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Peripheral Vascular and Lymphatic

Terms in this set (35)

-note skin color, hair distribution, enous patterns, size, lesions, ulcers >>>pallor-vasoconstriction, erythema-vasodilation, cyanosis
-venous pattern should be flat and barely visible
-legs should be symmetric, if lower legs look asymmetric or of DVT is suspected, measure calf circumference, if lymphedema suspected, measure at ankle, distal calf, knee, thigh >>>bilateral edema with systemic illnesses, acute unilateral painful swelling and asymmetry of calves is abnormal, DVT could be present, 1-3cm: mild lymphedema, 3-5cm: moderate lymphedema, +5: severe lymphedema
-note size and location of skin discoloration, ulcers, gangrene >>>brown: chronic venous stasis caused by hemosiderin deposits from RC degradation, venous ulcers occur at medial malleolus b/c of bacterial invasion of poorly drained tissues, ulcers at tips of toes, metatarsal heads, lateral malleoli w/ arterial deficits
-palpate for temp, skin should be warm bilaterally, bilateral cool feet may be due to environmental factors, inote increase in temp higher up the leg and if it is gradual or abrupt >>>unilateral cool foot or leg or sudden temp change could be arterial deficit
-flex knee and compress gastrocnemius.calf muscle against tibia, no tenderness should be present >>>calf pain could be DVT, superficial phlebitis, achilles tendinitis, gastrocnemius and plantar muscle injury, lumbosacral disorder
-palpate inguinal lymph nodes, small palpable nodes not unusual
-palpate peripheral arteries (femoral, popliteal, dorsalis pedis, posterior tibial), grade on 3 point scale, locate femoral arteries, press and release noting pulse tap, auscultate for bruit if weak/diminished >>>bruit occurs w/ turbulent blood flow, indicating partial occlusion
-compress popliteal pulse against bone, hard to find
-press softly on posterior tibial pulse, feel tapping between malleolus and achilles tendon
-+45 years, harder to find dorsalis pedis or posterior tibial but not both on the same foot
-check pretibial edema, fingers should not leave indentation >>>bilateral dependent pitting edema w/ HF, diabetic neuropathy, hepatic cirrhosis
-pitting edema scale: 1+ mild, slight indentation, no perceptible swelling of leg, 2+ moderate, indentation subsides rapidly, 3+ deep, indentation remains for short time, looks swollen, 4+ very deep, inflammation lasts long time, grossly swollen and distorted >>>unilateral edema w/ occlusion of deep vein, unilateral or bilateral w/ lymphatic obstruction, "brawny" or nonpitting edema feells hard to touch
-scale commonly used but not completely reliable, anlke circumferance more reliable >>>bilateral edmea- examine neck veins, distended neck veins could be heart disease or pulmonary hypertension, if normal neck veins edema could be from iver disease, nephrosis, chronic venous insufficiency, antihypertensive or hormonal medications
-note visivle dilated and tortous veins when standing up, ask if varicose veins are painful, swelling, fatigue, cramping >>>occur in saphenous veins, examination techniques not reliable, use doppler