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Advanced health Assessment - Peripheral Vascular Assessment
Terms in this set (199)
internal jugular vein
external jugular vein
great saphenous vein
behind the knee
posterior tibial artery
anterior tibial artery
dorsalis pedis artery
small saphenous vein
Celiac truck perfuses:
esophagus, stomach, proximal duodenum, liver, gallbladder, pancreas, spleen (foregut)
Superior mesenteric artery perfuses:
small intestine-- jejunum, ileum, cecum; large intestine-- ascending and transverse colon, right splenic flexure (midgut)
Interior mesenteric artery perfuses:
large intestine--descending and sigmoid colon, proximal rectum (hindgut)
Contains cirsumferential rings of elastic tissue and smooth muscle that change vein caliber in response to minor changes in venous ressure
The smallest veins that drain capillary beds and form interconnecting venous plexuses (such as prostatic and the rectal venous plexuses)
What do the arterial arches provide?
What does ABGs stand for?
arterial blood gases
Blood clots can develop in both superficial and deep veins, but a clot in which one is more worrisome?
In which veins are varicose veins observed?
small saphenous veins
_____________ veins connect the deep system with the superficial system
3 types of veins
deep vein, superficial vein, perforator (communicator)
major arteries of the leg
-femoral, politeal, dorsalis pedia, posterior tibial
major arteries of the arm
brachial, radial artery, ulnar artery
Venous stasis risk factors
-lack of muscular activity
-vein wall damage
Physical signs of arterial insufficiency
cold, pale, clammy skin
thin, shiny skin with loss of hair
Elevate both legs about 90 degrees for up to 2 min until there is maximal pallor of the feet-- Ask patient to sit up with legs dangling down-- return of pinkness normally takes 10 sec or less
Buerger test (arterial insufficiency)
Discomfort behind the knee with forced doriflexion on the foot
Key Components of Peripheral arterial examination
-measure BP in both arms
-auscultate for aortic, renal, and femoral bruits; palpate aorta and assess its maximal diameter
-palpate the pulses of the brachial, radial, ulnar, femoral, popliteal, DP, and PT
-inspect the ankles and feet for color, temp, and skin integrity; note any ulcerations, hair loss, trophic skin changes, hypertrophic nails
Ankle-brachial Index measurements
1.0-1.2 ABI = normal, no arterial insufficiency
0.8-1.0 ABI = mild insufficiency
0.5-0.8 ABI = moderate insufficiency
< 0.5 ABI = severe insufficiency
< 0.3 ABI = limb threatening
redness, thickening and tenderness along the vein. Aching or cramping may occur with walking or Homan's. Swelling and inflammation are often noted.
Measuring pitting edema:
1+ = Edema is barely detectable/2mm disappears rapidly.
2+ = Slight indentation/ 4mm, disappears in 10-15 sec
3+ = Leaves a deeper fingerprint/6mm, may last > 1 minute
4+ = Very deep pit/8mm, lasts 2-5 min, extremity grossly distorted
pink coloration returns to the palms within 3-5 seconds if the ulnar and radial artery is patent
Palpable epitrochlear lymph nodes (inner arm near elbow)
normally not palpable
suspect infection in the hand or forearm
Capillary refill more than 2 seconds:
vasoconstriction, decreased cardiac output, shock, arterial occlusion or hypothermia
Rapid pallor, cyanosis and redness, swelling, pain, numbness, tingling, burning, throbbing and coldness
swelling of feet or legs
lymphatic obstructions, venous insufficiency, DVT
_______ ulcers: painless, lower leg or medial ankle
_______ ulcers: painful, toes, foot, or lateral ankle
ropelike, bulging or contorted leg veins
Pain awakening a patient from sleep
chronic arterial occlusive disease
Heaviness, aching aggravated by standing or sitting for long periods of times, relieved by rest
Cramping calves, thighs, or buttock and weakness with activity, relieved by rest
Physical signs of venous insufficiency
warm, brown skin around ankles
True or false? A clot in the veins of the leg would most likely cause an issue in the heart
dorsalis pedis pulse
posterior tibial pulse
True or false? The brachial pulse is more toward the lateral side of the body
The radial pulse is more toward the ____________ side of the body
When trying to locate the dorsalis pedis pulse, measure from the ankle to the _________ of the toes, and start ____________ between those landmarks. Then, find the _________ _______ tendon and palpate ___________ to that
base; halfway; great toe; lateral
The popliteal pulse is ___________ the knee
The femoral pulse is palpated ___________ between the iliac crest and the __________ ___________, and is located specifically in the __________.
halfway; pubic symphysis; crease
Drains fluid from the right side of the head, neck, thorax, and right upper limb and empties into the junction of the right internal jugular and right subclavian veins
right lymphatic duct
Collects lymph fluid from the rest of the body and empties into the junction of the left internal jugular and left subclavian veins
The only superficial lymph nodes accessible to physical examination:
cervical, axillary, and nodes in the arms and legs
Where do the lymph nodes drain?
the heart/central circulatory system
Common and concerning symptoms for peripheral vascular system
-abdominal, flank, or back pain
-pain or weakness in the arms or legs
-cold, numbness, pallor in the legs; hair loss
-swelling in calves, legs, or feet
-color change in fingertips or toes in cold weather
-swelling with redness or tenderness
Stenotic, occlusive, and aneurysmal disease of the abdominal aorta, its mesenteric and renal branches, and the arteries of the lower extremities, exclusive of the coronary arteries
peripheral arterial disease (PAD)
Symptoms of persistent abdominal pain, "food fear", weight loss, or dark stool
Pain or cramping in the legs during exertion that is relievd by rest within 10 minutes
PAD warning signs
-fatigue, aching, numbness, or pain that limits walking or exertion in the legs; if present, identify location, ask about ED
-any poorly healing or nonhealing wounds of legs or feet
-any pain present when at rest in the lower leg or foot and changes when standing or supine
-abdominal pain after meals and weight loss
-any first degree relative with AAA
Risk factors for lower-extremity PAD
-Age > 50 with hx of DM or smoking
-leg symptoms with exertion
PAD risk factors
*smoking, DM, HTN, elevated cholesterol, African Americans, CAD
The ratio of blood pressure measurements in the foot and arm; values <0.9 are considered abnormal
ankle-brachial index (ABI)
What is the strength of an arterial pulse measured as "0"?
What is the strength of an arterial pulse measured as "1+"?
thready (like a little string)
What is the strength of an arterial pulse measured as "2+"?
What is the strength of an arterial pulse measured as "3+"?
What is the strength of an arterial pulse measured as "4+"?
Give a situation in which an absent pulse would be present
Give a situation in which a thready pulse would be present
Give a situation in which a weak pulse would be present
Give a situation in which an appropriate/normal pulse would be present
Give a situation in which a bounding pulse would be present
aortic insufficiency (aortic valve regurgitation); could also be an athlete after exercise
With thready and weak pulses, the __________ is going down
What is intermittent claudication?
pain (usually in the leg, but could also be in the arm) that happens with exercise (exertional condition)
If intermittent claudication is bad enough, it can even be experienced while
Intermittent claudication can be relieved by ___________ because the oxygen ___________ is able to catch up with the muscle's ___________ for oxygen
sitting down; supply; demand
Measuring the systolic pressure in the posterior tibial arteries versus the systolic pressure in the brachial arteries (leg pressure ÷ arm pressure) is a measurement of what?
ankle brachial index
What is the normal range of the ankle brachial index?
True or false? When measuring the ankle brachial index, the blood pressure in both spots should be about the same
If the ankle brachial index is abnormal, it indicates _________
peripheral artery disease (PAD)
Raynaud's disease is also known as _____________, and is caused by constricted arteries in the ____________, which __________ the blood flow
red, white, and blue disorder; fingers; block
Raynaud's disease tends to go hand in hand with
autoimmune disease (e.g., hyperthyroidism, lupus)
To reverse the symptoms of Raynaud's disease, a person could simply run their hand under __________ water
Thromboangitis obliterans (Buerger's disease) is when
diminished blood supply causes damage and death to tissues
Buerger's disease goes hand in hand with
What does SVT stand for?
superficial vein thrombosis
In superficial thrombophlebitis, a blood clot can form in either a superficial or a deep vein. When localized symptoms of tenderness, pain, redness, warmth, and a palpable cord form, this is a sign that the blood clot is in a ________ vein
In deep vein thrombosis, an embolus can dislodge from the clot and go to the _________
calf swelling, erythema (red swelling), and leg warmth could mean that a person has ________
SVT is a _____________ condition
DVT is a ____________ condition
______________ can turn into lymphedema
Chronic arterial insufficiency can also be referred to as
peripheral artery disease (PAD)
Chronic venous insufficiency can also be referred to as
peripheral vascular disease (PVD)
What kind of pain is associated with PAD?
intermittent claudication, progressing to pain at rest
What kind of pain is associated with PVD?
none to an aching pain on dependency
What kind of pulses are associated with PAD?
decreased or absent
What kind of pulses are associated with PVD?
normal, though may be difficult to feel through edema
What skin color is associated with PAD?
pale, especially on elevation; dusky red on dependency (dependent rubor)
What skin color is associated with PVD?
normal, or cyanotic on dependency; petechiae and then brown pigmentation appear with chronicity
What are petechiae?
tiny bruises (can expand to bigger bruises)
When there is plaque build-up in the main arteries, the superficial arteries/arterioles start to pick up the slack, giving off
rubor (purplish-red color)
What temperature is associated with PAD?
What temperature is associated with PVD?
What kind of edema is associated with PAD?
absent or mild; may develop as the patient tries to relieve rest pain by lowering the leg
What kind of edema is associated with PVD?
present, often marked
What kind of skin changes are associated with PAD?
trophic changes: thin, shiny, atrophic skin; loss of hair over the foot and toes; nails thickened and ridged
What kind of skin changes are associated with PVD?
often brown pigmentation, especially around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops
What kind of ulceration occurs with PAD?
if present, involves toes or points of trauma on feet
What kind of ulceration occurs with PVD?
if present, develops at side of ankle, especially medially (can also go all the way around ankle)
In PAD, gangrene
In PVD, gangrene
does not develop
With arterial insufficiency, the person is experiencing a ________ of blood supply
What are some signs/symptoms of stasis dermatitis?
inflammation of ankles, lesions
With veinous insufficiency, blood pools. The veins can only take so much stress before _________ occurs.
Neuropathic ulcers are classic of patients with ____________
Diabetic patients should not walk around the house with ___________ feet if they have peripheral vascular disease
True or false? All the columns of blood in the neck are trying to get to the right atrium.
When JVD reaches the jaw line, this is a sign that
the heart is starting to fail
When measuring jugular venous dissension, you must always add __________ to the visible measurement you obtain.
What is the normal range for measurement of jugular veinous distension?
If the measurement of jugular venous distention is greater than 9 cm, this is a sign of ____________ JVD and signifies an increase in jugular venous __________ (JVP)
Positive JVD is an indicator of what conditions?
increase in central venous pressure (right side of heart backing up); CHF (right side of heart)
When measuring JVD on a patient, put the patient at a _________ angle
The right atrium is ________ below the sternal angle
When measuring JVD, the horizontal measurement is done from the __________ point of JVD to the sternal angle
The carotid artery gives a ____________ wave form
The jugular vein gives a ___________ tap/wave
True or false? The pulse can be felt in the jugular vein?
The Allen test is done to check that the ______________ _____________ is in good condition
With the Allen test, the hand should pink back up in _____ seconds
When doing the Allen test, if the hand does not pink back up within 2 seconds, this is a sign of a(n) ___________ problem (PVD)
When measuring ABGs, you typically go into the __________ artery
When measuring a person's pulse from lying -> sitting -> standing, if the pulse raises by 20 points or more, this is a sign of
Orthostatic hypotension is indicated in a patient when the systolic blood pressure (being measured from lying -> sitting -> standing) __________ by _________ points or more
Orthostatic hypotension is indicated in a patient when the diastolic blood pressure (being measured from lying -> sitting -> standing) ________ by _________ points or more
True or false? A patient could have orthostatic hypotension according to their pulse, but not to their blood pressure.
capillary refill is an assessment for what?
brisk capillary refill is when the nailbed returns to it's pink color in ____________ or less
sluggish capillary refill is when it takes the nailbed _________ than 2 seconds to return to it's pink color
Poor capillary refill points to poor ____________, or a problem with circulation perfusion
If the heart is only ejecting 15% of its volume, _____________ will occur
cervical lymph nodes
Posterior auricular lymph node
occipital lymph node
Superficial cervical lymph node
Deep cervical lymph node
Posterior cervical lymph node
Supraclavicular lymph node
Preauricular lymph node
Tonsilar lymph node
Submental lymph node
Submandibular lymph node
Parotid lymph area
The lymph nodes drain back toward the __________ (into circulatory system)
Normally, the lymph nodes should not be palpable, unless there is _____________ or inflammation
When the posterior cervical lymph nodes are inflamed and none of the others are, this is a sign of _________
runs in families
The manual compression test is used when a person has
In the manual compression test, the caregiver would push a few times on the ________________, and if they feel a _________ lower down on the limb, this could be a sign of ______ or DVT
varicose vein; pulse; SVT
SCDs stands for
sequential compression devices
If no pulse is felt lower down on the vein when doing the manual compression test, this is a sign of
good, clear flow
What are some causes of varicose veins?
obesity and smoking
What are some causes of poor capillary refill?
dehydration, PAD, shock, CHF, atherosclerosis
Capillary refill is an assessment for ____________ circulation
Orthostatic hypotension could be caused by
anemia, CHF, cardiomyopathy
The Homan's test is used in
In the Homan's test, the caregiver has the patient dorsiflex their foot _________ and deliberately. Then the caregiver puts their hands around the top of the swelled area or where the ________ is, applies pressure, and if the patient experiences _________, this is a ___________ Homan's sign and points to _________
slowly; clot; pain; positive; DVT
worst pitting edema you've ever seen/supersonic pitting edema
With edema, a patient can also experience
crackles, wheezes, and rhonchi
+1 pitting edema is a ______mm indentation
+2 pitting edema is a ______mm indentation
+3 pitting edema is a ______mm indentation
+4 pitting edema is a ______mm indentation
Patients with _________ commonly get pitting edema
Lymphedema is most commonly caused by
lymphedema is usually
Edema that is linked to CHF would be expected to be
clubbing of the fingers is a sign of
A palpable lymph node is
a jelly-like sac that is easily moveable and pliable
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