Topic 9

Question 1

arteriosclerosis

Answer 1

hardening of the arteries (Peripheral blood vessels grow more rigid with age)

Question 2

Atherosclerosis

Answer 2

condition in which fatty deposits called plaque build up on the inner walls of the arteries

Question 3

what trophic changes may be associated with arterial insufficiency

Answer 3

o Thin, shiny skin
o Thick, ridged nails
o Loss of hair on lower legs

Question 4

what is the strongest risk factor associated with PAD

Answer 4

smoking

Question 5

what age does the AHA recommend screening for

Answer 5

-all people over the age of 70
-between 50-69 who have history of smoking or diabetes

Question 6

what are you noting for when inspecting a persons arms

Answer 6

color of skin and nail beds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing

Question 7

how do you inspect and palate the arms

Answer 7

Lift person’s both hands in your hands

Question 8

how do you detect early clubbing

Answer 8

Use profile sign (viewing finger from side) (normal nail bed angle is 160 degrees)

Question 9

what are some causes of edema in the upper extremities

Answer 9

Lymphatic blockage, DVT, infection

Question 10

what does capillary refill check

Answer 10

its an index of peripheral perfusion and cardiac output

Question 11

how do you check capillary refill

Answer 11

-hands near level of the heart
-depress and blanch nail bed; release

Question 12

what is a normal capillary refill

Answer 12

color returns in less than 1 or 2 seconds

Question 13

what conditions can skew the capillary refill findings

Answer 13

a cool room, decreased body temperature, cigarette smoking, peripheral edema, and anemia

Question 14

when palpating both radial pulses, what is the nurse noting?

Answer 14

rate, rhythm, elasticity of vessel wall, and equal force

Question 15

Grading force of pulse

Answer 15

3+, increased, full, bounding
2+, normal
1+, weak
0, absent

Question 16

Modified Allen Test

Answer 16

constriction of the radial and ulnar artery while patient makes a fist several times when the had turns blanch have them stop and release the pressure off of the ulnar artery while compressing the radial artery…
o Adequate circulation is suggested by a return to hand’s normal color in approximately 2 to 5 seconds

Question 17

The modified Allen test is used to evaluate

Answer 17

collateral circulation prior to occluding radial artery

Question 18

If lower legs look asymmetric…

Answer 18

measure leg at widest point, taking care to measure other leg in exactly same place, same number of centimeters down from patella or other landmark

Question 19

Chronic venous stasis causes

Answer 19

brown discoloration and ulceration/infection

Question 20

Chronic arterial deficit causes

Answer 20

ulcers on toes

Question 21

Where are the femoral arteries located?

Answer 21

just below inguinal ligament halfway between pubis and anterior superior iliac spines

Question 22

if the femoral artery pulse is weak or diminished…

Answer 22

auscultate site for bruit

Question 23

what is one way to expose the femoral artery

Answer 23

ask person to bend his or her knees to side in a froglike position

Question 24

how do you check popliteal pulse

Answer 24

With leg extended but relaxed, anchor your thumbs on knee, and curl your fingers around into popliteal fossa
-Press your fingers forward hard to compress artery against bone (lower edge of femur or upper edge of tibia); often it is just lateral to the medial tendon

Question 25

what pulse is often impossible to palpate

Answer 25

popliteal

Question 26

Posterior tibial pulse

Answer 26

curve your fingers around medial malleolus
o Feel the tapping right behind it in groove between malleolus and Achilles tendon

Question 27

Dorsalis pedis pulse

Answer 27

equires a very light touch
o Normally it is just lateral to and parallel with extensor tendon of big toe

Question 28

occasionally either dorsalis pedis or posterior tibial pulse may be hard to find in what age group

Answer 28

In adults over 45 years

Question 29

Check for pretibial edema

Answer 29

o Firmly depress skin over tibia or medial malleolus for 5 seconds and release
o Normally your finger should leave no indentation, although a pit commonly is seen if person has been standing all day or during pregnancy

Question 30

grade for pitting edema

Answer 30

1+ Mild pitting, slight indentation, no perceptible swelling
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains, leg looks swollen
4+ Very deep pitting, indentation lasts long time, leg very swollen

Question 31

when does arterial circulation deficit worsen

Answer 31

with elevation of the legs causing pallor

Question 32

color of light-skinned person’s feet

Answer 32

a little pale but still should be pink

Question 33

color of dark-skinned person’s feet

Answer 33

soles should reveal extreme color change

Question 34

how long does it take for color to normally return to feet

Answer 34

10 seconds or less

Question 35

Dependent rubor

Answer 35

deep blue-red color of the lower extremities; caused by severe arterial insufficiency.

Question 36

Doppler ultrasonic probe

Answer 36

Device to detect a weak peripheral pulse
-measures low blood pressure or blood pressure in lower extremity (magnifies pulsatile sounds from heart and blood vessels)

Question 37

Doppler ultrasonic probe technique

Answer 37

o Position person supine, with legs externally rotated so you can reach medial ankles easily
o Place drop of coupling gel on end of handheld transducer
o Place transducer over pulse site, swiveled at a 90-degree angle; apply very light pressure; locate pulse site by the swishing, whooshing sound

Question 38

a weak and thready pulse is rated…

Answer 38

1+

Question 39

a full bounding pulse is rated…

Answer 39

3+

Question 40

Pulsus Paradoxus

Answer 40

beats have weaker amplitude with respiratory inspiration, stronger with expiration (changes w respiration cycle)

Question 41

Pulsus Bigeminus-ectopy

Answer 41

irregular conduction