Peripheral Vascular

Question 1

Pulse characteristics

Answer 1

Contour - quick rising or falling
Amplitude - strength of pulse
Rate 
Rhythm
Symmetry -lack of symmetry may be impaired circulation

Question 2

Assessment of pulses

Answer 2

Auscultation for bruits 
Inspect for distentions at 45 degrees
Inspect extremities for color,skin and nail changes
Presence of hair
Muscular atrophy
Edema
Varicose

Question 3

Palpate extremities for

Answer 3

Warmth
Pulse quality
Tenderness
Putting edema

Question 4

Arteries

Answer 4

Tough, tensile and less distensibleb

Question 5

Veins

Answer 5

Less sturdy and more passive
Valves
Can expand if increased BF

Question 6

Arterial pulse

Answer 6

From systole
0.2 seconds to reach dorsalis pesos
2 seconds for RBCs to travel there

Question 7

Characteristics of Pulses

Answer 7

Volume of blood ejected (SV)
Distensibility of aorta and large arteries
Viscosity
Arteriole resistance

Question 8

A wave (JVP)

Answer 8

Most prominent

Brief backflow into vena cava

Question 9

C wave

Answer 9

Backward push created by TV closure during systole

Question 10

V wave

Answer 10

Increased volume and pressure of RA

Question 11

X slope

Answer 11

Passive RA filling

Question 12

Y slope

Answer 12

Open TV and filling of RV

Question 13

HPI: leg pain

Answer 13

Onset 
Character
Continuous pain in toes, thigh , butt
Skin changes - cold, pallor, redness 
Limping 
Walking at night with pain
Swelling

Question 14

HPI SWOLLEN ANKLES

Answer 14

Onset and duration
Related circumstances- elevation, air travel
Associated symptoms - nocturia, SOB
Treatment - rest, massage, heat, elevate
Meds - heparin, warfarin

Question 15

Varicose Veins

Answer 15

Women 4x more likely 
Genetics
Tobacco, sedentary, high BMI
Age decreases elasticity
Hx of lower extremity trauma, DVT

Question 16

Palpatable pulses

Answer 16

Carotid 
Brachial
Radial
Femoral
Poiteal
Dorsalis pedis
Posterior tibial

Question 17

Amplitude pulse scale

Answer 17

4: bounding, aneurysmal
3: full, increased
2: expected
1: diminished, barely palpable
0: absent

Question 18

Irregular HR

Answer 18

Increased HR on inspiration and decreases on expiration
Compare on auscultation
Strength? Lack of symmetry?
Compare upper, lower, left and right extremities

Question 19

Femoral pulse

Answer 19

Usually as strong as radial

Absent femoral may be coarctation of aorta, atherosclerosis, PAD, vasculitis

Question 20

Which arteries are asucultated for bruits

Answer 20

Temporary
Carotid
Subclavian 
Abdominal aorta
Renal
Iliac
Femoral 
*hold breath to suspend breath sounds

Question 21

Types of Bruits

Answer 21

Radiation of murmurs

Obstructive arterial disease

Question 22

Diminished circulation will lead to signs and symptoms that are related to the following

Answer 22

Site
Degree of stenosis
Ability of collateral channels to compensate
Rapidity at which problem develops

Question 23

Claudication

Answer 23

Dull ache 
Muscle fatigue and cramps 
Usually appears during exercise
Few minutes rest provides relief
Recurs with more activity
Continued activity makes pain worse

Question 24

Theee P’s of occlusion

Answer 24

Pain
Pallor
Pulselessness

Question 25

After determining pain characteristics, note the following

Answer 25

``` Pulses Bruits Loss of warmth Pallor or cyanosis Collapsed veins Atrophied skin or hair loss ```

Question 26

Arterial insufficiency

Answer 26

``` Pain Pulses Color Temp Edema Skin changes Ulceration Gangrene ```

Question 27

Pain in calf

Answer 27

Obstruction of superficial femoral artery

Question 28

Pain in thigh

Answer 28

Obstruction of femoral artery/external Iliad

Question 29

Pain in buttock

Answer 29

Iliac artery or distal aorta obstruction

Question 30

JVP

Answer 30

Can be visualized not palpate Lay or flat to reveal distentions then raise head up for evident pulsation Value should be less than 9cm

Question 31

Conditions that make JVP examination difficult

Answer 31

Severe R CHF, TV insufficiency, constructive pericarditis, tamponade Severe volume depletion Obesity

Question 32

Assessment for venous obstruction and insufficiency

Answer 32

Thrombosis - red,thick,tender Homan sign - flex knee and foot to test calf pain which could mean thrombosis Edema grade 1-4 to assess R CHF varicose veins incompetent wall or valve or obstruction

Question 33

Assessing Edema

Answer 33

1 slight,no visible deformities, disappears rapidly 2 - 10-15s no dostoritons 3- >1min, full/swollen extremity 4 - 2-5mins, grossly distorted

Question 34

Venous insufficiency

Answer 34

``` Pain Pulses Color Temp Edema Skin changes Ulceration Gangrene ```

Question 35

Arterial aneurysm

Answer 35

Localized dilation | 1.5x diameter of normal artery

Question 36

PAD

Answer 36

Stenosis of BF to extremities caused by plaque

Question 37

Atrterial Embolic Disease

Answer 37

A fib can lead to clot in heart which can become embolism

Question 38

Venous thrombosis

Answer 38

Sudden or gradual | Immboilization or trauma

Question 39

Infants

Answer 39

Brachial, radial, femoral easily palpable | Evaluate capillary refill

Question 40

Children

Answer 40

Venous hum common HTN in 1-3% Caused by renal disease, coarctation or pheochromocytoma Stenosis of descending aortic arch is common near origin of left subclavian Rule out COA by checking lower extremity for equal pulses

Question 41

Preganant

Answer 41

BP falls 16-20 weeks | Greater than 140/90 indicates preganancy induced HTN

Question 42

Preeclampsia-eclampsia

Answer 42

HTN that occurs after 20th week of pregnancy and presence of proteinuria Eclampsia is PE with seizures

Question 43

Older adults

Answer 43

Foot pulses difficult to palpate Loss of elasticity increases BP HTN in older is >140/90

Question 44

Venous ulcers

Answer 44

Chronic venous insufficiency leads to lower extremity venous HTN

Question 45

Sinus arrythmia

Answer 45

Increased HR on inspiration and decreased on expiration | Unpredictable rate may be heart disease or a-fib

Question 46

Noting an irregular rate

Answer 46

Compare bilateral Auscultate heart Note strength of pulse

Question 47

After determining leg pain, note the following

Answer 47

``` Pulses - strong, weak or absent Possible systolic bruits Loss of expected body warmth over area Localized pallor or cyanosis Collapsed superficial veins with delay in filling Thin, atrophied skin, muscle atrophy ```

Question 48

Judge degree of narrowing and potential severity of arterial insufficiency

Answer 48

Have patient lie supine Elevate extremity Note degree of blanching Have pt sit on edge of bed or table Note time it takes for maximal color return Slight pallor and return to full is expected A delay of many seconds or minutes is abnormal

Question 49

Constant pain in venous insufficiency occurs along with the following

Answer 49

swelling and tenderness of muscles engorgement of superficial veins erythema or cyanosis

Question 50

Thrombosis

Answer 50

Redness, thickening and tenderness along a superficial vein

Question 51

Unilateral vs Bilateral edema

Answer 51

Unilateral - occlusion of major vein Bilateral - CHF Edema w/o pitting - aterial insufficiency or lymphedema

Question 52

Edema with thickening of ulceration of skin indicates

Answer 52

deep venous obstruction venous valvular incompetence Caused by mechanical pressure of increased blood volume in area

Question 53

Varicose veins

Answer 53

dilated, swollen, with diminished rate of BF and increased intravenous pressure Have pt stand ten times on toes in succession Competent veins will disappear in a few seconds Distention that is sustained is venous insufficiency