Topic 9 Flashcards
arteriosclerosis
hardening of the arteries (Peripheral blood vessels grow more rigid with age)
Atherosclerosis
condition in which fatty deposits called plaque build up on the inner walls of the arteries
what trophic changes may be associated with arterial insufficiency
o Thin, shiny skin
o Thick, ridged nails
o Loss of hair on lower legs
what is the strongest risk factor associated with PAD
smoking
what age does the AHA recommend screening for
-all people over the age of 70
-between 50-69 who have history of smoking or diabetes
what are you noting for when inspecting a persons arms
color of skin and nail beds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing
how do you inspect and palate the arms
Lift person’s both hands in your hands
how do you detect early clubbing
Use profile sign (viewing finger from side) (normal nail bed angle is 160 degrees)
what are some causes of edema in the upper extremities
Lymphatic blockage, DVT, infection
what does capillary refill check
its an index of peripheral perfusion and cardiac output
how do you check capillary refill
-hands near level of the heart
-depress and blanch nail bed; release
what is a normal capillary refill
color returns in less than 1 or 2 seconds
what conditions can skew the capillary refill findings
a cool room, decreased body temperature, cigarette smoking, peripheral edema, and anemia
when palpating both radial pulses, what is the nurse noting?
rate, rhythm, elasticity of vessel wall, and equal force
Grading force of pulse
3+, increased, full, bounding
2+, normal
1+, weak
0, absent
Modified Allen Test
constriction of the radial and ulnar artery while patient makes a fist several times when the had turns blanch have them stop and release the pressure off of the ulnar artery while compressing the radial artery…
o Adequate circulation is suggested by a return to hand’s normal color in approximately 2 to 5 seconds
The modified Allen test is used to evaluate
collateral circulation prior to occluding radial artery
If lower legs look asymmetric…
measure leg at widest point, taking care to measure other leg in exactly same place, same number of centimeters down from patella or other landmark
Chronic venous stasis causes
brown discoloration and ulceration/infection
Chronic arterial deficit causes
ulcers on toes
Where are the femoral arteries located?
just below inguinal ligament halfway between pubis and anterior superior iliac spines
if the femoral artery pulse is weak or diminished…
auscultate site for bruit
what is one way to expose the femoral artery
ask person to bend his or her knees to side in a froglike position
how do you check popliteal pulse
With leg extended but relaxed, anchor your thumbs on knee, and curl your fingers around into popliteal fossa
-Press your fingers forward hard to compress artery against bone (lower edge of femur or upper edge of tibia); often it is just lateral to the medial tendon
what pulse is often impossible to palpate
popliteal
Posterior tibial pulse
curve your fingers around medial malleolus
o Feel the tapping right behind it in groove between malleolus and Achilles tendon
Dorsalis pedis pulse
equires a very light touch
o Normally it is just lateral to and parallel with extensor tendon of big toe
occasionally either dorsalis pedis or posterior tibial pulse may be hard to find in what age group
In adults over 45 years
Check for pretibial edema
o Firmly depress skin over tibia or medial malleolus for 5 seconds and release
o Normally your finger should leave no indentation, although a pit commonly is seen if person has been standing all day or during pregnancy
grade for pitting edema
1+ Mild pitting, slight indentation, no perceptible swelling
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains, leg looks swollen
4+ Very deep pitting, indentation lasts long time, leg very swollen
when does arterial circulation deficit worsen
with elevation of the legs causing pallor
color of light-skinned person’s feet
a little pale but still should be pink
color of dark-skinned person’s feet
soles should reveal extreme color change
how long does it take for color to normally return to feet
10 seconds or less
Dependent rubor
deep blue-red color of the lower extremities; caused by severe arterial insufficiency.
Doppler ultrasonic probe
Device to detect a weak peripheral pulse
-measures low blood pressure or blood pressure in lower extremity (magnifies pulsatile sounds from heart and blood vessels)
Doppler ultrasonic probe technique
o Position person supine, with legs externally rotated so you can reach medial ankles easily
o Place drop of coupling gel on end of handheld transducer
o Place transducer over pulse site, swiveled at a 90-degree angle; apply very light pressure; locate pulse site by the swishing, whooshing sound
a weak and thready pulse is rated…
1+
a full bounding pulse is rated…
3+
Pulsus Paradoxus
beats have weaker amplitude with respiratory inspiration, stronger with expiration (changes w respiration cycle)
Pulsus Bigeminus-ectopy
irregular conduction
