Neurovascular assessment - important concepts Flashcards
What do veins do, as opposed to arteries?
Veins bring blood to the heart (mostly deoxygenated except for the pulmonary veins).
Arteries bring blood away from the heart (mostly oxygenated except for the pulmonary artery and its branches).
Veins have valves to prevent backflow and can accomodate bigger volumes of blood through stretching.
Arteries have a thick smooth muscle layer.
What is the pump for arteries? For veins?
Arterial pump is the heart.
Pump for veins is the calf
What systems are assessed during a neurovascular assessment?
Peripheral nervous and circulatory systems
What type of information are we looking for in a vascular part of the neurovascular assessment?
information related to circulation (arterial and venous) - such as:
colour, temperature, capillary refill, edema and pulse
What is evaluated for the neurological portion of the neurovascular assessment?
information related to movement and sensation
When would we perform a neurovascular assessment?
Trauma to limb - i.e. fracture
Presence of cast or other protective device
Surgery to a limb
presence of wound on a limb
conditions that may cause poor circulation (diabetes, heart failure)
Client complaining of discomfort in a limb
Smoking + other risk factors
Why do we perform a neurovascular assessment when a person has a cast?
External pressure on limb can compromise the arterial-venous system
The risk factors for neurovascular disease are the same as those for what?
Cardiovascular disease
Wearing down of valves or vessels causing fluid accumulation/pooling of blood
varicose veins
Change in the angle of the nail bed due to chronic hypoxia.
Clubbing
What is dependency of a limb?
Position where a limb is hanging.
What kind of pain do we see with venous problems?
Dull ache which does not come and go
What kind of pain do we see with arterial issues?
Pain during exertion but relieved when resting since the arterial system can keep up then
What is the difference between arterial insufficiency, and venous insufficiency?
Arterial insufficiency is usually due to some blockage causing reduced blood flow to the periphery.
Venous insufficiency is related to stretched out valves which results in pooling of blood, causing distension, edema and difficulty pumping the blood back to the heart
How is pain relieved for those with arterial insufficiency?
Relieved with short rest
How is venous insufficiency pain relieved?
When limb is elevated
What colour is a leg of arterial insufficiency when elevated? When dependent?
Elevated - pale
Dependency - rubor (red)
What kind of individual is susceptible to varicose veins without a ārealā pathophysiology?
Pregnant women
What is the difference in signs between venous and arterial insufficiency for: colour?
Arterial: pale/white
Venous: brown discolouration around ankles
What is the difference in signs between venous and arterial insufficiency for: Temperature?
Arterial: cool
Venous: consistent with rest of body
What is the difference in signs between venous and arterial insufficiency for: pulse?
Arterial: decreased or absent (decreased cap refill)
Venous: palpable unless there is a lot of edema
What is the difference in signs between venous and arterial insufficiency for: Edema
Arterial: absent or mild
Venous: usually present and can be severe
What is the difference in signs between venous and arterial insufficiency for: Skin changes?
Arterial: thin, shiny, thickened nails, less hair growth
Venous: venous stasis (brown discolouration)
What is the difference in signs between venous and arterial insufficiency for: ulcers?
Arterial: punched out, deep, distal locations (toes); pale/white, necrotic base, dry exchar covering
Venous: irregular borders, superficial medial malleolus, yellow exudate, granulation tissue
Why is their a brown discolouration for venous insufficiency?
Build-up of waste products, especially heme.
Why are the limbs pale or white for arterial insufficiency?
Lack of blood flow to limb - i.e. poor cap refill
Why is the temperature cool for arterial insufficiency?
When can the temperature be warm for venous insufficiency?
Lack of warm blood flow
Can be warm if there is a wound and inflammation
Why is there barely a pulse in arterial insufficiency?
Blood is simply not getting to the limbs
What type of edema is typical of venous insufficiency?
Pitting
Why is there a lack of hair growth for arterial insufficiency?
Lack of blood flow and thus oxygen and nutrients to support hair growth
What does exchar mean?
Black colour of necrotic tissue for arterial insufficiency
Are the wounds caused by arterial and venous insufficiency infected?
NO! (but they can get infected)
Insufficiencies mostly affect which limbs?
The legs
What are some Vital Sign hints of neurovascular issues?
Respiratory?
higher blood pressure (tends to be higher)
Difficulty breathing
What is very important during the neurovascular assessment?
Assess bilaterally
What is pitting edema?
When you press down on a bony surface, hold for 5 seconds and let go ā tissue does not rebound right away and stays depresed
What is non-pitting edema? What is it generally associated with?
Edema present but tissue bounces back after 5 second depression
Generally associated with soft tissue inflammation.
What is the expected time frame for cap refill?
2-3 seconds
What is done to measure leg circumference?
What is considered pathological?
Go to tibial tuberosity, go down 10cm and measure calf circumference.
Anything over 3cm is considered pathological.
What are the two nerves assessed for the lower extremities in the neurovascular assessment?
Peroneal nerve
Tibial nerve
Where do we palpate for the peroneal nerve (sensation)?
Webbing between the great (big) toe and second toe
What type of motion do we assess for the peroneal nerve
Towards nose (dorsiflexion of foot)
Where do we palpate for the tibial nerve (sensation)?
Across balls of feet
What type of motion do we assess for the tibial nerve?
Gas pedal - plantar flexion of the foot
For someone with carpal tunnel, which nerve is impinged?
Median
What is done to assess sensation of the radial nerve?
Motion?
Sensation: Touch the web space between the thumb and index
Motion: Hyperextension of thumb, fingers and writst
What is done to assess sensation of the ulnar nerve?
Motion?
Sensation: Touch the distal pad of the small finger.
Motion: finger abduction
What is done to assess sensation of the median nerve?
Motion?
Sensation: Touch the distal surface of the index.
Make the person touch pinky to thumb (three).
What are different ways in which we can add auscultation to our assessment of the peripheral vascular sytsem?
Ausculation of carotid artery for bruits
Calculation of the ABI (ankle-brachial index)
Use of doppler to assess pulse presence if difficult to palpate
How is the ABI calculated?
Ankle blood pressure/brachial blood pressure (both systolic)
What is the normal ABI range?
> /= 0.91 - = 1.30
greater or equal to 0.91 to less than or equal to 1.30
An ABI of less than what is diagnostic of PAD?
What are the ranges?
Less than or equal to 0.90 ā> PAD
Mild = 0.70-0.90
Moderate = 0.41-0.90
Severe or Critical limb ischemia - less than or equal to 0.40
A non-compressible artery would have a reading of what?
Why?
Greater or equal to 1.31
Due to calcification of artery such that it cannot be compressed
Why would we perform an ABI before we use a therapy for venous insufficiency?
If it is in fact arterial insufficiency instead, treatment for venous insufficiency will only make the condition worse (i.e. compression socks)
What do compression socks do?
Help valves close a bit more
What are treatments for arterial insufficiency?
Blood thinners, ACE inhibitors, beta blockers
endorectomies
amputation if very bad
How kind of meds can be used for venous insufficiency?
Clot busters
Describe getting an ABI measurement.
Take brachial BP from both arms and use the highest number for both legs.
Take the blood pressure for the dorsalis pedis and posterior tibialis for each leg and use the highest value for the ABI.
What is a good acronym for neurovascular assessment.
Cute Men Spend Time Buying Extra Presents
C - colour M - movement S - sensation (numbness, tingling, pain) T - temperature B - blanching E - edema P - pulse
What is monofilament testing?
Used to assess sensation in Neurovascular assessment.
Basically use of fishing line to poke patient until they feel it.
Tests for peripheral neuropathy - often with diabetic neuropathy
What are acute situations of serious vascular compromise?
Arterial occlusion
Deep venous thrombosis (DVT)
Compartment syndrome
What is arterial occlusion?
Manifests as sudden onset of pulseless limb
What is DVT?
Deep venous thrombosis - clot formed in the blood that has pooled in the system, which has the potential to become a pulmonary embolism
Clots often form after what? What do we give for this?
How do we treat pulmonary embolisms?
Clots often form post-surgery due to immobility - reason for giving blood thinners
Treat pulmonary embolism with clot busters like warfarin
What is compartment syndrome?
Tends to occur after a major trauma, mostly with breaking of the femur.
Blood will pool and compress the surrounding tissue
What is done to treat compartment syndrome?
Fasciotomy and have it heal by secondary intention
What are the 6 Pās for emergency pain in an extremity?
P - pain (acute and severe)
P - pallor (mottled looking skin)
P - pulselessness
P - poikilothermia or polar sensation (cold to touch)
P - parasthesia (burning, tingling or numbness)
P - paralysis (lack of movement)
