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Physical Diagnosis & Assessment > Peripheral Vascular Exam > Flashcards

Peripheral Vascular Exam Flashcards

1
Q

what type of structure do arteries consist of?

A

muscular-walled tubes forming part of the circulation
system by which blood (oxygenated) is
conveyed from the heart to all parts of the body

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2
Q

what is the function of veins & how do they differ from arteries?

A

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

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3
Q

what does palpation of the peripheral pulses evaluate for? what are the grades for peripheral pulses?

A 
how well the arteries are working based on strength & equality of the pulses 
0= absent
1+ = weak/thready
2+ = normal
3+ = full, bounding
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4
Q

what pulses are in the upper extremity and why are distal pulses in BUE important in hospital settings?

A
  • Carotid
  • Brachial
  • Radial -> more superficial, where ABG is done
  • Ulnar
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5
Q

what pulses are compared in the Allen Test & why is it important?

A

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

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6
Q

what pulses are evaluated in the lower extremities?

A
  • Femoral
  • Popliteal
  • Dorsalis Pedis
  • Posterior Tibialis
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7
Q

while the femoral pulse is deferred in adults, what type of patients is it evaluated in?

A

peds & infants

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8
Q

True or false:

the abdominal aortic pulse is palpable

A

True

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9
Q

which pulses in the abdomen are non-palpable?

A

• 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

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10
Q

on inspection of the upper & lower extremities, what are you evaluating for?

A
  1. color: pallor, erythema, rubor, cyanosis
    - appropriate skin tone for pt
    - same color throughout
  2. hair distribution
  3. skin changes
    ex) excoriations, ulcerations, blistering, bullae
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11
Q

on palpation of BUE & BLE, what are you evaluating for?

A 
• Temperature
-must use back of the hand 
-look for symmetry 
• Edema
• Pulses
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12
Q

what is pitting edema and when might you see this?

A

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
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13
Q

what can pitting edema in the bilateral lower extremities indicate? what should you also look for in these patients?

A

venous insufficiency

  • texture of skin
  • appearance of sock lines
  • toenails
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14
Q

how do you do the Brueger test & what is it used to evaluate for?

A

elevation of pt’s legs x1 minute at 60°

  • evaluate for color return/venous filling when pt is sitting up
  • PAD
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15
Q

what is the normal time for color return and venous filling?

A

color return: 5-10 seconds

venous return: 10-20 seconds

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16
Q

on exam of BLE, there is delayed color return and diminished pulses. what do you suspect?

A

possible PAD

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17
Q

if a pt presents with leg pain/claudication that is worse w/ exertion & leg elevation, what should you suspect?

A

PAD

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18
Q

what is PAD associated with?

A

• Related to narrowing or decreased oxygenated blood to the

extremities

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19
Q

what are risk factors for PAD>

A 
age > 65
age >50 with history of DM or smoking
• History of coronary artery disease
• Ethnicity: increased in African American
• Family history of AAA
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20
Q

what symptoms occur with PAD?

A 
leg pain w/ exertion
non-healing or poorly healed wounds 
fatigue
aching/pain with limited exertion 
abdominal pain
hair loss
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21
Q

on inspection of the extremities for a pt with PAD, what are typical findings?

A
  • Cold, numbness, pallor to extremities
  • Swelling
  • Color changes
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22
Q

if PAD affects the aorto-iliac artery, what might a pt present with?

A

pain in the buttocks, hip, thigh

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23
Q

if PAD affects the iliac-pudendal artery, what problem might a pt report?

A

erectile dysfunction

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24
Q

if PAD affects the common femoral artery, what might a pt present with?

A

thigh pain

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25
Q

if PAD affects the superficial femoral artery, what might a pt present with?

A

upper calf pain

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26
Q

if PAD affects the popliteal artery, what might a pt present with?

A

lower calf pain

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27
Q

if PAD affects the tibial or peroneal arteries, what might a pt present with?

A

pain in feet

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28
Q

if PAD affects the celiac or mesenteric arteries, what might a pt present with? when does this happen?

A

abdominal pain

-occurs when pt’s vessels are being used -> onset of sx after eating due to digestion

29
Q

Incompetency of valves and weakness of the walls can lead to ____ _____ in the periphery

A

varicose veins

30
Q

varicose veins can be linked to ______ BP in the veins

A

increased

31
Q

when assessing a pt who has varicose veins, why is there pain upon palpation?

A

increase of blood pressure to the area

32
Q

Obesity, constipation, tumors, genetics, and ____ are linked to an increase in BP in the veins which can lead to varicose veins.

A

pregnancy

33
Q

what might a pt c/o if they have varicose veins?

A

swelling
aching/heaviness
leg cramps
itching

34
Q

on inspection of a pt with varicose veins, the affected veins appear to be blue and _____

A

bulging

35
Q

what risk factors are associated w/ varicose veins?

A 
Age 
• Sit or stand for long periods of time • Inactive lifestyle 
• Obesity or overweight 
• Family history of varicose veins •
 Pregnancy
36
Q

in stage 4 of varicose veins, it is common for patients to have varicose eczema & _____

A

trophic ulcerations

37
Q

_____ occurs in stages 3-4 of patients with varicose veins

A

venous stasis

38
Q

stage 3 of varicose veins will exhibit ____ of the lower legs

A

edema

39
Q

on inspection of the lower extremities, pt appears to have reticular/spider veins. what stage is this?

A

stage 1

40
Q

stages ____ & ____ in varicose veins skin changes that are associated with chronic venous insufficiency

A

3 & 4

41
Q

True or false: compression stockings & surgery cannot reverse the color change in patients with varicose veins.

A

true

42
Q

Raynaud’s disease affects the _____ & are associated with cold temperatures and/or stress.

A

distal extremities

43
Q

what is the physiologic process that occurs in Raynaud’s disease?

A

episodic vasoconstriction that is reversible

44
Q

In (primary/secondary), Raynaud’s disease is related to autoimmune disease.

A

secondary

45
Q

what colors will a pt’s fingers & toes w/ Raynaud’s appear from beginning to end?

A

pallor -> cyanotic -> red -> pallor

46
Q

in arterial ulcerations, they are typically _____ or traumatic

A

distal location

47
Q

venous ulcerations are typically seen in the _____

A

posterior ankles

48
Q

neuropathic ulcerations occur in _____ of the body

A

pressure points

49
Q

in bed bound patients that develop bed sores (ulcerations), what pressure point is affected?

A

sacroiliac

50
Q

in diabetic patients that are unaware of ulcerations or pain to their feet, this is considered _____

A

neuropathic

51
Q

what is the main concern when a pt is diagnosed with a DVT?

A

thrombus may travel up back to the heart & cause PE

52
Q

deep veins carry ____ of blood back to the heart which is why a thrombosis is concerning.

A

90%

53
Q

True or false: there is a concern for a thrombus developing into a PE in patients diagnosed with superficial phlebitis.

A

False

54
Q

what are treatment options for superficial thrombophlebitis?

A 
heat
ice
NSAIDs
Celebrex
Mobic
55
Q

in superficial thrombophlebitis, there is inflammation and thrombosis to the ____ veins

A

superficial

56
Q

what test is used to evaluate for PAD and how is it calculated?

A

Ankle brachial index

> BP in arms compared to BP in posterior tibialis

57
Q

Less than ____ is abnormal for an ABI

A

0.9

58
Q

the ABI test has ___ sensitivity and ___ specificity

A

low

high

59
Q

claudication is a process that affects the ____. patients with PAD will also have hairless, dry, and shiny skin

A

arteries

60
Q

Hyperpigmented and erythematous skin can indicate _____

A

venous insufficiency

61
Q

in patients with ___, palpation of the extremities will feel cold

A

PAD

62
Q

when assessing for pulses, you must use your index or middle finger. why can’t you use the thumb?

A

thumb has a stronger pulse

63
Q

which pulse is difficult to detect depending on the patient?

A

dorsalis pedis

64
Q

the dorsalis pedis pulse is lateral to the ____ tendon

A

extensor

65
Q

what is the largest artery in the lower extremities?

A

femoral

66
Q

if there is too much pressure upon palpation of the DP pulse, you can ___ the arteries and prevent the pulse.

A

occlude

67
Q

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?

A

PAD

> venous filling has nothing to do w/ veins

68
Q

the rubor test can only be performed when the patient is ____. in patients ___ years old, it is used to r/o PAD.

A

supine

-over 65

Physical Diagnosis & Assessment (7 decks)

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