Peripheral Vascular Assessment PDF Fall 2024

0 PERIPHERAL VASCULAR ASSESSMENT N313  0 Learning Objectives 1. Describe the structure and the function of arteries and veins. 2. List the pulses accessible to examination. 3. Descri...

0 PERIPHERAL VASCULAR ASSESSMENT N313  0 Learning Objectives 1. Describe the structure and the function of arteries and veins. 2. List the pulses accessible to examination. 3. Describe the mechanisms that keep blood moving toward the heart in the venous system. 4. Explain the term capacitance vessels. 5. List the risk factors for venous stasis. 6. Relate the structure and function of the lymph vessels. 7. Describe the function of the lymph nodes. 8. Cite the location of the superficial groups of lymph nodes that are accessible to examination. 9. Name the related organs and functions of the lymphatic system. 10. Incorporate health promotion concepts when performing an assessment of the peripheral vascular system.  0 Case Study Henry Lee is a 46 year old man who is relatively healthy, but obese (weight 250 lb; height 5’9’’). He comes to the clinic to see the nurse practitioner with the following statement: “ I must have pulled something in my right leg. I was walking when I felt some soreness in my lower right leg, and now there is some swelling. It really hurts to walk.” He states that he is self-employed developer of computer software programs.  0 Anatomy Review Arteries Veins Carry ____________ oxygenated blood and Carry _______________ blood, nutrient-rich blood from heart to deoxygenated nutrient depleted from tissues capillaries back to heart. __________ Pressure system Low pressure system High ________ stretches with systole; ______ No pump to generate blood recoil with diastole flow Each heart beat creates a Contracting skeletal muscle, pressure wave: PULSE respiratory pressure gradient, Feel Pulse only at sites where and intraluminal valves artery is close to skin and over Course parallels that of arteries a bone. Body has more veins than arteries Lie closer to skin surface  0 Arterial Pulses Locations Grading temporal 0 =absent 1+ =weak, thready Obstruction carotid occlusion brachial 2+ =“normal” 3+ =full, bounding radial ulnar femoral Titworkout Anxiety popliteal posterior tibial dorsalis pedis 0  0 Anatomy: Veins  0 Anatomy: lymphatics Completely separate vessel system Drain excess fluid and plasma proteins from ________________ interstitialfluid and returns to bloodstream Faulty lymphatic drainage leads to build up of fluid in interstitial spaces ie: edema Drain into two main trunks that empty into subclavian veins Right lymphatic duct Thoracic duct 0  0 Superficial lymph nodes of the arms and legs accessible Easily  0 Peripheral Vascular: Subjective Data (PG Lets 511-512) go back to Mr. Lee. What might you ask him? Exursize previous heartproblems Pc pation Biographical data DUT blood clots Chief complaint followed by HPI Past history Family history Functional assessment (lifestyle/health practices)  0 Objective Data Preparing the client Gown Warm room Explain examination Equipment Centimeter tape Stethoscope Doppler Ultrasound Device Conductivity gel Tourniquet Blood pressure cuff Physical Assessment  0 Arms: Inspection ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS PROCEDURE Inspect arms, hands, & Arms/hands Asymmetry Edema nails for edema, symmetrically sized Lesions lymph issues lesions, clubbing Clubbing hypoxia COPD No edema Clinical Tip: Mark locations on arms with a permanent No lesions marker to ensure the exact same locations are used with each reassessment. No clubbing  0 Arms: Inspection ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS PROCEDURE Inspect coloration Color varies depending on Raynaud disorder caused by of the hands and the client’s skin tone, vasoconstriction leads to color arms although color should be the same bilaterally changes suin as red or blue cyanosis  0 Arms: Palpation ASSESSMENT PROCEDURE NORMAL ABNORMAL FINDINGS FINDINGS Palpate arms, hands, fingers Skin is warm to A cool extremity oxygenation issue for temperature the touch bilaterally Palpate to assess capillary 2 seconds may indicate refill time vasoconstriction, decreased cardiac output, shock, arterial occlusion, or hypothermia.  0 Arms: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate the radial pulse Pulses are bilaterally Full, bounding (3+) strong (2+) Weak, thready (1+) Absent (0) Palpate the brachial pulse Pulses are bilaterally Full, bounding (3+) strong (2+) Weak, thready (1+) Absent (0)  0 Arms: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Perform the Allen test Pink coloration returns to the Pallor that persists or palms within 7 seconds if the ulnar sluggish return to color Evaluates collateral circulation artery is patent before cannulating the radial artery  0 Legs: Inspection ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS PROCEDURE Observe skin Even skin tone Pallor vasoconstriction coloration and size Legs symmetrically Erythema vasodilation sized Pallor on elevation/rubor on dependence Asymmetry DVT lymphaticssue Gangrene/necrosis oxugadeficiency  0 Legs: Inspection ASSESSMENT NORMAL FINDINGS ABNORMAL Older Adult PROCEDURE FINDINGS Considerations Observe hair Hair covers legs, even if Loss of hair on the legs Hair loss on the lower extremities occurs with aging distribution on leg hair shaved still and is, therefore, not an legs observe hair on dorsa of Thin, shiny skin absolute sign of arterial toes insufficiency in the older client. Observe for No lesions or ulcers _________ ulcers- Arterial lesions or ulcers smooth, even margins that occur at pressure areas, injurist pressure __________ Venousulcers- irregular edges, bleeding, and possible bacterial infection that occur on the medial ankle  0 Legs: Inspection ASSESSMENT NORMAL ABNORMAL FINDINGS PROCEDURE FINDINGS Observe for edema Symmetrically Diffuse bilateral edema Disease illness * Note veins, tendons sized & shaped * Compare both Acute, unilateral edema DUT blood clot extremities at the same No edema/atrophy locations Asymmetry lymphademai DUT Asymmetric calf swelling DUT  0 Legs: Inspection ASSESSMENT NORMAL ABNORMAL FINDINGS Older Adult Considerations PROCEDURE FINDINGS Observe for Veins are flat and Varicose veins may appear as Varicosities are common in the older varicosities barely visible distended, nodular, bulging, and client. *Stand patient tortuous, depending on severity.  0 Varicosities Thrombophlebitis Superficial thrombophlebitis resulting from thrombus formation in the superficial veins. Often seen with unilateral localized pain, achiness, edema, redness, and warmth to touch  0 Legs: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate bilaterally for Warm & equal bilaterally Unilateral cool foot or leg temperature of the feet and arterial insuffilianly legs Sudden decrease in temperature as you move down the leg *Use the backs of your fingers. Increased warmth Inflammation  0 Legs: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate for edema No edema Pitting edema heart failure Diabetes  0 Pitting edema grading scale O normal 1+ mild pitting, slight indentation, no perceptible swelling of the leg 2+ moderate pitting, indentation subsides rapidly 3+ deep pitting, indentation remains for a short time, leg looks swollen 4+ very deep pitting, indentation lasts a long time, leg is grossly swollen & distorted  0 Legs: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate the femoral pulses Pulses are bilaterally Full, bounding (3+) strong (2+) Weak, thready (1+) Absent (0) Auscultate the femoral pulses bruit (if No bruit Bruit pulse is weak or diminished) oillusionor blockage  0 Legs: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate the popliteal pulses Pulses are bilaterally strong Full, bounding (3+) (2+) *Ask the client to raise (flex) the Weak, thready (1+) knee partially. Absent (0)  0 Legs: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate the dorsalis pedis pulses Pulses are bilaterally Full, bounding (3+) strong (2+) Weak, thready (1+) Absent (0)  0 Legs: Palpation ASSESSMENT PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS Palpate the posterior tibial Pulses are bilaterally Full, bounding (3+) pulses strong (2+) Weak, thready (1+) Absent (0)  0 Peripheral Vascular Disease: Mr. Lee is diagnosed with PVD. He wants to know, “what is it ?” A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs feeling cold painful What causes it? Most commonly atherosclerosis (build-up of fatty deposits in blood vessels) Other causes- diabetes, obstruction, infections, arteritis, blood vessel defects, blood vessel spasms What do we inspect? Depends on whether affecting the veins or arteries  0 Chronic Venous Insufficiency Poor vinous Rturn to hear Location: calf, lower leg Character: aching, tiredness, feeling of fullness Onset & duration: chronic pain, increased at end of day Aggravating factors: prolonged standing/sitting Relieving factors: elevation, lying, walking big veins Associated symptoms: edema, varicosities, weeping ulcers at ankles, hemosiderin staining Risk factors: job with prolonged sitting/standing, prolonged bed rest, history of heart failure, obesity, varicosities or thrombophlebitis, trauma to veins 0  0 Reduced arterial Chronic Arterial Insufficiency blood flow Location: deep muscle pain, usually in calf, but my be lower leg or dorsum of foot Character: intermittent claudication Onset & duration: chronic pan, onset after gradual exertion Aggravating factors: activity (walking up stairs) Relieving factors: rest (usually within 2 minutes) Associated symptoms: low ankle-brachial index; cool, pale skin; diminished pulses, pallor on elevation Risk factors: older adult, smoking, diabetes, HTN, hypercholesterolemia, obesity, chronic kidney disease  0 Acute Arterial Insufficiency Location: varies, distal to occlusion (may involve entire extremity) Character: throbbing Onset & duration: sudden onset (within 1 hr) Associate symptoms: six P’s- pain, pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis Risk factors: history of vascular surgery, invasive arterial procedure, abdominal aneurysm, trauma to arteries, chronic atrial fibrillation  0 Comparison arterial/venous insufficiency characteristic venous arterial Emergent color normal or Pale with cyanotic elevation rubor with dependence temperature normal Cool pulse decreased or normal absent edema often marked absent or mild skin changes brown shiny skin; pigmentation decreased hair around ankles growth; thick nails  0 Testing for Arterial Insufficiency A. Elevate legs 12 inches off table and ask patient to wag feet for 30 seconds B. Follow by having patient sit up with legs over the side of table and compare color of both feet Marked pallor of foot when elevated indicates arterial insufficiency brightrid Persistent rubor of dependent foot indicates arterial insufficiency  0 Deep Vein Thrombosis Deep vein occluded by a thrombus Subjective- sudden onset of intense, sharp, deep muscle pain Objective- increased warmth; swelling; erythema; dependent cyanosis; tender to palpation Wells Score for assessing DVT risk Causes of DVT Immobility Problffist smoking meds Use of estrogen Python Heart failure  0 Deep vein thrombosis (DVT)  0 Documentation Be specific Be concise Be complete Avoid vague terms like normal or good Specify any parts of an exam omitted or deferred Use standard abbreviations Record exact size or placement of skin lesions (draw a diagram)  0 Read subjective Objective: Inspection. Lower extremity size = bilat. With no swelling or atrophy. No varicosities. Color. L leg pink, R leg pink when supine, but marked pallor to R foot on elevation. Black gangrene at tips of R 2nd, 3rd, 4th toes. Leg hair present but absent on involved toes Palpation. R foot cool and temp. gradually warms as proceed palpating up R leg Pulses. Femoral both 1 +; popliteals, both 0; post. Tibial, both 0 but present with doppler; dorsalis pedis 0, but left dorsalis pedis is present with doppler, and right is not present with doppler  0 Documentation: Arterial pulses Radial pulse Radial pulses: Bilaterally equal, regular, strong; no tenderness or thickening of vessels, 76/min. Rt. Lt. Temporal 2+ 2+ Amplitude & character of Brachial 3+ 2+ peripheral pulses Femoral 2+ 2+ Popliteal 0+ 0+ Posterior tibial Unable to palpate Dorsal pedis 1+ 1+ Carotid pulse: Carotid pulses: Equal, strong, no characteristics bruits auscultated. & ± bruit