Peripheral Vascular System and Lymphatic System

Question 1

Subjective Data

Answer 1

1. Leg pain or cramps
   - Location
   - Description (burning, aching, stabbing, cramping)
   - Onset (gradual or sudden)
   - Aggravated by activity? walking?
   - How many blocks (stairs) does it take to produce this pain?
   - Recent change in the amount?
   -Relieving factors/or worsening factors ( Elevation, temperature)
   - Does the pain wake you up at night
   - Recent exercise changes
   - Associated with change in sexual function?
   - History of vascular problems, heart problems, smoking, diabetes, alcohol, hypertension, diabetes, obesity, pregnancy, trauma, prolonged standing, or bed rest?
2. Skin changes on arms or legs
   - color
   - change in temperature(warm or cool)
   - crooked or bulging veins?
   - use of support hose?
   - leg sores or ulcers? where? pain?
3. Swelling in arms or legs
4. Lymph node enlargement
   - enlarged lymph nodes occur with infection, malignancies, and immunologic disorders
5. Medications
   - These may cause a hypercoaguable state. Also note that low-dose aspirin or clopidogrel is used to prevent blood clots in some people.
6. Smoking history
   - Tobacco constricts arteries, increases coagulability, injures endothelium, and promotes inflammation. Smoking is the strongest risk factor for PAD

Question 2

Objective Data

Answer 2

1. Inspect and palpate the arms
   - note color color of skin and nail beds; temperature, texture, and turgor of skin; and presence of of lesions, edema, or clubbing
   - check capillary refill (normal is 1-2 seconds) –>refill >2 seconds signifies vasoconstriction or decreased cardiac output (hypovolemia, heart failure, shock). Hands are cold, clammy, and pale.
   - Check radial pulses (note: rate, rhythm, elasticity of vessel wall and equal force)–> grading scale:
   3+ Increased, full, bounding
   2+ Normal
   1+ Weak
   0 Absent

• radial, ulnar, brachial pulses

2. Inspect and palpate the legs
   3.

Question 3

Preparation for Assessment

Answer 3

• Examine arms at the very beginning when checking vital signs and as the person is sitting
• Examine legs directly after the abdominal examination while the person is still supine
• Examination of the arms and legs include the peripheral vascular characteristics, the skin, musculoskeletal findings, and neurologic findings
• Room temperature is comfortable to prevent vasodilation or vasoconstriction
• Include bilateral comparison