peripheral vascular
TRANSCRIPT
PERIPHERAL VASCULAR
ASSESSMENT
Prepared by: Angelo P. Angeles, RN MAN
Anatomy and PhysiologyREVIEW OF STRUCTURES AND FUNCTIONS
ARTERIES ARTERIES
Carry oxygenated blood
Receives high pressure from the LV of the heart
Major Arteries of the ARM and LEGS
Brachial Artery Radial artery Ulnar artery
Femoral Artery Popliteal
Anterior branch– Dorsalis Pedis a.
Posterior branch - Posterior Tibial a.
VEINS Carry
deoxygenated blood, and wastes
SVC: head, arms, upper trunk, head and neck
IVC: lower trunk and legs
Larger and can expand in diameter
VEINS
VeinsDeep veins Femoral vein Popliteal vein
Superficial veins Great saphenous
(longest) Small saphenous
Perforator veins
VeinsMechanisms that
propel blood back to the heart:
1. Presence of One-way Valves
2. Muscular contraction
3. Creation of pressure gradient (though breathing)
Lymphatic System Composed of lymphatic capillaries,
lymphatic vessels, and lymph nodes Functions:1. It drains excess fluid and plasma
proteins from body tissues and return them to venous system
2. Aids in defending the body against MO3. Absorbs fat from the small intestine into
the bloodstream
Lymphatic System (Ducts)
Superficial lymph nodes of the arms and legs Epitrochlear lymph
nodes
Inguinal lymph nodes Horizontal Vertical
Capillaries and Fluid Exchange
COLLECTING SUBJECTIVE DATANURSING HEALTH HISTORY
COLLECTING SUBJECTIVE DATA Change in Skin color, temperature or
texture ARTERIAL INSUFFICIENCY – cold, pale, clammy
skin; thin shiny skin with loss of hair VENOUS INSUFFICIENCY – warm skin, brown
pigmentation around the ankles Leg Pains or Cramps
Intermittent Claudication – cramping in the calves, thighs, or buttocks and weakness upon activity (ARTERIAL disease)
Heaviness and aching sensation aggravated by standing or sitting for longer periods (VENOUS disease)
Leg pain at night (CHRONIC ARTERIAL dse) Numbness (NEUROPATHY)
COLLECTING SUBJECTIVE DATA Varicose veins
Hereditary Venous pressure and venous pooling
Leg Ulcers Arterial – painful Venous – painless
Edema (with/without pain) Obstruction of lymphatic flow, incompetent
valves, osmotic pressure, DVT Swollen lymph nodes
Infection Male clients: Change in sexual activity
Leriche’s syndrome Impotence/Erectile Dysfunction
COLLECTING SUBJECTIVE DATAPAST HEALTH HISTORY
History of Peripheral Vascular Diseases History of Cardiovascular surgeries
FAMILY HISTORY DM, HPN, Coronary Heart Disease,
Hypercholestrolemia
COLLECTING SUBJECTIVE DATALIFESTYLE AND HEALTH PRACTICES
Cigarette smoking
Exercise
Female clients: Intake of Oral/ transdermal contraceptives
Stress
Wearing of supportive hose
COLLECTING OBJECTIVE DATAP H Y S I C A L E X A M I N A T I O N
COLLECTING OBJECTIVE DATA Preparation
Have client wear examination gown Upright position Adjust room temperature Explain exposure of parts to be assessed Explain position changes
Equipment Centimeter tape Stethoscope Doppler UTZ device Conductivity gel Gauze/tissue Water proof pen Blood pressure cuff
PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings
Observe for the arm size and venous pattern; look also for edema
Arms are bilaterally symmetric; no edema or prominent venous patterning
Lymphedema (blocked lymphatic circulation)
PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings
Observe for coloration of the hands and arms
Color varies depending on client’s skin tone
Rapid changes in color (pallor, cyanosis, redness) – Raynaud’s disease
PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings
Palpate for client’s fingers, hands and arms. Note temp.
Warm bilaterally from fingertips to upper arms
Cool extremity/ Cold fingers and hands
Assess Capillary Refill
Capillary beds refill (color returns in 1-2 seconds)
> 2 secs (vasoconstriction, CO, shock, arterial occulsion)
Palpate for the radial pulse
Equal strength bilaterally (2+)
Increased – hyperkineticDiminished or absent – occlusion
PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings
Palpate for the ulnar pulses
Equal strength; may not be detectable
Lack or resilience or inelasticity (arteriosclerosis)
Palpate the brachial pulse (if suspected for arterial insufficiency)
Equal strength bilaterally
Increased, diminished, absent
PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings
Palpate for the epitrochlear lymph node
Not palpable Enlarged/swollen
PHYSICAL ASSESSMENT OF THE ARMSProcedure Normal Findings Abnormal Findings
Perform Allen test
Pink coloration return to palms within 3-5 seconds
Pallor persists
PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsObserve skin color while inspecting both legs from toes to groin
Uniform pigmentation
Pallor (elevated) & rubor (dependent) – A.I.Brownish – V.I
Inspect distribution of hair
Hair cover the skin and appears on the dorsal surface
Loss of hair (A.I)
Inspect for lesions
Legs are free of lesions/ulcers
Ulcers
PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsInspect for Edema
Identical size/shape; no swelling
Bilateral edema
Palpate for Edema
No edema Pitting or non pitting edema
Grading for Pitting edema
Edema Grading:
1+ = slight pitting2+ = deeper than 1+3+ = noticeably deep
pit; looks larger 4+ = very deep pit;
gross edema in extremity
PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsPalpate bilaterally for temp of feet and legs
Equally warm Generalized coolness (A.I.), Warmth (thrombophlebitis)
Palpate superficial inguinal lymph n.
Nontender, maybe movable
Swelling >2cm
PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsPalpate: Femoral Popliteal P. Dorsalis Pedis P. Posterior Tibial P.
Strong and equal bilaterally
Weak or absent
PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsInspect for varicosities and thrombophlebitis
Veins are flat and barely seen under the skin
Distended, nodular, bulging and tortuous veins
PHYSICAL ASSESSMENT OF THE LEGSProcedure Normal Findings Abnormal FindingsCheck for the Homans’ sign
(-) Homans’signNo pain or tenderness elicited
(+) Homans’ sign Calf pain and tenderness
SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsPosition change test
Feet: pink to slightly pale in color (elevation); pinkish color returns to toes and feet in ≤ 10 secs, 15 secs for superficial veins on top of feet. (dangled)
Marked pallor
> 10 secs and > 15 secs (A.I.)
Persistent rubor
SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsAnkle- brachial pressure index (ABPI) – ratio of ankle systolic BP to brachial systolic BP.
Ankle pressure is same or slightly higher than the brachial pressure (ABPI: 1)
ABPI: 0.5 to 0.95 (mild to mod A.I.)ABPI: 0.25 or lower (severe stenosis)
SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsManual Compression test
No pulsation is palpated (competent valves)
Pulsation with the upper fingers (incomptent valves)
SPECIAL TESTS FOR A.I. OR V.I.Procedure Normal Findings Abnormal FindingsBrodie-Trendelenburg test
Saphenous vein fills from below in 30 seconds; no rapid filling of veins from above after removal of torniquet
Filling from above with the tourniquet in place (while client is standing) – incompetent valves