Peripheral Vascular Assessment
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What do arteries do for the blood and body tissues?
What kind of fibers do the arteries contain?
Elastic and muscle
Why do the walls of the arteries need to be strong?
Because it is a high pressure system
What do veins do for the blood and tissues?
Drain de-oxygenated blood and its waste products from tissues and return it to the heart
Why are veins walls thinner than arteries?
Low pressure system
What is the mechanism that keeps blood moving?
Competent, unidirectional valves
Which are the deep veins?
Femoral and iliac
Which are the superficial veins?
great and small saphenous
What three situations cause venous stasis?
- Calf muscle contraction is insufficient
- Incompetent valves
- Occluded lumens
Who is at risk for venous stasis?
- People with…
- Prolonged standing, sitting or bedrest
- Hypercoagulable states
- Vein wall trauma
- Varicose veins
What is post-thrombotic syndrome?
Clot causes venous wall trauma
What do lymphatics do for blood and tissues?
Retrieves excess fluid from tissue spaces and returns it to bloodstream
What do axillary lymph nodes drain?
Breast and upper arm
What do Epitrochlear lymph nodes drain?
Hand and lower arm
What do Inguinal lymph nodes drain?
Lower extremity, external genitalia and anterior abdominal wall
What is difference between arteriosclerosis and atherosclerosis?
Hardening of arteries (arteriosclerosis) versus plaque build up in arteries (atherosclerosis)
What is dependent edema?
Edema caused by prolonged standing
What is claudication?
Pain with exertion
Why is pain of venous stasis worse at the end of the day?
Because fluid builds up throughout the day
What is hemocsiderin?
Staining from iron buildup when venous stasis is present
What do you inspect for when assessing peripheral vascular system?
- Extremities for color
- Hair distribution
- Symmetry of extremities
What do you palpate for when assessment peripheral vascular system?
- Capillary refill
- Lymph nodes
What do you auscultate when assessing peripheral vascular system?
- Temporal, Carotid and femoral pulses
- Bruits (none should be present)
What do you note when palpating arterial pulses?
What is the Allen test?
Testing perfusion of ulnar artery by occluding both and releasing the radial artery
What is bilateral edema a symptom of (usually)?
Chronic disease or heart disease
What is lymphedema?
Damage to lymph vessels and fluid cannot be drained
What is brauny edema?
Hardening of lymph vessels
What is Homan’s sign?
Pain upon dorsi-flexion of the foot, which indicates DVT
What is compression test?
Tests for venous insufficiency by compressing distal and proximal ends of varicose vein, releasing proximal end and feeling for wave.
Signs of arterial deficit?
- Thickened/absent nails
- Cool extremities
What is dependent rubor?
Severe peripheral arterial disease causes loss of vasomotor flow causing deep blue/red tone
When is a full/bounding pulse found?
After exercise, fright, hyperthyroidism or anemia
What is pulsus begminus?
Regular beat followed by premature beat. Occurs with conduction disturbances and often do not perfuse to extremities
What is pulsus alternans?
Regular pulse with alternating strong and weak beats, indicative of heart failure
What are signs of PVD/peripheral arterial disease?
- Ulcers or sores on legs and feet that don’t heal, pale and dry
- Hairlessness on legs, shiny legs, thickened nails
- Absent or weak pulse
- Prolonged capillary fill
- Coldness/pallor in lower legs and feet
What are symptoms of PVD/peripheral arterial disease?
- Claudication pain
- Pain aggravated with elevation, relieved with dependency
What are signs of Venous insufficiency?
- Varicose veins/post thrombotic leg syndrome
- Ulcers (granulation tissue present, highly exuding, uneven wound edge)
- Edema (upside down champagne bottle)
What are symptoms of venous insufficiency?
- Pain: increases at end of day, aching/tiredness, relieved with elevation
- No symptoms of claudication pain
What is main treatment of venous insufficiency?
Compression wrap the leg (make sure arterial blood flow is good)
What are the causes for DVT?
- Prolonged bedrest
- Varicose veins or injury
- Clotting disorders
- Estrogen therapy
Signs of DVT?
- Increased warmth
- Unilateral edema
Symptoms of DVT?
- Sudden onset of intense pain
- Homan’s sign
- Pain to palpation of calf
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