PV and lymph Flashcards
What are components of inspection to be on the look out for?
•Color
Paleness =lack of arterial supply
Blue = lack of oxygenation
Purple = venous congestion
Brown or Rust colored = hemoglobin pigmentation
In darker skinned people look at the soles of the feet
•Edema
Measure circumference and height of edema
Note and grade pitting
•Presence of Hair
•Ulceration
•Swollen veins
What are the characteristics we may observe upon palpation?
•Skin Temperature
–Hot, Cold, or Normal
•Skin Texture
–Smooth or Rough
–Thickened or thinning
•Edema is usually non-pitting
•Grade pulses
•Thrill is turbulent flow through an artery consistent with partial obstruction
•Lymph nodes-note characteristics
What are the special tests we talked about?
- Allen’s
- Ankle/brachial index
- Postural color change
- Homan’s sign
- Venous valve competency
Where do we find these pulses?
–Radial
–Brachial
–Dorsalis Pedis
–Posterior tibial
–Radial on radial side of wrist
–Brachial is medial to biceps tendon
–Dorsalis Pedis is lateral to the extensor hallucis longus
–Posterior tibial is poster to the medial malleolus
Location of these pulses?
- popliteal
- femoral
- carotid
–Popliteal is posterior to the knee in the skin crease
–Femoral is inferior to the inguinal ligament in the inguinal crease
–Carotid is medial to sternal head of the sternocleidomastoid muscle
How do we grade pulses?
Always include a numerator and denominator, since different scales can be used.
•Strength-Usually graded on a scale of 3, i.e. 2/3 but the scale may be on a scale of 4
0 Unable to palpate
1 Diminished
2 Normal briskness (expected)
3 Bounding
What are the characteristics of pulses we need to assess?
Regularity, impulse character, symmetry between sides
What arteries do we auscultate?
What are we listening for? How should we do it?
–Carotid
•Have patient hold breath
–Temporal
–Aorta
–Renal
–Iliac (hard to hear)
- Bruit is the sound of turbulent flow through an artery consistent with partial obstruction
- Best heard with the bell
What sound does a normal artery make?
No sound, due to laminar flow.
What does ankle-brachial index test?
Indicates peripheral artery disease
What is a normal Ankle-brachial index finding?
Normal
A resting ankle-brachial index of 0.9 to 1.3 is normal and suggests no significant narrowing or blockage of blood flow.
What is an abnormal Ankle-brachial index finding?
Abnormal
A resting ankle-brachial index of less than 0.9 is abnormal. If the ABI is 0.41 to 0.9, there is mild to moderate peripheral arterial disease. If ABI is 0.4 or below, there is severe peripheral arterial disease.
Describe the Allen test
•Have the patient open and close the fist several times quickly, then will hold it closed tightly. Apply firm pressure over the radial and ulnar arteries. Ask the patient to open the hand slowly. Release the pressure on one of the arteries and observe the return of pink coloration of the hand. Repeat the process to test the collateral artery supply.
What test is shown here?
Allen Test
Describe the postural color change test
- Tests for chronic peripheral arterial disease
- With the patient lying on their back, elevate the affected extremity for at least 1 minute
- If the color becomes pale, lower the extremity to watch for return of pinkness which should occur within 10 seconds
What is the common denominator in arterial disease?
Decreased arterial perfusion
What are the common symptoms of arterial disease?
(7)
- –Pain (Ischemic)
- –Coldness
- –Numbness
- –Hair loss (Chronic)
- –Color change (Chronic)
- –Loss of pulse
- –3 P’s-Pain, Pallor, Pulselessness
What are the three P’s?
Pain, Pallor, Pulselessness
Describe an acute arterial occlusion
- Occlusion of the artery by embolus often a thromboembolus
- Sudden onset of very severe extremity pain
- Unilateral
- Not aggravated by movement or position change
SSX and physical findings of an acute arterial occlusion?
- Associated sx: Cold, weak, numb distally
- Physical findings: Extremity is pallid, cool and pulseless
What is this an example of?
Acute Arterial Occlusion
What is this an example of?
Acute Arterial Occlusion
This is?
Acute Arterial Occlusion - End stage
Describe PAD
Peripheral Arterial Disease (PAD)
•Chronic inadequate arterial flow
•Intermittent claudication while walking, relived by rest
•Associated symptoms: muscle fatigue, numbness, cold feet
•Physical findings: decreased distal pulses, pallor on elevation, ulcers/gangrene
•Ankle Brachial Index is the ratio of the dorsal pedis and brachial arterial pressures (See Bates’ 10th Edition, Page 496)
•An index of less than 0.9 indicates PAD.
•
What is indicitive of Chronic PAD?
Rubor and Ischemic ulcer
What are we looking for on venous inspection?
–Varicosities
–Venous ulcers
–Hemosiderin deposits
–Edema
–Erythema