Peripheral Vascular System

Question 1

• arteriosclerosis: peripheral blood vessels grow more rigid
• loss of lymphatic tissue results in fewer number of lymph nodes and decrease in size of the nodes that are left remaining
• Dorsalis pedis and posterior tibia pulses may be difficult to find
• changes w/ arterial insufficiency include thin, shiny skin, thick, ridged nails, and loss of hair on lower legs

Answer 1

Developmental competence in aging adults

Question 2

question topics to ask the client:

• Leg pain or cramps
• Skin changes on arms or legs
• Swelling
• Lymph node enlargement
• Medications
• Smoking history

Answer 2

subjective data

Question 3

• examining arms and legs
• inspection and palpation is used (looking and touching)
• examination of arms and legs includes peripheral characteristics such as pulses, color, hair, skin, temperature, and sensation
• comparing findings w/ opposite extremity

Answer 3

objective data

Question 4

MUST be examined at the very beginning when checking vital signs and the person is sitting during a complete physical examination

Answer 4

examining the arms

Question 5

MUST be examined after examining the abdomen while person is still in supine position

the person has to then stand up to evaluate leg veins to see if there’s any changes

Answer 5

examining the legs

Question 6

• inspect, then turn the hands over, note the color of skin and nail beds
• temp, texture, and turgor of skin
• look for any presence of lesions, edema, or clubbing

Answer 6

Assessing upper extremities: Lifting both patient’s hands in your hands

Question 7

• depress and blanch nail beds; then release and note time for color return
• within a fraction of a second, the vessels should refill
• if the color returns in less than 1 to 2 seconds, then it’s normal

Answer 7

Assessing upper extremities: W/ person’s hands at level of heart, checking capillary refill

Question 8

conditions that could skew findings during capillary refill assessment

Answer 8

• cool room
• decreased body temperature
• cigar smoking
• peripheral edema
• anemia

Question 9

• palpate bilateral upper and lower extremity pulses
• note the rate, rhythm, elasticity of vessel wall, and equal force
• force (amplitude) is graded on a three-point scale:
  3+
  2+
  1+
  0

Answer 9

assessing pulses

Question 10

increased, full, bounding

Answer 10

3+

Question 11

normal

Answer 11

2+

Question 12

weak

Answer 12

1+

Question 13

absent

Answer 13

0

Question 14

• Testing for ulnar artery circulation
• necessary before Arterial Blood Gas (ABG)

5 - 15 seconds

Answer 14

Allen’s test

Question 15

• measure leg at widest point to inspect symmetry of leg
• look at skin color; note any presence of discoloration, skin ulcers, or gangrene, note size and exact location
• use the back of hands to palpate for temperature
• Posterior tibial pulse
• dorsalis pedis pulse requires a very light touch
• adults over 45 = either dorsalis pedis or posterior tibial pulse may be difficult to find, but NOT BOTH on the same foot

Answer 15

Assessment of lower extremity

Question 16

absent pulses = consider causes

other circulation assessment?
use doppler and mark pulse, then notify and document

Answer 16

Abnormal assessment

Question 17

check for edema in legs

firmly depress skin over tibia or medial malleolus for 5 sec and release

if pitting edema is present, use this following scale to grade it
1+
2+
3+
4+

Answer 17

pitting edema

Question 18

Mild pitting, slight indentation, no perceptible swelling

Answer 18

1+

Question 19

Moderate pitting, indentation subsides rapidly

Answer 19

2+

Question 20

Deep pitting, indentation remains, leg looks swollen

Answer 20

3+

Question 21

Very deep pitting, indentation lasts long time, leg very swollen

Answer 21

4+

Question 22

• ask person to stand to assess for venous system
• note any visible, dilated, and tortuous veins
  varicose veins will lead to pain, swelling, fatigue, and cramping (only if visible)
• note any color changes (pallor/mottling that improves standing)
• test lower legs for strength and sensation

Answer 22

standing assessment

Question 23

risks include smoking (which is the strongest factor), DM, and HTN

Main cause is atherosclerosis

Pain is sharp (worse at night)
Painful walking
Skin: Cool, thin, dry scaly, no hair, thick toenails
Poor wound healing
Claudication distance - blocks walked before pain starts – Monitor for sudden decrease in claudication distance or pain not decreased by rest.
Ulcer – toes, top of foot, deep and rounded edges, little drainage, pale or narcotic

Answer 23

PVD: Peripheral Arterial Disease (PAD)

Question 24

a.k.a. Buerger’s dependency test

used to assess for the adequacy of the arterial supply to the leg

Answer 24

Rubor Dependency Test

Question 25

Veins cannot push blood back to heart

Damage to valves – Varicose veins

Impede blood flow – Clot – DVT

signs and symptoms:
- Heavy, dull, throbbing pain
- Pain worse when sitting or standing for long periods
- Skin: Warm, thick, brownish (dark) color
- Edema/Swelling
- Skin breakdown – Cellulitis
- Pooling of blood – Clots
- Ulcers – Lower legs and ankle, shallow with irregular edges, Swollen with drainage, granulation

Answer 25

Peripheral Venous Disease (PVD)

Question 26

• varicose vein
• deep vein thrombosis

Answer 26

Abnormal PVS

Question 27

easier to assess when standing

lead to pain, swelling, fatigue, and cramping (only if visible)

damage to valves

Answer 27

Varicose vein

Question 28

Wells Score

unilateral swelling

redness - heat - pain

Answer 28

Deep Vein Thrombosis

Question 29

testing for the amount of probability of DVT

Measure at widest point – more than 1cm is abnormal –
>3 high probability for DVT development

Answer 29

Wells Score for DVT

Question 30

Accumulation of protein-rich fluid in interstitial space.

Risk: Older age, Obesity, surgery near or of lymph system, Infection

signs and symptoms: unilateral swelling, non pitting edema,

Answer 30

Lymphedema

Question 31

No leg pain, no skin changes, no swelling or lymph node enlargement.
No past history of heart or vascular problems, diabetes, or obesity.
Does not smoke. On no medications.

Answer 31

Sample documentation (subjective)

Question 32

Inspection. Extremities have pink-tan color without redness, cyanosis, or any skin lesions. Extremity size is symmetric without swelling or atrophy.

Palpation. Temperature is warm and = bilaterally.
All pulses present, 2+ and = bilaterally. No lymphadenopathy.

Answer 32

Sample documentation (objective)

Question 33

Elevate – pallor after 45-60 seconds – mild arterial insufficiency

Pallor after 30-45 seconds – Moderate

Pallor within 25 sec - severe

Answer 33

pallor