Examine Peripheral Vasuclar System

Question 1

Exam for diaphoresis:

Excess sweating can be associated with ______ _____ _____

Answer 1

Decreased CO

Question 2

Exam arterial pulses: decreased or absent pulses can be associated with ___ ____ ___

Answer 2

Peripheral artery disease

Question 3

When examining pulses, start with most ___ pulses

Answer 3

Distal

Question 4

With LE pulses, patient should be _____

Answer 4

Supine

Question 5

Cyanosis is related to decreased ______ _____ or ______

Answer 5

Cardiac output

Cold

Question 6

Pallor is associated with decreased ____ ____ ____

Answer 6

Peripheral blood flow

Question 7

______ is dependent redness with PAD

Answer 7

Rubor

Question 8

Clubbing: curvature of the fingernails with ___ ____ enlargement at base of nail
Associated with ____ ____ ____, _____ ____ ____, or ____ ___

Answer 8

Chronic oxygen deficiency
Chronic pulmonary disease
Heart failure

Question 9

Trophic changes: pale, shiny, dry skin, with loss of ____ is associated with PAD

Answer 9

Hair

Question 10

______ _______ is when the dorsal skin folds of the toes and fingers are resistant to lifting
This is indicative of ____ ____ and _______

Answer 10

Stemmers sign

Fibrotic changes and lymphedema

Question 11

Intermittent claudication: pain and cramping and LE fatigue occurring during ______, and relieved by _____, associated with PAD

Answer 11

Exercise

Rest

Question 12

IC pain is typically in ____. May also be in what other places?

Answer 12

Calf

Thigh, hips, buttocks

Question 13

With IC, pt may experience pain at ____ with severe decrease in arterial blood supply. Typically in ______, Worse at _____

Answer 13

Rest
Forefoot
Night

Question 14

Edema: for regular intervals, measure with _______. For irregular body parts (foot/hand), measure with _______.

Answer 14

Tape measure

Volumeter

Question 15

Pitting edema scale: 1+

Answer 15

Mild, barely perceptible indentation

<1/4 inch pitting

Question 16

Pitting edema scale: 2+

Answer 16

Moderate, easily identified depression
Returns to normal within 15 seconds
1/4 - 1/2 inch pitting

Question 17

Pitting edema scale: 3+

Answer 17

Severe, depression takes 15-30 seconds to rebound

1/2 - 1 inch pitting

Question 18

Pitting edema scale: 4+

Answer 18

Very severe
Depression lasts for > 30 seconds or more
> 1 inch pitting

Question 19

What are two peripheral causes of edema?

Answer 19

Chronic venous insufficiency

Lymphedema

Question 20

B/L edema is associated with ___ ___ ___

Answer 20

CHF

Question 21

Tests of Peripheral Venous Circulation:

Examine _____ system before _____ system

Answer 21

VENOUS before arterial because venous insufficiency tests can invalidate some arterial tests

Question 22

Tests of Peripheral Venous Circulation:
The percussion test determines competence of ____ ___ ____
Describe it

Answer 22

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

Question 23

Tests of Peripheral Venous Circulation:
Trendelenberg test (retrograde filling test): determines competence of _____ ____ and ____ ____
Describe

Answer 23

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

Question 24

Tests of Peripheral Venous Circulation:
Venous filling time:
Describe:

What is delayed filling time?

Answer 24

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

Question 25

Tests of Peripheral Venous Circulation: | Doppler US: describe

Answer 25

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

Question 26

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

Answer 26

Patency Volume Calf Venous return, arterial inflow

Question 27

Tests of Peripheral Arterial Circulation: | ABI: the ratio of _______ pressure divided by ______ pressure

Answer 27

LE / UE

Question 28

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

Answer 28

Supine 5 min Brachial Dorsalis pedis, posterior tibial

Question 29

ABI assists in risk stratification for CV disease. | < ________ is associated with 2-4x increased risk for CV events and death

Answer 29

0.90

Question 30

ABI < _______ increased risk of progression to severe or critical limb ischemia in 1 year

Answer 30

0.50

Question 31

ABI index values: list the 5 rows.

Answer 31

``` >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 ```

Question 32

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

Answer 32

Color change Pallor Reactive hyperemia 30 seconds

Question 33

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

Answer 33

``` Level 1 mph Pallor Hair Diuretic ```

Question 34

IC Pain scale: Grade 1

Answer 34

Minimal discomfort or pain

Question 35

IC Pain scale: Grade 2

Answer 35

Moderate discomfort or pain | Patient’s attention can be diverted

Question 36

IC Pain scale: Grade 3

Answer 36

Intense pain | Pt’s attention cannot be diverted

Question 37

IC Pain scale: Grade 4

Answer 37

Excruciating and unbearable pain

Question 38

Lymphatic system: Palp with superficial nodes?

Answer 38

Cervical, axillary, epitrochlear, superficial inguinal

Question 39

What two tests can you use that provide info about lymph flow, lymph node uptake, and backflow?

Answer 39

Lymphangiography | Lyphoscintography using radioactive agents (x-ray of lymph vessels)