Lab 5: Vascular exam, evaluation, and management Flashcards
Capillary Refill
* UE or LE
* Press on nail bed, hold, then release and look for pallor to return to normal (red/pink) within 3 seconds
Claudication Time or Distance - Push beyond the pain point
* Have the pt walk on the treadmill, level grade, 1 mile per hour
* If treadmill is not available, patient can walk on a level surface at a comfortable speed
* Stop test when pain begins - so for the test we stop when pain comes on
* Measure the time and distance
Subjective Gradation of Claudication Discomfort:
* Grade 1: minimal discomfort of pain
* Grade 2: Moderate discomfort of pain, patient’s attention can be diverted - want to push them to here w/ walking program - but w/ the test we stop when pain starts - this is the actual walking program
* Grade 3: Intense pain, patient’s attention cannot be diverted
* Grade 4: Excruciating and unbearable pain
Exam for AAA = 4+ bounding pulse
Dependent Rubor Test ~30 seconds - if it becomes painful we know blood isnt getting up there - pallor = pale - are we losing color and getting pale? - will become very pale if they have arterial disease - when taken off table should turn bright red because blood is coming back. Depdent rubor is the whole thing while elevation test is just the elevation portion.
* Elevation pallor can be performed with this
* Check color change in skin during elevation of foot, followed by dependency
* Elevate about 60 degrees, hold. Pt will feel pain and decreased pallor
* Have pt stand - pallor should icnrease
* elevation pallor - check skin color change when leg is elevated like in DRT
Ankle Brachial index - taken in supine
Start by taking BP in both UE and use the highest BP
Next take the BP in both legs
* Keep cuff directly above malleoli
* Use Doppler to find pulse on dorsum of foot, proximal
* Pump the cuff until you cannot hear the pulse anymore, then deflate slowly until it reappears
* Note # that it appeared again - systolic BP
Documentation: systolic R LE/UE and systolic L LE/UE
* Compare to see if one extremity is worse than the other
* You will want the numerator to be equal or higher than the denominator
Bruits - stethoscope to carotid, you will hear a whoooooshh clogged artery
Wells deicsion tool = assessment for the presence of a DVT
* Alternate test = apply a blood pressure cuff around the distal ankle/below calf and inflate to 40-60 mmhg. pts w/ venous occlusion of some form cannot tolerate pressures >40 mmHg
Pitting edema = stemmer sign
Circumferental measures
* 4 in or 8 in marks
Be consistent 4 inches used in Ue 8 in LE
bed ridden, active cancer/surgery = ask about dvt
