Fall 2022 Peripheral Vascular Student 2 PDF

PERIPHERAL VASCULAR & LYMPHATIC ASSESSMENT Vascular System and Lymphatics  Structure and Function Arteries Heart pumps freshly oxygenated blood through arteries to all body tissues Pumping heart makes this a high-pressure system Artery walls are strong, tough, and tense t...

PERIPHERAL VASCULAR & LYMPHATIC ASSESSMENT Vascular System and Lymphatics  Structure and Function Arteries Heart pumps freshly oxygenated blood through arteries to all body tissues Pumping heart makes this a high-pressure system Artery walls are strong, tough, and tense to withstand pressure demands Contain elastic fibers, which allow their walls to stretch with systole and recoil with diastole Contain muscle fibers (vascular smooth muscle, or VSM), which control amount of blood delivered to tissues VSM contracts or dilates, which changes the diameter of arteries to control the rate of blood flow Arteries in the Arm Vessels in the Leg Venous Flow Lymphatic Ducts and Drainage Patterns Immune-Related Organs Structure and Function: Developmental Competence Aging adult Arteriosclerosis vs. Atherosclerosis Rise in systolic blood pressure Progressive enlargement of the intramuscular calf veins Increased risk of deep venous thrombosis and subsequent pulmonary embolism Subjective Data Leg pain or cramps Skin changes on arms or legs Swelling in arms or legs Lymph node enlargement Medications Smoking Breast changes Objective Data Inspect and palpate the arms Lift both person’s hands in your hands Inspect, then turn person’s hands over, noting color of skin and nailbeds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing Use profile sign (viewing finger from side) to detect early clubbing Normal nail bed angle is 160 degrees Capillary Refill - < 2 seconds Temperature Symmetry Skin Allen Test  Objective Data Inspect and palpate the legs Uncover the legs while keeping genitalia draped In presence of skin discoloration, skin ulcers, or gangrene, note size and exact location Palpate for temperature along legs down to feet, comparing symmetric spots Flex person’s knee, then gently compress gastrocnemius (calf) muscle anteriorly against tibia; no tenderness should be present Locate femoral, popliteal, posterior tibial, and dorsalis pedal pulses Deep Vein Thrombosis (DVT) Assessment  15 Pulse Grading Scale 0 = Absent 1+ = Weak 2+ = Normal 3+ = Full/Bounding  Objective Data Inspect and palpate the legs (cont.) Check for pretibial edema If pitting edema is present, grade it on following scale: 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 Manual Compression Test  18 Trendelenburg Test Objective Data Color changes If you suspect an arterial deficit, raise legs about 30 cm (12 inches) off table and ask person to wag feet for 30 seconds to drain off venous blood Note also time it takes for superficial veins around feet to fill Normal time is about 15 seconds This test is unreliable if person has concomitant venous disease with incompetent valves Test lower legs for strength https://my.clevelandclinic.org/-/scassets/images/org/health/articles/17357-peripheral-artery- disease Test lower legs for sensation  FALL 2012 20 Using a Doppler to Measure Blood Flow  FALL 2012 21 Arterial Insufficiency Deep Muscle Pain Pain Claudication Pallor Rest Pain Pulselessness Dependent Rubor Diminished Pulses Paresthesia Skin Changes Poikilothermia Paralysis  FALL 2012 22 Arterial Risk Factors Age Smoking Diabetes mellitus Hypertension Increased Lipid Levels Male Obesity High Fat Diet Heavy Alcohol Use Coagulation Abnormalities Physical Inactivity https://medlineplus.gov/ency/images/ency/fullsize/18020.jpg  23 Venous Insufficiency Aching Worsens with Prolonged Standing, Sitting Brawny Edema Coarse Thickened Skin Dermatitis, Pruritis https://cdn-banfi.nitrocdn.com/ZtvRKfnAxDHjGycexgygLBDikFFymiPS/assets/static/optimized/rev- f903e2e/wp-content/uploads/2021/11/splash-stages-of-venous-insufficiency.png  24 Venous Risk Factors Pregnancy Prolonged sitting, standing Limited physical activity Age Obesity Use of constrictive clothing Know the difference? https://www.registerednursern.com/wp-content/uploads/2019/10/arterial-venous-ulcers-nursing.png Abnormal Findings: Variations in Arterial Pulse Weak, “thready” pulse Full, bounding pulse Pulsus paradoxus  Slide 20- 27 Sample Charting  Slide 20- 28 Sample Charting (cont.) MALE AND FEMALE GENITOURINARY SYSTEMS  Subjective Data Usual bowel routine Change in bowel habits Rectal bleeding, blood in stool Medications: laxatives, stool softeners, iron Rectal conditions: pruritus, hemorrhoids, fissure, fistula Family history Patient-centered care: diet of high- fiber foods, most recent examinations Copyright © 2020 by Elsevier Inc. All rights reserved. Health Promotion Teaching - Males  Prostate cancer, colorectal cancer (CRC) and HPV PSA—effective early screening test Screening for CRC starts at age 50 with recommended colonoscopy FIT—Fecal Immunochemical test—start at age 40 HPV vaccine—Men under 26 years of age Copyright © 2020 by Elsevier Inc. All rights reserved. Culture and Genetics: Prostate Cancer  Most frequently diagnosed cancer in men  Known risk factors: Increasing age, African ancestry, family history, and inherited mutation of BRCA1 and BRCA2 genes  Ethnic/geographic variation is seen in terms of occurrence.  Follow screening recommendations relative to identified risk Copyright © 2020 by Elsevier Inc. All rights reserved. Self-Care: Testicular Self-Examination (TSE)  Points to include during health teaching are: T—timing, once a month S—shower, warm water relaxes scrotal sac E—examine, check for, and report changes immediately Copyright © 2020 by Elsevier Inc. All rights reserved. Subjective Data Menstrual History Recommended Obstetric History screening for cervical Gravida cancer Para Acute pelvic pain Abortions Urinary symptoms Menopause Vaginal discharge Recommended Past History screening for cervical Sexual Activity cancer Contraceptive use STI Contact Subjective Data Questions: Patient-Centered Care  Ask about self-breast exam (SBE) Teaching moment to review basics of examination  Review screening guidelines recommendations based on age and patient history American Cancer Society  Begin at ages 40 to 44, screening mammography  Annual mammography from ages 45 to 54  Biennial mammography over age 55 or continuation of annual Copyright © 2020 by Elsevier Inc. All rights reserved. Regional Lymphatics Copyright © 2020 by Elsevier Inc. All rights reserved. Teach Breast Self-Examination (BSE) Copyright © 2020 by Elsevier Inc. All rights reserved. Health Promotion - Females HPV Vaccination Preparation for possible sexual activity Prevention of STI’s Prevention of unintended pregnancy Sexual identity Use of alcohol and drugs Physical safety in family and sexual relationships Cyberbullying or bullying in school