Chapter 21 Flashcards
How many blocks (stairs) does it take to produce this pain?
Claudication distance is the number of blocks walked or stairs climbed to produce pain.
Does the pain wake you up at night?
Night leg pain is common in aging adults.
It may indicate the ischemic rest pain of PAD, severe night muscle cramping (usually the calf), or restless legs syndrome.
Is it associated with any change in sexual function (males)?
Aortoiliac occlusion is associated with erectile dysfunction (Leriche syndrome).
Any history of vascular problems, heart problems, smoking, diabetes, obesity, pregnancy, hypertension, trauma, prolonged standing, or bed rest?
Diabetes and smoking are stronger risk factors for PVD than they are even for heart disease.
Do your leg veins look bulging and crooked?
Varicose veins
Any change in temperature—what does coolness indicate?
occurs with PAD
Swelling in arms and legs:
Is swelling associated with pain, heat, redness, ulceration, hardened skin?
Edema is bilateral when the cause is generalized (heart failure) or unilateral when it is the result of a local obstruction or inflammation.
What range is the point scale when grading the force?
0 to 3
What does “full, bounding pulse” indicate?
hyperkinetic states like exercise, anxiety, fever, anemia, and hyperthyroidism
What does “Weak, thready pulse (1+)” indicate?
shock and PAD.
decreased cardiac output, peripheral arterial disease, aortic valve stenosis
What is the Allen test used for?
evaluate the adequacy of collateral circulation before cannulating the radial artery.
used to evaluate upper extremity arterial circulation
If pitting edema is present, what is the grading scale?
1 to 4
this Use of the Doppler stethoscope is a highly specific, noninvasive, and readily available way to determine the extent of peripheral arterial disease (PAD).
Ankle- brachial index
Use this device to detect a weak peripheral pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity.
Doppler ultrasonic probe
accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment.
Lymphedema
May have cold, numbness, or pain along with pallor or cyanosis stage; then burning, throbbing pain, swelling along with rubor.
Raynaud’s Phenomenon
Nurse is assessing a patient with chief complaints of cold, numbness, and pain in her fingers, which abnormal finding do you suspect?
Raynaud’s Phenomenon
Nurse assess a patient and objective data includes unilateral swelling, measurement of arm volume, non pitting brawny edema, overlying skin indurated. What does the patient have?
Lymphedema
What kind of ulcer:
Diabetes hastens changes described with arterial ischemic ulcer, with generalized dysfunction in all arterial areas: peripheral, coronary, cerebral, retinal, and renal
Neuropathic ulcer
What type of ulcer?
Objective data includes: Firm, brawny edema; coarse, thickened skin; pulses normal; brown pigment discoloration; petechiae; dermatitis
Venous stasis ulcer
Subjective data includes:
Aching, heaviness in calf, easy fatigability, restless legs, burning, throbbing, cramping.
Superficial varicose veins
Patient complains of aching pain when sitting or standing too long. Skin assessment findings of lower extremities including weeping and edema. Which ulcers might also be present?
Venous stasis ulcer
What type of ulcer?
Coolness in only one foot or leg, pallor, dependent rubor; diminished pulses; systolic bruits; signs of malnutrition, distal gangrene.
Arterial ischemic ulcer
Buildup of fatty plaques on intima (atherosclerosis) plus hardening, calcification of arterial wall (arteriosclerosis).
What does the patient have?
Arterial ischemic ulcer
Patient states: aching pain in calf or lower leg, worse at end of day, worse when standing or sitting for a long time. What do you indicate the patient has?
Venous stasis ulcer
You inspect the patient, and she states deep muscle pain in the calf and worsens when she elevates her leg. Objective findings include: Coolness in only one foot or leg, diminished pulses, bruits, and thick ridged nails. What do you determine the patient has?
Arterial ischemic ulcer
Intermittent claudication, feels like “cramp,” “numbness and tingling,” “feeling of cold”
chronic arterial disease
IT feels like throbbing; & associated symptoms: Six Ps: pain, pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis (indicates severe
acute arterial disease
The relieving factors include “rest” and “dangling”?
chronic arterial disease
patient complains of leg pain while walking on the treadmill. The nurse asks what relieves the pain and patient states “rest,” this is most likely due to arterial or venous disease?
arterial
Patient complains of pain in lower extremities, you note pallor on inspection, and you are unable to palpate posterior tibialis or dorsalis pedis pulses. What is the significance of these findings?
acute arterial disease
Patient comes in for assessment on the lower leg calf. He describes it feels like aching, tiredness, feeling of fullness. & associated symptoms of edema, weeping ulcers at the ankle
chronic venous
moderate to intense; sharp deep muscle tender to touch; symptoms include: red, warm, swollen leg
acute venous
What is the strongest risk factor for PAD?
Smoking
Rhythm coupled, every other beat comes early, or normal beat followed by premature beat; conduction disturbance
pulsus bigeminus
Rhythm regular, but force varies, with alternating beats of large and small amplitude
pulsus alternans
Beats have weaker amplitude with inspiration, stronger with expiration
pulsus paradoxus
Each pulse has two strong systolic peaks with a dip in between; best assessed at the carotid artery
pulsus biferiens
deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema.
DVT
chronic gradual buildup of fatty streaks, fibroid plaque, calcification of the vessel wall, and thrombus formation.
occlusions, caused by athersclerosis
What are the subjective and objective data for DVT?
S–> Sudden onset of intense, sharp, deep muscle pain.
O–> Increased warmth; swelling; redness; dependent cyanosis is mild or may be absent; tender to palpation
a sac formed by dilation in the artery wall.
aneurysm
What are the risk factors of arterial occulsions?
obesity, cigarette smoking, hypertension, diabetes mellitus, elevated serum cholesterol, sedentary lifestyle, and family history of hyperlipidemia
What is the purpose of the profile sign?
to detect early clubbing
Aneurysm increases rapidly in what factor?
men older than 55 years and women older than 70 years
You are assessing cap refill of the feet and note 4 second filling time. These findings can indicate the presence of which of the following abnormalities?
vasoconstriction & decreased cardiac output
A patient is complaining of numbness and tingling in her left foot, which pulse should you assess for circulation?
left dorsalis pedis
The nurse is assessing circulation of the peripheral arms, which pulses should he assess?
radial
a patient complains of sudden onset of intense, sharp, deep muscle pain. What finding would you indicate?
DVT
These type of veins are dilated and torturous
Superficial varicose veins
Describe the Water- hammer. “Corrigan” 3+
Greater than normal force, then collapses suddenly
