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What is claudication?
- It's a peripheral vascular problem seen in adults.
- It causes pain bc of episodic ischemia induced by exercise due to atherosclerosis.
- Pain is usually in the calf muscles.
Common changes in childbearing women?
- Systemic vascular resistance and peripheral vasodilation decreased.
- Enlargement of the uterus causes compression of the vena cava causing Hypotension, dependent edema, and hemorroids, etc)
- HBP starts to rise in abt 20 weeks.
- If persist > 140/90, it might be pregnancy induced HTN.
What are the common finding in Newborns?
- Ductus arteriosus: closes 12-14 hrs from change in O2 tension.
- Foramen Ovale: closes after Lft sided pressures increase greater than Rt pressures when lungs expand and ductus venosus closes.
Important differences in infants?
- brachial pulses is more palpable than radial.
- Radial pulses for HR not accurate until at least 2 yrs, Prefer to take apical pulse.
- Capillary refill: It's an excellent way to assess perfusion. (More than 2-3 secs is problematic.
Important differences in assessment in children?
- Start routine BP measurement by age 3, unless renal or cardiovascular problem.
- Venous hum is normal.
What is the preferable order to assess PV?
- Check for edemas.
- Palpate Arteries.
- Capillary refills.
What is Edema? How to assess it? Grading?
- Edema is accumulation of fluid in interstitial space (tissues)
- Compare one foot and leg w the other.
- Check for pitting Edema.
- Grading: +1,+2,+3,+4 (grade x 2 = # in MM)
Assessment of arteries? Importance? What are the arteries to palpate? Grading?
- They should be consistent laterally and upper to lower.
- Arteries: Carotid, Brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial.
- 3+ (bounding), +2 (Brisk, expected (normal)), 1+ (diminished, weaker than expected), 0 absent, unable to palpate.
What is a bruit? What is a venous hum?
- Bruit: It is a blowing, swishing sound indicating blood flow turbulence.
- When present may indicate artherosclerosis narrowing.
- Probably won't hear it in a child.
- Venous hum: vein walls vibrate and hum from blood flow.
- It is usually benign.
- Usually heard in pregnant women.
- Caused by narrowing or blockage.
- CM: Cramping in legs, arterial claudication (usually when exersing), pain in legs at night, deep sores that do not heal.
- Causes kidney failure, MIs, etc.
what is the Allen Test?
To evaluate arterial insufficiency of the hand.
What is claudication?
Pain from muscle ischemia. Usually pain or cramping when exercising that is relieve with rest.
Common signs for arterial disease? venous obstruction/insufficiency?
- AD: claudication, cool, no hair, nail thick and ridged.
- VI: Edema, warm, brwon pigment,
How to assess thrombosis? symptoms?
- Homan sign (to detect a clot, pain when positive) dorsiflex foot to see of there is resistance.
- Symptoms: swelling, pain, warmth, redness.
How to assess for varicose veins?
- Trendelenburg test: identifies incompetence venous.
- Raise leg, occlude saphenous vein --> have pt stand w vein occluded --> note if there is rapid filling after saphenous released --> if yes, incompetent valve.