Transcript Assessment of Peripheral Vascular System

Peripheral Vascular Assessment
Dr. Belal M. Hijji, RN, PhD
April 2, 2012
Learning Outcomes
By the end of this lecture, students will be able to:
• Describe the structure and functions of the peripheral vascular
system.
• Carry out a health history focusing on the peripheral vascular
system.
• Carry out a physical assessment of the peripheral vascular
system.
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Structure and Function of Arteries, Veins, Lymphatic
System, And Capillaries
• Arteries
– Blood vessels that carry nutrient-rich oxygenated
blood from the heart to capillaries. Does every artery
carry oxygenated blood?
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– The arterial network is a high-pressure system that requires
thick and strong arterial walls. Such walls contain elastic
fibers that can stretch
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– The major arteries of the arm are:
• The brachial artery that supplies the arm.
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– The major arteries of the leg
• The femoral artery is the major supplier of blood to the
legs..
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• Veins
– Blood vessels that carry deoxygenated, nutrient-depleted,
waste-laden blood from the tissues back to the heart.
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– Blood in the veins is carried under much less pressure than
in the arteries. Therefore, the vein walls are much thinner.
Veins are larger in diameter than arteries and can expand if
blood volume increases.
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• Lymphatic system:
– Is an integral and complementary component of the
circulatory system, composed of lymphatic capillaries,
lymphatic vessels, and lymph nodes
– Its function is to drain excess fluid and plasma proteins from
tissues and return them to venous system.
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• Capillaries and fluid exchange: Capillaries are small blood
vessels that form the connection between the arterioles and
venules and allow the circulatory system to maintain the vital
balance between the vascular and interstitial spaces.
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Health Assessment
• Collecting subjective data: The nursing health history.
– Disorders of the PV develop gradually.
– Severe symptoms may not occur unless damage is
extensive.
– Nurses are in position to ask questions about symptoms that
the patient may consider unimportant.
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History of Present Illness
• Ask the following question to elicit important information
– Have you noticed any color, temperature, or texture in your
skin?
• Rationale: Extremities with cold, pale, clammy skin,
and thin, shiny skin with loss of hair over the lower legs
arterial insufficiency. Warm skin and brown
pigmentation around the ankles
venous
insufficiency
– Do you experience pain or cramping [sudden painful
involuntary contraction of a muscle] in legs?
• Rationale: Intermittent claudication characterised by
cramping pain may indicate arterial disease.
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Past Health and Family History
• Describe any problems you had in the past with
circulation in your extremities.
– Rationale: A positive history of PV disease
increases risk of recurrence.
• Do you have any heart or blood vessel surgeries or
treatments?
– Rationale: Appearance of skin and underlying
tissue may be altered by previous surgery.
• Do you have a family history of DM, HTN, CAD, or
hypercholesterolemia?
– Rationale: These disorders cause blood vessels
damage.
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Lifestyle and Health Practices
• Do you smoke?
– Rationale: Smoking increases the risk for chronic arterial
insufficiency
• Do you exercise regularly?
– Rationale: Regular exercising improve PV circulation and
decreases the risk for developing PV disease.
• Describe the level of your stress
– Rationale: Stress increases HR and BP and may contribute
to PV disease.
• Are you regularly taking prescribed medications to improve
your circulation?
– Noncompliance increases the risk for developing PV
disease.
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– Do you have ropelike, bulging, or contorted veins?
• Rationale: These signs may indicate varicose veins.
– Do you have any sores or open wounds on your legs?
• Rationale: Arterial ulcers are usually painful, while
venous ulcers are usually painless.
– Do you have any swelling in your legs and feet?
• Rationale: Peripheral edema results from obstruction of
the lymphatic flow, venous insufficiency, or DVT.
– Do you have swollen glands or lymph nodes?
• Enlargement may indicate local or systemic infection.
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• Collecting objective data: Physical exam of arms
– Inspection
• Look for size, venous patterns, and edema
– Lymphedema [Condition of localized fluid retention
and tissue swelling caused by a compromised
lymphatic system] maybe caused by breast surgery.
– Prominent venous patterning with edema may
indicate venous insufficiency.
• Observe color of hands and arms
– Raynaud’s disease is caused by vasospasm of the
fingers or toes. Signs and symptoms are pallor,
cyanosis, redness, swelling, pain, throbbing, and
coldness.
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Raynaud’d disease
Lymphedema
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– Palpation
• Palpate the fingers, hands, and arms.
– A cool extremity may indicate arterial insufficiency.
• Palpate to assess capillary refill
– Capillary refill time > 2 seconds may indicate
vasoconstriction, decreased cardiac output, shock,
arterial occlusion, or hypothermia.
• Palpate the radial pulse
– ↑ pulse indicates hyperkinetic state, ↓ or absent pulse
indicate arterial occlusion.
• Palpate the epitrochlear [Inside of the upper arm, just
above the elbow] lymph nodes [next slide].
– Enlargement may indicate infection in the hand or
arm; this also accompanies lymphadenopathy.
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Palpation of Epitrochlear Lymph Nodes
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• Physical exam of the legs
– Inspection, palpation, and auscultation
• Look for lesions, ulcers, and edema
– Ulcers with even margins result from arterial
insufficiency; those with irregular edges and
bleeding result from venous insufficiency
– Bilateral edema may indicate CHF or lymphedema
• Palpate for edema and for temperature of the feet and
legs
– Pitting edema is associated with CHF, liver
cirrhosis, venous stasis due to insufficiency,
obstruction, or prolonged standing or sitting.
– Cold leg suggest arterial insufficiency; ↑warmth
suggests superficial thrombophlebitis.
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• Palpate and auscultate for femoral pulses
– Weak or absent femoral pulses indicate partial or complete
arterial occlusion. Bruits [A sound heard over an artery,
reflecting turbulence of flow] suggest partial obstruction of
the vessel and decreased blood flow to legs.
• Palpate the popliteal and dorsalis pedis pulses
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– Normal circulation can exist with undetectable popliteal
pulse.
– Arterial occlusion can also cause absent popliteal pulse.
– The dorsalis pedis pulse is congenitally absent in 5%-10%
of population. A week or absent pulse may also indicate
impaired arterial circulation.
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– Palpate the posterior tibial pulses
• These are absent in about 15% of healthy people.
• A weak or absent pulse may indicate partial or complete
arterial occlusion.
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– Inspect for varicosities and thrombophlebitis
• Varicose veins resulting from incompetent valves, weak
vein walls, or an obstruction above the varicosity.
• Redness, thickening, pain, and tenderness along the vein
indicate thrombophlebitis.
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