Ch. 22 Assessing the Peripheral Vascular System

Question 1

arteries

Answer 1

carry oxygen/nutrient blood to body

Question 2

Arterial pulse

Answer 2

each heartbeat forces blood through arterial vessels under pressure

Question 3

Peripheral arteries

Answer 3

major arteries of arms and legs

Question 4

Major arm arteries

Answer 4

brachial, radial, ulnar

Question 5

Major leg arteries

Answer 5

femoral, popliteal, dorsalis pedis, posterior tibial

Question 6

Veins

Answer 6

carry deoxygenated blood to heart, lower pressure than arteries

Question 7

Three types of leg veins

Answer 7

deep, superficial, perforator. most susceptible to dysfunction

Question 7

Two specific veins in the legs

Answer 7

deep veins - femoral, popliteal. account for 90% of venous return

Question 8

What is it called when venous return is impeded?

Answer 8

venous stasis

Question 9

Capillaries

Answer 9

small blood vessels, connection between arterioles/venules, equilibrium between vascular and interstitial space, helps prevent edema

Question 10

Lymphatic system

Answer 10

complex vascular system, drains extra fluid/plasma from bodily tissues/returns to vascular system. lymph nodes

Question 11

Lymph nodes

Answer 11

filter lymph - microorganisms, dead cells, foreign material, abnormal cells.

Question 12

What do we get if the lymphatic system is not working right?

Answer 12

edema or swelling (lymphedema)

Question 13

History of health concern

Answer 13

changes in skin color/temp/texture, pain/cramping in legs (COLDSPA), heaviness/aching in legs, bulging/contorted/ropelike veins, open wounds/sores on legs, edema, swollen lymph nodes, changes in male sexual activity

Question 14

Personal history

Answer 14

past problems w/ circulation in arms/legs? PVD? heart/blood vessel surgeries?

Question 15

Family history

Answer 15

DVT, diabetes, hypertension, coronary heart disease, intermittent claudication, elevated cholesterol levels

Question 16

Lifestyle/health practices

Answer 16

smoke, exercise, transdermal contraceptives (female), new stress, circulation problems, leg ulcers/varicose veins, support hose, medication to improve circulation

Question 17

What are risks of using transdermal contraceptives and smoking?

Answer 17

DVTs, Raynaud disease, hypertension, edema

Question 18

Raynaud disease

Answer 18

feel numb/cold in response to cold temp/stress

Question 19

Equipment

Answer 19

cm tape, stethoscope, doppler ultrasound, conductivity gel, tourniquet, gauze/tissues, waterproof pen, bp cuff

Question 19

Arm inspection

Answer 19

size, venous pattern, edema, symmetry, color of arms/hands. usually lymphedema only one extremity (no pigment change/ulceration)

Question 20

Leg inspection

Answer 20

color (toes to groin), hair distribution, lesions/ulcers, edema, varicosities/thrombophlebitis

Question 21

What could loss of hair indicate?

Answer 21

arterial insufficiency. older adults may have less

Question 22

Arm palpation

Answer 22

fingers/hands/arms - note temp, cap refill <2sec, palpate radial pulse, ulnar pulses, brachial pulses if suspect arterial insufficiency, epitrochlear lymph nodes

Question 23

What could cool arms indicate?

Answer 23

arterial insufficiency

Question 24

Rating pulse

Answer 24

normal 2+, bounding 3+, less 1+

Question 25

Which pulse do you start with?

Answer 25

farthest from heart

Question 26

Allen test is for

Answer 26

evaluates patency of radial or ulnar arteries, essential before abg, used when patency questionable

Question 27

Performing Allen test

Answer 27

palm side up on exam table, make fist, occlude ulnar artery w/ thumb, while applying pressure release fist, palm remains pale, release thumb and watch for color return. same for radial

Question 28

Leg palpation

Answer 28

edema, bilaterally for temp (feet/legs), superficial inguinal lymph nodes, femoral, popliteal, dorsalis pedis, posterior tibial pulses.

Question 29

Popliteal pulse

Answer 29

can be hard to detect

Question 30

Posterior tibial pulse is absent in how many healthy clients?

Answer 30

15%

Question 31

Auscultate femoral pulses

Answer 31

if suspect arterial occlusion in femoral, position stethoscope over femoral artery/listen for bruits. normal = not hearing sounds

Question 32

Arterial insufficiency

Answer 32

sharp pain, pulses low, dry/shiny skin, thick toenails, no edema, deep wounds but circular - wound base black/dry/gangrene, less pain when dangling

Question 33

Venous insufficiency

Answer 33

insufficiency aching, pulses noted but hard to find through edema, skin thick/tough, edema, wounds superficial/irregular - beefy red wound base, less edema/pain w/ legs elevated

Question 34

Special tests for arterial or venous insufficiency

Answer 34

position change test, ankle-brachial index (ABI), manual compression test, trendelenburg test

Question 35

Position change test is for

Answer 35

arterial insufficiency

Question 36

Position change test

Answer 36

supine, put forearms under knees and ankles/raise 12 inches above heart, pump feet up and down for a minute (drains venous blood), sit up/dangle legs, note color/time it takes to return

Question 37

Ankle brachial index is for

Answer 37

arterial insufficiency

Question 38

Determining ABI (ankle brachial index)

Answer 38

supine at least 5 min, bp cuff on one arm then other to determine brachial pressure using doppler - record highest reading between arms. bp on right ankle, use doppler to record posterior tibial and dorsalis pedis systolic pressures, do left ankle. right ABI = highest pressure in right ankle/highest pressure in both arms. left vice versa

Question 39

Manual compression test is for

Answer 39

venous insufficiency, varicose veins

Question 40

Manual compression test

Answer 40

stand, compress lower portion of varicose, put other hand 6-8 inches above, feel for pulsation to fingers in upper hand. repeat on other leg if varicose veins present

Question 41

Trendelenburg test is for

Answer 41

varicose veins. determines competence of saphenous vein valves/retrograde filling of superficial veins

Question 42

Trendelenburg test

Answer 42

supine, elevate legs 90 degrees for 15 seconds, apply tourniquet to upper thigh, stand up/observe venous filling, remove tourniquet after 30 second standing/watch for sudden filling of varicose veins from above