Peripheral Vascular System Flashcards
- 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
Developmental competence in aging adults
question topics to ask the client:
- Leg pain or cramps
- Skin changes on arms or legs
- Swelling
- Lymph node enlargement
- Medications
- Smoking history
subjective data
- 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
objective data
MUST be examined at the very beginning when checking vital signs and the person is sitting during a complete physical examination
examining the arms
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
examining the legs
- 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
Assessing upper extremities: Lifting both patient’s hands in your hands
- 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
Assessing upper extremities: W/ person’s hands at level of heart, checking capillary refill
conditions that could skew findings during capillary refill assessment
- cool room
- decreased body temperature
- cigar smoking
- peripheral edema
- anemia
- 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
assessing pulses
increased, full, bounding
3+
normal
2+
weak
1+
absent
0
- Testing for ulnar artery circulation
- necessary before Arterial Blood Gas (ABG)
5 - 15 seconds
Allen’s test
- 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
Assessment of lower extremity
absent pulses = consider causes
other circulation assessment?
use doppler and mark pulse, then notify and document
Abnormal assessment
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+
pitting edema
Mild pitting, slight indentation, no perceptible swelling
1+
Moderate pitting, indentation subsides rapidly
2+
Deep pitting, indentation remains, leg looks swollen
3+
Very deep pitting, indentation lasts long time, leg very swollen
4+
- 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
standing assessment
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
PVD: Peripheral Arterial Disease (PAD)
a.k.a. Buerger’s dependency test
used to assess for the adequacy of the arterial supply to the leg
Rubor Dependency Test
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
Peripheral Venous Disease (PVD)
- varicose vein
- deep vein thrombosis
Abnormal PVS
easier to assess when standing
lead to pain, swelling, fatigue, and cramping (only if visible)
damage to valves
Varicose vein
Wells Score
unilateral swelling
redness - heat - pain
Deep Vein Thrombosis
testing for the amount of probability of DVT
Measure at widest point – more than 1cm is abnormal –
>3 high probability for DVT development
Wells Score for DVT
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,
Lymphedema
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.
Sample documentation (subjective)
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.
Sample documentation (objective)
Elevate – pallor after 45-60 seconds – mild arterial insufficiency
Pallor after 30-45 seconds – Moderate
Pallor within 25 sec - severe
pallor
