Assessment of the Peripheral Vascular SystemPeripheral Vascular SystemConsists of a system of intertwining veins and arteries which carry blood to and from the heart and lungsAlso involves the capillaries and lymph system Peripheral Vascular Disease Disorders which alter the normal flow of blood through the arteries and veins Effects the lower extremities more frequently the the upper A client with a diagnosis of PVD implies arterial disease rather than venous Some client have both arterial and venous diseaseFocus of Assessment Assessment of skin hair nails pulses temperature pain and sensation

Raynauds Disease Caused by vasospasms of the arterioles and arteries of the upper and lower extremities Affects hands but can be on toes and tip of nose S/S chronic, intermittent, numbness, coldness, pain and pallor Women 16-40 years of age Cause is unknown After spasm the skin becomes reddened and hyperemic Nursing care Pain control Teach client to avoid stimuli which may trigger episode (stress, cold air temp, smoking) Keep extremity warm Use hair dryer, warm H2O, etc Protect area from trauma

Review of Assessment of Arterial Pulses Palpate the central and peripheral pulses Carotid brachial radial femoral popliteal dorsalis pedis posterior tibial

Subjective data:

Leg pain or cramps Where, type of pain Aggravating factors Skin changes on arms or legs Color: redness, blue, brownish discoloration Temp: any changes in temperature Vein bulging or crooked Sores Swelling in arms or legs When did it start, when is it worse, relief Lymph node enlargement Medications What medications is the patient taking?

Focus of Assessment Upper extremities: Arms and hands Inspection: skin nails hair Palpation: pulses (describe), capillary refill time palpate arms for temperature, moisture and edemaRadial Pulses

Focus of Assessment Palpate pulses noting: Rate Rhythm Elasticity Force Pulses Grade force (four-point scale) 4+ bounding 3+ increased 2+ normal 1+ weak 0 absent Lower extremities Inspection: skin nails hair presence of varicosities on legs Palpation: pulses, capillary refill timeObjective DataThe Physical Exam, continuation Legs- Inspect & palpate Skin & hair Symmetry Temperature Calf muscle Inguinal lymph nodes

Legs- Inspect & palpate, continuation Femoral pulse Popliteal pulse Posterior tibial pulse Dorsalis pedal pulse

Femoral Pulse

Popliteal PulseReview of Assessment of Arterial Pulses Auscultate the carotid and femoral arteries Auscultate for bruits, using the bell of the stethoscope (the bell detects low pitch sound) Auscultate for bruit Perform the allen test (optional)Allen test- the allen test evaluates patency of the radial or ulnar arteries. It is implemented when patency is questionable or before such procedures as a radial artery puncture.

Homans Sign

To determine whether a deep vein thrombosis is present

Varicose Veins Dilated, tortuous leg veins with back flow of blood caused by incompetent valve closure, which results in venous congestion and vein enlargement Usually affects the saphenous vein and its branches Causes Unknown but may be R/T congenital weakness of valve Thrombophlebitis Venous stasis pregnancy, prolonged standing Familial tendency Diagnosis History and physical Venogram Trendelburgs test demonstrates the backward flow of the blood in the venous system

Catandaunes State CollegesCOLLEGE OF HEALTH SCIENCESVirac, Catnduanes

Submitted by:Patricia Dawn G. MolinaBSN I-A

Submitted to:Mary Elaine Tapel RN MANClinical Instructor