Peripheral Vascular System

Question 1

Nodes to palpate during examination

Answer 1

Cervical—head and neck
Axillary—breast and upper arm
Epitrochlear—hand and lower arm
Inguinal—lower extremities, external genitalia, anterior abdominal wall

Question 2

Organs with involvement in the lymph system

Answer 2

spleen, tonsils, thymus gland

Question 3

DC: Infants and children

Answer 3

lymph nodes larger; superficial nodes may be palpable

Question 4

DC:SD: Aging adult

Answer 4

• peripheral blood vessels become rigid
• Arteriosclerosis—increased BP
• Enlargement of intramuscular calf veins
• 29% over 70—have PAD
• Increased risk for PAD: smoking, DM, dyslipidemia, HTN
• Increased risk for DVT: prolonged BR, prolonged immobilization, heart failure

Question 5

What increases risk for PAD in aging adult?

Answer 5

Smoking
Diabetes Mellitus
Dyslipdemia
HTN

Question 6

What increases risk for DVT in aging adult?

Answer 6

Prolonged bedrest
Prolonged immobilization of limb
Heart failure

Question 7

Capillary refil function and results

Answer 7

Index of peripheral perfusion and cardiac output
Normal= less than 2 seconds
Abnormal= Vasoconstriction or decreased CO (hypovolemia, heart failure, shock)
-Hands are cold, clammy

Question 8

Factors that can affect capillary refill results

Answer 8

Cold room
decreased body temp
cigarettes
peripheral edema
anemia

Question 9

Asymmetric arms indicate?

Answer 9

Edema
If of upper arm d/t upper arm lymphatic drainage obstruction
-Breast surgery or radiation

Question 10

Factors to document with pulse assessment?

Answer 10

Rate, rhythm, elasticity, and equal force

Question 11

How is the force of the pulse graded?

Answer 11

3+ Increased, full, bounding
2+ Normal
1+ Weak
0 Absent

Question 12

Causes of increased, full, bounding pulse force?

Answer 12

Hyperkinetic states
Anemia
Hyperthyroidism

Question 13

Modified Allen Test function and results

Answer 13

• Evaluates the adequacy of collateral circulation before cannulating radial artery
• Pallor or sluggish returns suggest occlusion of collateral arterial flow

Question 14

Leg exam components

Answer 14

Skin color, temperature
Hair distribution
Venous pattern
Size (swelling or atrophy)
Symmetry
Skin lesions or ulcers

Question 15

Associated factors that occur with arterial insufficiency

Answer 15

Malnutrition
Pallor
Coolness

other: motor and sensory loss

Question 16

Brown discoloration in the legs indicates

Answer 16

Chronic venous stasis d/t hemosiderin deposits from RBC’s

Question 17

Venous ulcers location

Answer 17

lower leg

medial ankle

Question 18

Arterial ulcers location

Answer 18

Tips of toes
Metatarsal heads
lateral malleoli

Question 19

What does a unilateral cool foot or leg or sudden temperature drop as you move down the leg in an assessment signify?

Answer 19

Arterial deficeiency

Question 20

Developmental competence

Answer 20

• Pulses may be more difficult to find
• Trophic (skin) changes associated with arterial insufficiency—also occur with normal aging!
• Thin, shiny skin
• Thick-ridged nails
• Loss of hair on lower legs

Question 21

Dependent rubor

Answer 21

deep blue-red color—severe arterial insufficiency

Question 22

Delayed venous filing occurs with?

Answer 22

arterial insufficiency

Question 23

Elevational pallor occurs with?

Answer 23

arterial insufficiency

Question 24

Pitting edema scale

Answer 24

1+ mild, slight indentation, no perceptible swelling in legs
2+ moderate, indentation subsides rapidly
3+ Deep, indentation remains for short time, legs swollen
4+ Very deep, indentation lasts long time, legs grossly swollen and disfigured

Question 25

Non pitting edema

Answer 25

Unilateral- occlusion of deep vein

Lymphatic obstruction presents with bilateral or unilateral edema-> hard to the touch

Question 26

Bilateral pitting edema

Answer 26

Examine neck veins
If necks veins distended-> heart disease or pulmonary HTN,
If neck veins normal-> Liver disease, nephrosis, chronic venous insufficiency, medications-antihypertensive, hormonal