss cause: disorder of rhythm
Large, bounding pulse:
-hyperkinetic or strong pulse. Readily palpation. Does not fade out. Not easily obliterated. 3+
-poss cause: exercise anxiety, fever, hyperthyroidism, aortic ridigity or atherosclerosis
Paradoxic pulse (pulsus paradoxus)
-exaggerated decrease (>10mmHG) him the amp of the pulsation during inspiration and increase amp during expiration
-poss cause: premature cardiac contraction, trachobronchial obstruction, bronchial asthma, emphysema, pericardial effusion, constrictive pericarditis
Water-hammer pulse (corrigan)
-collapsing pulse
-greater amp than expected, a rapid rise to a narrow summit, and a sudden descent
-poss cause: patent ductus arteriosus, aortic regurgitation.
Phys exam for PAD
Arteries in any location can become narrowed.
Diminished circulation signs and symptoms affect:
-Site
-Degree of narrowing
-Ability of collateral channels to compensate
-Rapidity with which the problem develops
Claudication pain
-Dull ache
-Muscle fatigue and cramps
-Usually appears during sustained exercise
-Few minutes of rest will ordinarily relieve it
-It recurs again with the same amount of activity
-Continued activity causes worsening pain
Site of pain is distal to the narrowing. After assessing pain, note:
-Pulses
-Possible systolic bruits that may extend through diastole
-Loss of body warmth in affected area
-Localized pallor and cyanosis
-Collapsed superficial veins
-Atrophies skin and muscle; thin skin
Peripheral vein physical exam
Jugular venous pressure
-The jugular pulse can only be visualized; it cannot be palpated.
-Several conditions make the examination more difficult.
Hepatojugular reflux
-Sign of right heart failure
-Exaggerated when right heart failure is present
Evaluation of hand veins
-useful in the absence of thrombosis or arteriovenous fistula in that arm, and in the absence of the superior vena cava syndrome
Assessment for venous obstruction and insufficiency
-An acute process may result from injury, external compression, or thrombosis.
-In the affected area, pain occurs simultaneously with: Swelling and tenderness over the muscles, Engorgement of superficial veins, Erythema and/or cyanosis
Thrombosis
Edema
Varicose veins
Physical exam infants and children
Infants
-Brachial, radial, femoral pulses are easily palpable.
-Rapid capillary refill times
Children
-Venous hum
-Venous thrombosis can occur with placement of central venous access devices.
Physical exam: preg
Pulse is easily palpated with abrupt rise and fall.
JVP remains normal.
Peripheral edema occurs.
Varicose veins occur
Physical exam: older adult
Superficial vessels are tortuous and distended.
Dorsalis pedis and posterior tibial pulses become difficult to find
Abnormalities of vessels
Temporal arteritis (giant cell arteritis)
-An inflammatory disease of the branches of the aortic arch, including the temporal arteries
Arterial aneurysm
-Localized dilation, generally defined as 1.5 times the diameter of the normal artery, caused by a weakness in the arterial wall
Arteriovenous fistula
-Pathologic communication between an artery and vein
Peripheral arterial disease
-Stenosis of the blood supply to the extremities by atherosclerotic plaques
Raynaud phenomenon
-Exaggerated spasm of the digital arterioles (occasionally in the nose and ears) usually inresponse to cold exposure
Arterial embolic disease
-Emboli that are dispersed throughout the arterial system
Venous thrombosis
-Sudden or gradual with varying severity of symptoms; can be the result of trauma or prolonged immobilization
Tricuspid regurgitation
-Back flow of blood into the right atrium during systole; a mild degree of tricuspid regurgitation can be seen inup to 75% of the normal adult population
Vessel abnormalities in children
Coarctation of the aorta
-Stenosis is seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum.
Kawasaki disease
-Acute small vessel vasculitic illness that may result in the development of coronary artery aneurysms
-Cause unknown
Vessel abN in preg
Preeclampsia-eclampsia
-Syndrome specific to pregnancy with hypertension that occurs after the 20th week of pregnancy and the presence of proteinuria; eclampsia is preeclampsia with seizures when no other cause for the seizures can be found
Vessel abN in older adults
Venous ulcers
-Results from chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension
When examining the radial pulse, you note a full and increased pulse. Your documentation demonstrates:
Radial pulse +4
Radial pulse +3
Radial pulse +2
Radial pulse +1
ANS: B
Rationale: The +4 pulse is described as bounding or aneurysmal; +3 pulse is described as full, increased; +2 pulse is described as expected; +1 pulse is described as diminished, barely palpable; and 0 is an absent, nonpalpable pulse.
The characteristics of arterial pulses are directly affected by all of the following except:
The volume of blood ejected
Peripheral arterial resistance
Venous valvular competence
Blood viscosity
ANS: C
Rationale: Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.
A positive hepatojugular reflux maneuver is indicative of:
Right heart failure
Left heart failure
Elevated arterial pressure
Liver failure
ANS: A
Rationale: Hepatojugular reflex is exaggerated when right heart failure is present, and its measurement is used to evaluate that condition.
The term claudication refers to:
Pain from muscle ischemia
Lack of palpable pulsations
Visible extremity changes of arterial occlusion
Numbness and tingling in toes and fingers
ANS: A
Rationale: Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping.
