Examine Peripheral Vasuclar System Flashcards
Exam for diaphoresis:
Excess sweating can be associated with ______ _____ _____
Decreased CO
Exam arterial pulses: decreased or absent pulses can be associated with ___ ____ ___
Peripheral artery disease
When examining pulses, start with most ___ pulses
Distal
With LE pulses, patient should be _____
Supine
Cyanosis is related to decreased ______ _____ or ______
Cardiac output
Cold
Pallor is associated with decreased ____ ____ ____
Peripheral blood flow
______ is dependent redness with PAD
Rubor
Clubbing: curvature of the fingernails with ___ ____ enlargement at base of nail
Associated with ____ ____ ____, _____ ____ ____, or ____ ___
Chronic oxygen deficiency
Chronic pulmonary disease
Heart failure
Trophic changes: pale, shiny, dry skin, with loss of ____ is associated with PAD
Hair
______ _______ is when the dorsal skin folds of the toes and fingers are resistant to lifting
This is indicative of ____ ____ and _______
Stemmers sign
Fibrotic changes and lymphedema
Intermittent claudication: pain and cramping and LE fatigue occurring during ______, and relieved by _____, associated with PAD
Exercise
Rest
IC pain is typically in ____. May also be in what other places?
Calf
Thigh, hips, buttocks
With IC, pt may experience pain at ____ with severe decrease in arterial blood supply. Typically in ______, Worse at _____
Rest
Forefoot
Night
Edema: for regular intervals, measure with _______. For irregular body parts (foot/hand), measure with _______.
Tape measure
Volumeter
Pitting edema scale: 1+
Mild, barely perceptible indentation
<1/4 inch pitting
Pitting edema scale: 2+
Moderate, easily identified depression
Returns to normal within 15 seconds
1/4 - 1/2 inch pitting
Pitting edema scale: 3+
Severe, depression takes 15-30 seconds to rebound
1/2 - 1 inch pitting
Pitting edema scale: 4+
Very severe
Depression lasts for > 30 seconds or more
> 1 inch pitting
What are two peripheral causes of edema?
Chronic venous insufficiency
Lymphedema
B/L edema is associated with ___ ___ ___
CHF
Tests of Peripheral Venous Circulation:
Examine _____ system before _____ system
VENOUS before arterial because venous insufficiency tests can invalidate some arterial tests
Tests of Peripheral Venous Circulation:
The percussion test determines competence of ____ ___ ____
Describe it
Greater saphenous vein
Patient is standing, palpate one segment of vein while percussing vein approx 20 cm higher.
If pulse wave felt by lower hand, the intervening veins are incompetent
Tests of Peripheral Venous Circulation:
Trendelenberg test (retrograde filling test): determines competence of _____ ____ and ____ ____
Describe
Communicating veins and saphenous systems
Pt positioned in supine with legs elevated to 60 deg (empties venous blood)
Tourniquet places on prox thigh (occludes venous flow in superficial veins)
Pt is then asked to stand
PT notes whether veins fill in normal pattern. Should take approx 30 seconds
Tests of Peripheral Venous Circulation:
Venous filling time:
Describe:
What is delayed filling time?
Pt supine - passively elevate LE to approx 45 deg for 1 minute
Then placed in dependent position
Note time it takes for veins to refill
Delayed: >15 seconds = indicative of venous insufficiency
Tests of Peripheral Venous Circulation:
Doppler US: describe
Useful in both venous and arterial diseases
Doppler probe placed over large vessel
US signal given transcutaneously, movement of blood causes an audible shift in frequency
Useful in locating nonpalpable pulses and measuring SBP in extremities
Tests of Peripheral Venous Circulation:
Air plethysmography (APG): pneumatic device calibrates to measure _____ of venous system; ______
Cuff is inflated around ____ and attached to pressure transducer and microprocessor
Occludes _____ _____, permits ______ _____
Recorder registers increasing volume with cuff; time to return to baseline with cuff deflation
Patency
Volume
Calf
Venous return, arterial inflow
Tests of Peripheral Arterial Circulation:
ABI: the ratio of _______ pressure divided by ______ pressure
LE / UE
Tests of Peripheral Arterial Circulation:
ABI: pt is positioned ______ and at rest for ____ minutes
BP cuff is inflated to occlude blood flow temporarily, the deflated. PT listeners for return of flow
Performed in UE at ______ artery, and LE at ____ ___ and ____ ____ arteries
Supine
5 min
Brachial
Dorsalis pedis, posterior tibial
ABI assists in risk stratification for CV disease.
< ________ is associated with 2-4x increased risk for CV events and death
0.90
ABI < _______ increased risk of progression to severe or critical limb ischemia in 1 year
0.50
ABI index values: list the 5 rows.
>1.40 = non-compliant arteries 1.00-1.40 = normal 0.91-0.99 = borderline < or = 0.90 = abn < or = 0.50 = severe arterial disease, may have pain at rest
Tests of Peripheral Arterial Circulation:
Rubor of dependency:
Examine ____ ____ in skin during elevation of foot followed by dependency of foot
With insufficiency, _____ develops in elevated position
_______ ________develops in dependent position
Changes that take longer than ____ _____ are also indicative of arterial insuff
Color change
Pallor
Reactive hyperemia
30 seconds
Tests of Peripheral Arterial Circulation: Intermittent claudication: With treadmill test, have patient walk on _____ grade, __ mph. Note level of claudication pain and time of test when pain was experienced
Examine for coldness, numbness, or ______ in the legs or feet
Loss of _____ over anterior tibial area
Leg cramps may also result from ______ use with hypokalemia
Level 1 mph Pallor Hair Diuretic
IC Pain scale: Grade 1
Minimal discomfort or pain
IC Pain scale: Grade 2
Moderate discomfort or pain
Patient’s attention can be diverted
IC Pain scale: Grade 3
Intense pain
Pt’s attention cannot be diverted
IC Pain scale: Grade 4
Excruciating and unbearable pain
Lymphatic system: Palp with superficial nodes?
Cervical, axillary, epitrochlear, superficial inguinal
What two tests can you use that provide info about lymph flow, lymph node uptake, and backflow?
Lymphangiography
Lyphoscintography using radioactive agents (x-ray of lymph vessels)
