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Patient Assessment > Peripheral Vascular Exam > Flashcards

Peripheral Vascular Exam Flashcards

1
Q

Peripheral Vascular System

A

Consists of a system of interconnected veins and arteries which carry blood to and from the heart & lungs

Also involves the capillaries and lymphatic system

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2
Q

3 Arterial Pulses in the Upper Extremity

A
  1. Brachial– antecubital fossa
  2. Radial
  3. Ulnar
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3
Q

4 Abdominal Arteries

A
  • Aorta
    • Renal
    • Iliac
    • Mesenteric
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4
Q

Upper Extremity Veins (7)

A 
Cephalic
Subclavian
Internal Jugular
radial 
ulnar
basilic
SVC
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5
Q

Four pulses of the Lower Extremity

A 
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis– 1st and 2nd 
                                metatarsals
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6
Q

2 systems of lower extremity veins

A

Superficial

 - Great Saphenous
 - Small Saphenous 2. Deep
 - Femoral
 - Popliteal
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7
Q

2 Lymph Nodes in the Upper Extremity

A
  1. Epitrochlear Node - 3 cm above medial epicondyle
    of the elbow
  2. Axillary Nodes - multiple in axilla
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8
Q

2 Lymph nodes in the lower extremity

A
  1. Horizontal Superficial Inguinal Nodes - lies in a
    chain in the proximal anterior thigh just below the
    inguinal ligament
  2. Vertical Superficial Inguinal Nodes – lies in a cluster
    in the upper part of the Saphenous vein
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9
Q

Risk factors of peripheral vascular diseases

A
  • Tobacco use
    • Alcohol abuse
    • Cocaine use
    • F/H of PAD/CAD/CVD/DVT/PE
    • Obesity (BMI > 30)
    • Age > 50 y/o
    • Recent long distance travel
    • Prolonged Inactivity
    • Pregnancy or Post Partum
    • Malignancy
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10
Q

Arterial Manifestations for peripheral vascular diseases

A
  • Diminished or absent pulses
    • Smooth, shiny, dry skin
    • Loss of hair on lower extremities
    • No edema
    • Round, regular shaped painful ulcers on distal foot,
      toes, or webs of toes
    • Dependent rubor– red color/tinge to the leg
    • Pallor or pain when legs elevated
    • Intermittent claudication- pain/ cramps ppl get
    • Brittle thick nails
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11
Q

acute symptoms of arterial compromise

A
  1. Sudden Pain
    2. Pulselessness
    3. Pallor
    4. Paraesthesias (numbness)
    5. Paralysis (sudden weakness)
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12
Q

Chronic Symptoms of arterial compromise

A

a. Intermittent Claudication
b. Rest Pain
c. Tissue loss
1. Peripheral = Ulcer
2. Cerebral = TIA/CVA
3. Visceral = Mesenteric Ischemia or Bowel Infarction

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13
Q

4 characteristics of arterial problems

A
  1. Arterial Circulatory Compromise (Most Common)
    a. Acute = Embolus
    b. Chronic = Thrombosis
    c. Compression = Positional/Postural
  2. Bleeding = Rupture of an Aneurysm or Trauma
  3. Spasm = Raynaud’s Disease
  4. Inflammation = Arteritis
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14
Q

Different locations of obstruction

A

Aorto-iliac Disease = Gluteal Claudication
Femoral-Popliteal = Leg/Calf Claudication
Axillary Embolus = Ischemic changes in the forearm & hand
Brachial Embolus = Ischemic changes in the fingers & hand
DVT = Painful, swollen unilateral arm or leg

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15
Q

Arterial Causes of peripheral vascular disease

A
  1. Atherosclerosis (Thrombosis, Embolic)
  2. Diabetes
  3. Vasospastic Disorders (Raynaud’s)
  4. Trauma
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16
Q

Venous Manefestations

A
  • Normal pulses
    • Brown patches of skin discoloration on lower legs
    • Dependent edema
    • Irregular shaped, usually painless ulcers on lower
      legs and ankles
    • Dependent cyanosis and pain
    • Pain relieved with legs elevated
    • No intermittent claudication
    • Normal nails
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17
Q

Venous Causes

A
  1. DVT/PE
  2. Varicosities
  3. Venous Stasis Disease
18
Q

JVP Exam

A
  • Elevate head of bed to 30 to 45 degrees
    • Look for increased JVP
    • Measure JVP from the right (7 cm or > abnormal)
19
Q

Upper Extremity Inspection

A 
- Inspect both arms from the fingertips to the
    shoulders and note:
    - Size, Symmetry, or any Swelling
    - Venous pattern
    - Color of nail beds
    - Capillary Refill (< 2 sec)
    - Lesions or Scars
20
Q

Lower Extremity Inspection

A
  • Inspect legs from groin to toes bilaterally and note:
    • Size, Symmetry, and any Swelling
    • Venous pattern & any venous enlargement or
      varicosities
    • Pigmentation, Scars, Ulcers or Rashes
    • Color of Nail Beds
    • Hair distribution on the legs, feet, & toes
    • Muscle atrophy
    • Loss of toes
    • Obvious Pulsatile Masses (ant=femoral aneurysm,
      post=popliteal aneurysm
21
Q

Pulse Grading

A 
- Grading
     0   = Absent
     1+ = Diminished
     2+ = Normal
     3+ = Increased
     4+ = Bounding (may occur with hyperthyroid, fever, 
              exercise, anxiety)
22
Q

Characteristics of Pulses

A 
Rate
    Rhythm
    Tortuosity
    Tenderness
    Bruits (Thrill)
23
Q

Palpations and Auscultation of the Head & Neck

A
  • Palpation: (Bilateral)
    1. Temporal Pulse (Pain = ? Temporal arteritis)
    2. Carotid Pulse (Auscultate for bruit first)
      - Auscultation: (using bell bilateral)
    3. Temporal Artery for Bruits (Temporal Arteritis)
    4. Carotid for Bruits at 3 points (Base, Mid, & at angle
      of Mandible)
    5. Supraclavicular & Infraclavicular for Subclavian
      bruits
24
Q

Upper Extremity Palpation

A
  1. Skin turgor, texture, & temperature
    1. Brachial, Radial, & Ulnar pulses
    2. Epitrochlear lymph node (size, consistency,
      mobility, & tenderness)
25
Q

Auscultation of the Upper Extremity

A
  1. Measure BP using Brachial Artery bilaterally normal
    is 120/80 per JNC7 criteria
    a. Change in BP > 20 mmHg Systolic & 10 mmHg
    diastolic from arm to arm is abnormal
    b. Orthostatic Hypotension
    c. Pulsus Paradoxus
26
Q

Pulsus Paradoxus

A

is a decrease in BP > 10 mmHg
during inspiration and may indicate several
conditions including Cardiac Tamponade, Pericarditis,
COPD, Chronic Sleep Apnea, & Croup

27
Q

Orthostatic Hypotension

A

is a decrease in systolic
BP > 10 mmHg & increase in heart rate > 10 bpm
with change of position from lying flat to sitting &
then to standing indicates hypovolemia

28
Q

Allen’s Test

A

for patency of radial & ulnar arteries
prior to A-line insertion or use of Radial A. in CABG
or for Cardiac Cath canulation

29
Q

Adson’s Test and Wright’s Maneuver

A

Test for Thoracic
Outlet Syndrome with complaints of pain or
numbness in arms from compression of
Subclavian A. between clavicle & 1st rib

30
Q

Palpation of Lower Extremity

A
  1. Skin turgor, temperature, & texture
    1. Muscle Tone
    2. Proprioception of toes (early sign of acute arterial
      ischemia)
    3. Capillary Refill (< 2 sec. is normal)
    4. Femoral Pulse
    5. Inguinal Lymph Nodes
    6. Popliteal Pulse
    7. Posterior Tibialis Pulse
    8. Dorsalis Pedis Pulse
31
Q

Auscultation of Lower Extremity

A
  1. Femoral for bruits with bell
    1. Use of doppler will help determine flow in others
      a. Biphasic = normal
      b. Monophasic or Absent = abnormal
32
Q

Ankle Brachial Index

A

measures systolic BP in
Brachial A. and compares with Posterior Tibial A. &
Dorsalis Pedis A. using a doppler
Index
1 – 1.2 normal
< 0.9 mild to moderate PAD
< 0.4 severe PAD
> 1.3 non-compressible (DM & Chronic RF)

33
Q

Other Tests that can be used for arterial Peripheral Vascular Disease

A
  • PVR & segmental limb pressures
    • Ultrasound
    • MRA– no radiation
    • CT Angiography
    • Conventional Angiography
34
Q

Palpation of abdominal aorta

A
  1. Aorta – just above umbilicus with patient supine,
    try to find the edges normal width approx. 3 cm if
    greater may indicate AAA
35
Q

3 Systems of the venous system

A
  1. Superficial
    1. Deep
    2. Perforating – connects superficial to deep
      All 3 systems have one way bicuspid valves that permit flow from superficial to deep & distal to proximal
36
Q

3 functions of the venous system

A
  1. Return deoxygenated blood to the heart
    1. Storage – contains 70% of total blood volume
    2. Thermoregulation
    3. Regulation of Cardiac Output
37
Q

Venous System Problems

A

Valvular Dysfunction – varicosities
Deep Venous Obstruction – DVT/PE
Chronic Venous Insufficiency – chronic DVT & post phlebitic syndrome
Superficial Vein Inflammation or Infection – superficial phlebitis

38
Q

Inspection of the Venous System PE

A

in supine & standing positions
- Unilateral/Bilateral extremity edema
- Dyspnea
- Presence of Varicosities
- Pain/Discomfort/Cyanosis of extremities
- Skin tension
- Hyperpigmentation of lower leg
- Ulcers
- Pallor with patchy cyanotic or gangrenous areas
- Presence of skin bullae or vesicles
- Prominent & dilated veins on chest wall & neck
along with facial edema = SVC obstruction

39
Q

Palpation of LE

A
  • Tenderness
    • Increased skin temp
    • Edema – pitting vs non-pitting
    • Measure circumference of calf at the same point on
      both sides 10 cm distal to tibial tubercle
    • Induration
    • Pulses of extremities
40
Q

Special Tests of the Venous System

A
  1. Venous Duplex Doppler to r/o DVT
  2. D-Dimer controversial use based on PERC criteria
  3. Chest Spiral CT to r/o PE

Patient Assessment (4 decks)

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