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Nursing 6410 - Health Assessment > Peripheral Vascular > Flashcards

Peripheral Vascular Flashcards

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1
Q

Pulse characteristics

A 
Contour - quick rising or falling
Amplitude - strength of pulse
Rate 
Rhythm
Symmetry -lack of symmetry may be impaired circulation
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2
Q

Assessment of pulses

A 
Auscultation for bruits 
Inspect for distentions at 45 degrees
Inspect extremities for color,skin and nail changes
Presence of hair
Muscular atrophy
Edema
Varicose
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3
Q

Palpate extremities for

A

Warmth
Pulse quality
Tenderness
Putting edema

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4
Q

Arteries

A

Tough, tensile and less distensibleb

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5
Q

Veins

A

Less sturdy and more passive
Valves
Can expand if increased BF

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6
Q

Arterial pulse

A

From systole
0.2 seconds to reach dorsalis pesos
2 seconds for RBCs to travel there

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7
Q

Characteristics of Pulses

A

Volume of blood ejected (SV)
Distensibility of aorta and large arteries
Viscosity
Arteriole resistance

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8
Q

A wave (JVP)

A

Most prominent

Brief backflow into vena cava

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9
Q

C wave

A

Backward push created by TV closure during systole

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10
Q

V wave

A

Increased volume and pressure of RA

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11
Q

X slope

A

Passive RA filling

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12
Q

Y slope

A

Open TV and filling of RV

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13
Q

HPI: leg pain

A 
Onset 
Character
Continuous pain in toes, thigh , butt
Skin changes - cold, pallor, redness 
Limping 
Walking at night with pain
Swelling
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14
Q

HPI SWOLLEN ANKLES

A 
Onset and duration
Related circumstances- elevation, air travel
Associated symptoms - nocturia, SOB
Treatment - rest, massage, heat, elevate
Meds - heparin, warfarin
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15
Q

Varicose Veins

A 
Women 4x more likely 
Genetics
Tobacco, sedentary, high BMI
Age decreases elasticity
Hx of lower extremity trauma, DVT
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16
Q

Palpatable pulses

A 
Carotid 
Brachial
Radial
Femoral
Poiteal
Dorsalis pedis
Posterior tibial
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17
Q

Amplitude pulse scale

A

4: bounding, aneurysmal
3: full, increased
2: expected
1: diminished, barely palpable
0: absent

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18
Q

Irregular HR

A

Increased HR on inspiration and decreases on expiration
Compare on auscultation
Strength? Lack of symmetry?
Compare upper, lower, left and right extremities

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19
Q

Femoral pulse

A

Usually as strong as radial

Absent femoral may be coarctation of aorta, atherosclerosis, PAD, vasculitis

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20
Q

Which arteries are asucultated for bruits

A 
Temporary
Carotid
Subclavian 
Abdominal aorta
Renal
Iliac
Femoral 
*hold breath to suspend breath sounds
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21
Q

Types of Bruits

A

Radiation of murmurs

Obstructive arterial disease

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22
Q

Diminished circulation will lead to signs and symptoms that are related to the following

A

Site
Degree of stenosis
Ability of collateral channels to compensate
Rapidity at which problem develops

23
Q

Claudication

A 
Dull ache 
Muscle fatigue and cramps 
Usually appears during exercise
Few minutes rest provides relief
Recurs with more activity
Continued activity makes pain worse
24
Q

Theee P’s of occlusion

A

Pain
Pallor
Pulselessness

25
Q

After determining pain characteristics, note the following

A 
Pulses
Bruits
Loss of warmth 
Pallor or cyanosis 
Collapsed veins 
Atrophied skin or hair loss
26
Q

Arterial insufficiency

A 
Pain 
Pulses
Color
Temp
Edema
Skin changes
Ulceration 
Gangrene
27
Q

Pain in calf

A

Obstruction of superficial femoral artery

28
Q

Pain in thigh

A

Obstruction of femoral artery/external Iliad

29
Q

Pain in buttock

A

Iliac artery or distal aorta obstruction

30
Q

JVP

A

Can be visualized not palpate
Lay or flat to reveal distentions then raise head up for evident pulsation
Value should be less than 9cm

31
Q

Conditions that make JVP examination difficult

A

Severe R CHF, TV insufficiency, constructive pericarditis, tamponade
Severe volume depletion
Obesity

32
Q

Assessment for venous obstruction and insufficiency

A

Thrombosis - red,thick,tender
Homan sign - flex knee and foot to test calf pain which could mean thrombosis
Edema grade 1-4 to assess R CHF
varicose veins incompetent wall or valve or obstruction

33
Q

Assessing Edema

A

1 slight,no visible deformities, disappears rapidly
2 - 10-15s no dostoritons
3- >1min, full/swollen extremity
4 - 2-5mins, grossly distorted

34
Q

Venous insufficiency

A 
Pain
Pulses
Color
Temp
Edema
Skin changes
Ulceration
Gangrene
35
Q

Arterial aneurysm

A

Localized dilation

1.5x diameter of normal artery

36
Q

PAD

A

Stenosis of BF to extremities caused by plaque

37
Q

Atrterial Embolic Disease

A

A fib can lead to clot in heart which can become embolism

38
Q

Venous thrombosis

A

Sudden or gradual

Immboilization or trauma

39
Q

Infants

A

Brachial, radial, femoral easily palpable

Evaluate capillary refill

40
Q

Children

A

Venous hum common
HTN in 1-3%
Caused by renal disease, coarctation or pheochromocytoma
Stenosis of descending aortic arch is common near origin of left subclavian
Rule out COA by checking lower extremity for equal pulses

41
Q

Preganant

A

BP falls 16-20 weeks

Greater than 140/90 indicates preganancy induced HTN

42
Q

Preeclampsia-eclampsia

A

HTN that occurs after 20th week of pregnancy and presence of proteinuria
Eclampsia is PE with seizures

43
Q

Older adults

A

Foot pulses difficult to palpate
Loss of elasticity increases BP
HTN in older is >140/90

44
Q

Venous ulcers

A

Chronic venous insufficiency leads to lower extremity venous HTN

45
Q

Sinus arrythmia

A

Increased HR on inspiration and decreased on expiration

Unpredictable rate may be heart disease or a-fib

46
Q

Noting an irregular rate

A

Compare bilateral
Auscultate heart
Note strength of pulse

47
Q

After determining leg pain, note the following

A 
Pulses - strong, weak or absent 
Possible systolic bruits 
Loss of expected body warmth over area
Localized pallor or cyanosis 
Collapsed superficial veins with delay in filling
Thin, atrophied skin, muscle atrophy
48
Q

Judge degree of narrowing and potential severity of arterial insufficiency

A

Have patient lie supine
Elevate extremity
Note degree of blanching
Have pt sit on edge of bed or table
Note time it takes for maximal color return
Slight pallor and return to full is expected
A delay of many seconds or minutes is abnormal

49
Q

Constant pain in venous insufficiency occurs along with the following

A

swelling and tenderness of muscles
engorgement of superficial veins
erythema or cyanosis

50
Q

Thrombosis

A

Redness, thickening and tenderness along a superficial vein

51
Q

Unilateral vs Bilateral edema

A

Unilateral - occlusion of major vein
Bilateral - CHF
Edema w/o pitting - aterial insufficiency or lymphedema

52
Q

Edema with thickening of ulceration of skin indicates

A

deep venous obstruction
venous valvular incompetence
Caused by mechanical pressure of increased blood volume in area

53
Q

Varicose veins

A

dilated, swollen, with diminished rate of BF and increased intravenous pressure
Have pt stand ten times on toes in succession
Competent veins will disappear in a few seconds
Distention that is sustained is venous insufficiency

Nursing 6410 - Health Assessment (16 decks)

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