Peripheral Vascular Exam Flashcards
what type of structure do arteries consist of?
muscular-walled tubes forming part of the circulation
system by which blood (oxygenated) is
conveyed from the heart to all parts of the body
what is the function of veins & how do they differ from arteries?
tubes forming part of the blood circulation system of the body, carrying in most cases oxygen-depleted blood toward the
heart
* work on vascular system
* dependent on a # of factors in the body
what does palpation of the peripheral pulses evaluate for? what are the grades for peripheral pulses?
how well the arteries are working based on strength & equality of the pulses 0= absent 1+ = weak/thready 2+ = normal 3+ = full, bounding
what pulses are in the upper extremity and why are distal pulses in BUE important in hospital settings?
- Carotid
- Brachial
- Radial -> more superficial, where ABG is done
- Ulnar
what pulses are compared in the Allen Test & why is it important?
Ulnar & radial: Compares patency of blood flow in ulnar and radial arteries
*important to check prior to checking ABG
*if done wrong -> can compromise blood flow to hands
what pulses are evaluated in the lower extremities?
- Femoral
- Popliteal
- Dorsalis Pedis
- Posterior Tibialis
while the femoral pulse is deferred in adults, what type of patients is it evaluated in?
peds & infants
True or false:
the abdominal aortic pulse is palpable
True
which pulses in the abdomen are non-palpable?
• Celiac: esophagus, stomach, duodenum, liver, gallbladder, pancreas
• Superior Mesenteric: small intestine, ascending and transverse colon,
right splenic flexure
• Inferior Mesenteric: descending and sigmoid colon, proximal rectum
on inspection of the upper & lower extremities, what are you evaluating for?
- color: pallor, erythema, rubor, cyanosis
- appropriate skin tone for pt
- same color throughout - hair distribution
- skin changes
ex) excoriations, ulcerations, blistering, bullae
on palpation of BUE & BLE, what are you evaluating for?
• Temperature -must use back of the hand -look for symmetry • Edema • Pulses
what is pitting edema and when might you see this?
palpable swelling that can be easily moved around
- divet will appear when pushing into skin
- d/t accumulation of fluid in the interstitial space
- pt w/ sprained ankle
what can pitting edema in the bilateral lower extremities indicate? what should you also look for in these patients?
venous insufficiency
- texture of skin
- appearance of sock lines
- toenails
how do you do the Brueger test & what is it used to evaluate for?
elevation of pt’s legs x1 minute at 60°
- evaluate for color return/venous filling when pt is sitting up
- PAD
what is the normal time for color return and venous filling?
color return: 5-10 seconds
venous return: 10-20 seconds
on exam of BLE, there is delayed color return and diminished pulses. what do you suspect?
possible PAD
if a pt presents with leg pain/claudication that is worse w/ exertion & leg elevation, what should you suspect?
PAD
what is PAD associated with?
• Related to narrowing or decreased oxygenated blood to the
extremities
what are risk factors for PAD>
age > 65 age >50 with history of DM or smoking • History of coronary artery disease • Ethnicity: increased in African American • Family history of AAA
what symptoms occur with PAD?
leg pain w/ exertion non-healing or poorly healed wounds fatigue aching/pain with limited exertion abdominal pain hair loss
on inspection of the extremities for a pt with PAD, what are typical findings?
- Cold, numbness, pallor to extremities
- Swelling
- Color changes
if PAD affects the aorto-iliac artery, what might a pt present with?
pain in the buttocks, hip, thigh
if PAD affects the iliac-pudendal artery, what problem might a pt report?
erectile dysfunction
if PAD affects the common femoral artery, what might a pt present with?
thigh pain
if PAD affects the superficial femoral artery, what might a pt present with?
upper calf pain
if PAD affects the popliteal artery, what might a pt present with?
lower calf pain
if PAD affects the tibial or peroneal arteries, what might a pt present with?
pain in feet
if PAD affects the celiac or mesenteric arteries, what might a pt present with? when does this happen?
abdominal pain
-occurs when pt’s vessels are being used -> onset of sx after eating due to digestion
Incompetency of valves and weakness of the walls can lead to ____ _____ in the periphery
varicose veins
varicose veins can be linked to ______ BP in the veins
increased
when assessing a pt who has varicose veins, why is there pain upon palpation?
increase of blood pressure to the area
Obesity, constipation, tumors, genetics, and ____ are linked to an increase in BP in the veins which can lead to varicose veins.
pregnancy
what might a pt c/o if they have varicose veins?
swelling
aching/heaviness
leg cramps
itching
on inspection of a pt with varicose veins, the affected veins appear to be blue and _____
bulging
what risk factors are associated w/ varicose veins?
Age • Sit or stand for long periods of time • Inactive lifestyle • Obesity or overweight • Family history of varicose veins • Pregnancy
in stage 4 of varicose veins, it is common for patients to have varicose eczema & _____
trophic ulcerations
_____ occurs in stages 3-4 of patients with varicose veins
venous stasis
stage 3 of varicose veins will exhibit ____ of the lower legs
edema
on inspection of the lower extremities, pt appears to have reticular/spider veins. what stage is this?
stage 1
stages ____ & ____ in varicose veins skin changes that are associated with chronic venous insufficiency
3 & 4
True or false: compression stockings & surgery cannot reverse the color change in patients with varicose veins.
true
Raynaud’s disease affects the _____ & are associated with cold temperatures and/or stress.
distal extremities
what is the physiologic process that occurs in Raynaud’s disease?
episodic vasoconstriction that is reversible
In (primary/secondary), Raynaud’s disease is related to autoimmune disease.
secondary
what colors will a pt’s fingers & toes w/ Raynaud’s appear from beginning to end?
pallor -> cyanotic -> red -> pallor
in arterial ulcerations, they are typically _____ or traumatic
distal location
venous ulcerations are typically seen in the _____
posterior ankles
neuropathic ulcerations occur in _____ of the body
pressure points
in bed bound patients that develop bed sores (ulcerations), what pressure point is affected?
sacroiliac
in diabetic patients that are unaware of ulcerations or pain to their feet, this is considered _____
neuropathic
what is the main concern when a pt is diagnosed with a DVT?
thrombus may travel up back to the heart & cause PE
deep veins carry ____ of blood back to the heart which is why a thrombosis is concerning.
90%
True or false: there is a concern for a thrombus developing into a PE in patients diagnosed with superficial phlebitis.
False
what are treatment options for superficial thrombophlebitis?
heat ice NSAIDs Celebrex Mobic
in superficial thrombophlebitis, there is inflammation and thrombosis to the ____ veins
superficial
what test is used to evaluate for PAD and how is it calculated?
Ankle brachial index
> BP in arms compared to BP in posterior tibialis
Less than ____ is abnormal for an ABI
0.9
the ABI test has ___ sensitivity and ___ specificity
low
high
claudication is a process that affects the ____. patients with PAD will also have hairless, dry, and shiny skin
arteries
Hyperpigmented and erythematous skin can indicate _____
venous insufficiency
in patients with ___, palpation of the extremities will feel cold
PAD
when assessing for pulses, you must use your index or middle finger. why can’t you use the thumb?
thumb has a stronger pulse
which pulse is difficult to detect depending on the patient?
dorsalis pedis
the dorsalis pedis pulse is lateral to the ____ tendon
extensor
what is the largest artery in the lower extremities?
femoral
if there is too much pressure upon palpation of the DP pulse, you can ___ the arteries and prevent the pulse.
occlude
when performing the dependent rubor test, pt appears to have pumping up of blood vessels when you are assessing venous filling. what should you suspect based on this?
PAD
> venous filling has nothing to do w/ veins
the rubor test can only be performed when the patient is ____. in patients ___ years old, it is used to r/o PAD.
supine
-over 65
