N 295 lecture 10 peripheral vasc student copy

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N 295 lecture 10 peripheral vasc student copy

  1. 1. Peripheral Vascular & Lymphatic Assessment spring 2012
  2. 2. Major Arteries Accessible to Examination: <ul><ul><li>Temporal </li></ul></ul><ul><ul><li>Carotid </li></ul></ul><ul><ul><li>Brachial </li></ul></ul><ul><ul><li>Radial </li></ul></ul><ul><ul><li>Femoral </li></ul></ul><ul><ul><li>Popiteal </li></ul></ul><ul><ul><li>Posterior Tibial </li></ul></ul><ul><ul><li>Dorsalis Pedis </li></ul></ul>spring 2012 <ul><li>Major Veins </li></ul><ul><ul><li>Internal jugular </li></ul></ul><ul><ul><li>External jugular </li></ul></ul>
  3. 3. Health History <ul><li>Current Symptoms </li></ul><ul><ul><li>Leg pain or cramps </li></ul></ul><ul><ul><li>Skin changes in the arms or legs </li></ul></ul><ul><ul><li>Swelling arms or legs </li></ul></ul><ul><ul><li>Open wounds </li></ul></ul><ul><ul><li>Lymph node enlargement </li></ul></ul><ul><li>Medication History </li></ul><ul><li>Personal History </li></ul><ul><li>Family History </li></ul>spring 2012
  4. 4. Examination: Upper Extremity <ul><li>Inspect for Edema / Color Changes / Lesions </li></ul><ul><li>Palpate Pulses </li></ul><ul><li>Perform the Allen Test </li></ul><ul><li>Palpate the Epitrochlear Lymph Nodes </li></ul>spring 2012
  5. 5. Pulse Grading Scale <ul><li>0 = Absent </li></ul><ul><li>1+ = Weak </li></ul><ul><li>2+ = Normal </li></ul><ul><li>3+ = Increased Normal </li></ul><ul><li>4+ = Bounding </li></ul>spring 2012
  6. 6. Palpate Epitrochlear node <ul><li>Support client’s hand with your hand </li></ul><ul><li>With other hand reach behind the elbow and place finger pad in groove between biceps and triceps muscle above the medial conyle of the humerus </li></ul><ul><li>Feel for node </li></ul>spring 2012
  7. 7. Examination: Lower Extremity <ul><li>Inspect for Color </li></ul><ul><li>Inspect for Lesions </li></ul><ul><li>Inspect for Edema </li></ul><ul><li>Palpate Peripheral Arteries </li></ul>spring 2012
  8. 8. Additional Assessments <ul><li>Manual Compression Test </li></ul><ul><li>Trendelenburg Test </li></ul>spring 2012
  9. 9. Abnormal Findings <ul><li>Variations in Arterial Pulse </li></ul><ul><ul><li>Weak, Thready </li></ul></ul><ul><ul><li>Full, Bounding </li></ul></ul><ul><ul><li>Water Hammer </li></ul></ul><ul><ul><li>Pulsus Paradoxus </li></ul></ul>spring 2012
  10. 10. Arterial Insufficiency <ul><li>Deep Muscle Pain </li></ul><ul><li>Claudication </li></ul><ul><li>Rest Pain </li></ul><ul><li>Dependent Rubor </li></ul><ul><li>Diminished Pulses </li></ul><ul><li>Skin Changes </li></ul><ul><li>P ain </li></ul><ul><li>P allor </li></ul><ul><li>P ulselessness </li></ul><ul><li>P aresthesia </li></ul><ul><li>P oikilothermia </li></ul><ul><li>P aralysis </li></ul>spring 2012
  11. 11. Arterial Insufficiency Ulcers <ul><li>Ulcer Location </li></ul><ul><li>Ulcer Margin </li></ul><ul><li>Ulcer Drainage </li></ul><ul><li>Peri-ulcer Area </li></ul>spring 2012
  12. 12. Venous Insufficiency <ul><li>Aching </li></ul><ul><li>Worsens with Prolonged Standing, Sitting </li></ul><ul><li>Brawny Edema </li></ul><ul><li>Coarse Thickened Skin </li></ul><ul><li>Dermatitis, Pruritis </li></ul>spring 2012
  13. 13. Venous Insufficiency Ulcers <ul><li>Ulcer Location </li></ul><ul><li>Ulcer Margin </li></ul><ul><li>Ulcer Tissue </li></ul><ul><li>Drainage </li></ul>spring 2012
  14. 14. Arterial Risk Factors <ul><li>Age </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Hypertension </li></ul><ul><li>Increased Lipid Levels </li></ul><ul><li>Male </li></ul><ul><li>Obesity </li></ul><ul><li>High Fat Diet </li></ul><ul><li>Heavy Alcohol Use </li></ul><ul><li>Coagulation Abnormalities </li></ul><ul><li>Physical Inactivity </li></ul>spring 2012
  15. 15. Venous Risk Factors <ul><li>Pregnancy </li></ul><ul><li>Prolonged sitting, standing </li></ul><ul><li>Limited physical activity </li></ul><ul><li>Age </li></ul><ul><li>Obesity </li></ul><ul><li>Use of constrictive clothing </li></ul>spring 2012
  16. 16. Developmental Considerations <ul><li>Aging Adult </li></ul><ul><li>Peripheral Blood Vessels Rigid </li></ul><ul><li>Increased Risk of DVT </li></ul><ul><li>Decreased Lymphatic Tissue </li></ul><ul><li>Decreased # of Lymph Nodes </li></ul>spring 2012
  17. 17. Health Promotion <ul><li>Smoking Cessation </li></ul><ul><li>Regular Exercise </li></ul><ul><li>Healthy Diet </li></ul>spring 2012
  18. 18. Nursing Diagnoses <ul><li>Altered Tissue Perfusion </li></ul><ul><li>Sensory Perceptual Alterations </li></ul><ul><li>Impaired Ambulation </li></ul><ul><li>Pain </li></ul><ul><li>Sleep Pattern Disturbance </li></ul>spring 2012
  19. 19. Abnormal Findings <ul><li>UE </li></ul><ul><ul><li>Raynaud’s Syndrome </li></ul></ul><ul><ul><li>Lymphedema </li></ul></ul><ul><li>LE: </li></ul><ul><ul><li>Chronic Arterial Insufficiency </li></ul></ul><ul><ul><li>Chronic Venous Insufficiency </li></ul></ul><ul><ul><li>Ulcers </li></ul></ul><ul><ul><li>Buergers Disease </li></ul></ul><ul><li>Aneurysms </li></ul><ul><li>Venous Thrombosis/ Thrombophlebitis </li></ul><ul><li>Hypertension </li></ul>spring 2012

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