Cardiac Conduction and Peripheral Vascular Assessment
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What is Cardiac Output?
The volume of blood pumped by the heart in one minute
What is Stroke Volume?
the amount of blood entering the aorta with each contraction
What is the formula for Cardiac Output (CO)
HR x SV= CO
The normal stroke volume is 60-70 mL/ min
What is the range of bradycardia and what causes bradycardia
- Less than 60 bpm
- Athletes, some cardiac meds, complications with the SA and AV node, hypothyroidism
What is the range of tachycardia and what causes tachycardia?
- higher than 100
- fever, exercise, anemia, hyperthyroidism, anxiety, fluid deficit, hemorrhage, need for increased CO
What causes a thready, weak pulse?
blood loss, decreased CO, and peripheral arterial disease
What causes a Bounding pulse
fever, anxiety, fluid excess
List 9 pulse sites and laymen's terms for where they are
- temporal: on the temple
- Carotid: on the neck
- brachial: on the ulnar side of the inner elbow
- ulnar: the interior side of the wrist
- radial: the exterior side of the wrist
- femoral: near the ileac crest near the groin
- popliteal: the inner side of the knee
- dorsalis pedis: on the Dorsal side of the foot
- Posterior tibial: underneath the ankle bone
During inspiration thoracic pressure _______, while abdominal pressure _______.
thoracic pressure decreases while abdominal pressure increases
Standing increases risk of ______, while walking helps __________.
- blood clots
- increase blood flow
List some common veins where patients may get blood clots.
- small saphenous vein (right behind the knee)
- popliteal vein ( also right behind knee)
- femoral (not as frequent)
If the epitrochlear node is swollen what may this indicate?
the epitrochlear node drains the hand and lower arm so there may be infection and edema in the hand and lower arm
Night leg pain in aging adults is most indicitive of....
ischemic rest pain of peripheral vascular disease
What is the scale for pulses?
- 0= absent
- 3= increased
- 4= bounding
What is the purpose of the Allen Test?
to check for clots in the ulnar artery
Coolness is associated with
What is a Homan's Sign
- A positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is flexed to 90 degrees.
- A positive Homan's sign does not mean the pt has definite phlebitis (inflammation of a vein)
When measuring calf size, they should be the same. Calf size difference greater than ___ is abnormal
Why should you never squeeze a clot in the calf?
You may dislodge the clot and it can travel elsewhere
The ankle bone is known as the
How do we measure edema
- +1 is 2 mm
- +2 is 4 mm
- +3 is 6 mm
- +4 is 8 mm
How would you perform elevation pallor?
- Raise legs about 12 in from bed, ask pt to pump feet for 30 seconds. Pallor occurs. Lower legs and color should return in about 15 seconds.
- This test is used to check arterial blood flow to the legs
What is the formula for Ankle-Brachial Index?
ABI% = ankle systolic pressure/ arm systolic pressure
What is an abnormal ABI and what does this indicate?
An ABI of less than 90% indicates PVD (peripheral vascular disease)
What is the difference between ATHEROosclerosis and ARTERIOsclerosis?
- atherosclerosis is plaque in the blood vessels
- arteriosclerosis is rigid peripheral blood vessels
Arteriosclerosis puts you at more risk for
At patient with arteriosclerosis has skin that is
shiny and has a loss of hair
How do varicose veins occur?
- When the valves in veins don't work well and veins get wide.
- 3x as more likely in women.
- Usually occur after age 45
- Extra weight = increased risk of varicose veins
How would you perform the manual compression test and what does this test for?
- While the person is still standing, test the length of the varicose vein to determine whether its valves are competent. Place one hand on the lower part of the varicose vein, and compress the vein with your other hand about 15 to 20 cm higher.
- Wave is not felt= competent valves
- Wave is felt: incompetent valves
A Doppler stethoscope is used to
detect a weak pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity
What is Raynaud's Disease?
- Episodes of abrupt progressive tricolor change of the fingers in response to cold, vibration, or stress
- first white (pallor) from arteriospasm and resulting deficit in supply;
- then blue (cyanosis) from slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of hemoglobin;
- finally red (rubor) due to return of blood into the dilated capillary bed
What is Lymphedema?
- Removal of lymph nodes with breast surgery, or damage to lymph nodes and channels with radiation therapy for breast cancer; can impede drainage of lymph
- Stagnant lymph fluid can lead to infection, delayed wound healing, chronic inflamation, and fibrosis of surrounding tissue
When patient has decreased arterial circulation the skin will look:
Will this patient have a pulse in the lower extremities?
- shiny, cool, pale, thin and hairless
- This patient will not have a pulse in the lower extremities.
Venous ulcers are caused when....
blood leaks out out of the vein and goes into subcutaneous tissue
A person with acute deep vein thrombosis or chronic incompetent valves will have skin that looks
- bronzy or brownish red color of skin, scaley, thick
- This patient will have a pulse in lower extremities
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