= Wi Re ion Assessing Peripheral Vascular SeesObjectives » Describe the structure and functions of blood vessels, including capillaries and lymphatic circulation. » Interview a client for an accurate nursing history of the peripheral vascular system. + Perform an accurate peripheral vascular assessment. » Describe finding frequently seen when assessing the client’s peripheral vascular system. » Analyze data from the interview and physical assessment of the peripheral vascular system to formulate valid nursing diagnosis, collaborative problems, and/or referrals.Anatomy and Physiology - Arteries - Arteries must respond to the variations that cardiac systole and diastole generate in cardiac output - Anatomy and size vary according to their distance from the heart + Arterial pulses are palpable when artery lies close to body surface if P Normal Artery WaitArms + Brachial. at bend of elbow just medial to biceps tendon cot » Radial: lateral flexor surface at wrist » Ulnar: medial flexor surface gsna (overlying tissues may obscure) Legs » Femoral: below inguinal ligament » Poplitesl passes medially ind the femur: palpable behind knee nepal ea » Dorsalis pedis: dorsum of toot lateral to extensor tendon of big toe » Posterior tibial’ behind medial... malleolus of ankle serahattertech con - 30579669Anatomy and Physiology - Veins - Veins are thin-walled and highly distensible + Deep veins \ E ~ Carry ~90% venous return from lower \( Ye-vanve extremilies and are well-supported by Ah \ surrounding tissues ae \\ oom + Superficial veins Gertoratnrt : - Subcutaneous with poor tissue support K iP peap «Include great saphenous and small A Ine deep vans saphenous veins \ f cpmmor ites, «+ Anastomotic veins connect two saphenous veins » Perforating veins connect superticial (saphenous) system with deep system 227 + Deep, superficial, and perforating veins have one-way valves Propel blood toward heart, preventing pooling, venous stasis, and backward |Anatomy and Physiology - Lymphatic System » Extensive vascular network that drains lymph from body tissues and returns it to venous circulation » Lymph nodes. - Round, oval, or bean-shaped structures - Vary in size according to location » Important role in body's immune system - Cells in lymph nodes engulf cellular debris/bacteria and produce antibodies » Only superficial lymph nodes accessible to physical examination a ool ms thant ent A teamWANTS * Soven or onan cl eave by papain he peter plses ard company fester fhe eno cues wth ‘the rc pdbes and ance puss. coset presen, fan- rd pues ol cinta ec bes wl best, CHLDREN * Chayesi heperprerd wsouabee sachs buishg, pee chia, 2nd pour, canine sein sys dsases chicen es. ad, menngrencn. OLDER ADULS. » Themen cto se cea muck cls re rela connec a, Te ier a Teries wero hel sion saree ated aviv inparren becaect he nove bia ard depend postin "Depend vaso aesonent should abeays noc uno ado arene ener, cba gs vty and sracion Ay clas sone ol he fndrysshald beneease Rees ieee » Skin changes (color, temperature, or texture) Ys » Leg pain, heaviness, or aching? Does it awaken you at night? » Leg veins (rope-like, bulging, or contorted)? » Leg sores or open wounds (location, pain)? » Swelling in legs or feet? » Men-sexual activity changes? » Swollen glands, or nodules (pain)?Past History » Previous problems with circulation in arms or legs (blood clots, ulcers, coldness, hair loss, numbness, swelling, or c poor healing)? =f » Heart or blood vessels “pm Siennen surgeries or treatments (== I (coronary artery bypass, “ repair of an aneurysm, or vein stripping)?Family History &Lifestyle and Healt actices » Family history of oe varicose veins, diabetes, hypertension, coronary heart disease, or elevated cholesterol or triglycerides level? Cigarettes or other forms of tobacco, past or present use, regular exercise, women: use of oral contraceptives, degree of stress, peripheral vascular problems that interfere with ADLs, use of medications, use of support hose?» Gather equipment (gloves, centimeter tape, stethoscope, Doppler ultrasound probe, and & tourniquet) » Ask client to put on gownAssess Arms » Inspect bilaterally for size, presence of edema and venous patterning. » Inspect bilaterally for skin color. » Inspect fingertips for clubbing. SenorAssess Arms . oa the = Palpate the epitrochlear lymph nodes. elbow in the groove iehacslehonka patie san between the biceps and "ur ninenendor ream triceps muscles. or Perform Allen test by occluding the radial and ulnar arteries and observing for palm pallor. Then release the ulnar i artery and watch for color ("= to return to hand. < +ALLEN’S TEST It is a test done to determine that collateral circulation is present from the ulnar artery in case thrombosis occur inAssess Legs » Inspect bilaterally for skin color (client in supine position). + Inspect bilaterally for distribution of hair. » Inspect for lesions or ulcer (note whether margins are smooth and even, location such as at pressure points, size depth, drainage, odor). SS Inspect distribution of hair. = Inspect distribution of hair. = Hair covers the skin an the lags and appears on the dorsal surface af the toes = Loss of hair on the legs > arterial insufficiency.Inspection- other features Venous Stars- nueisn vessets nat aistend above the slon surface Thrombophlebitis- supericial rea painfull lump Brown pigmentation- haemosiderin deposition Venous Eczema Venous Ulcers- over medial ankle Lipodermatosclerosis-progessive sclerosis of cutaneous fat- ankée benomes thin hard area above: becomes oedematous Scars from previous surgeryAssess Legs » Inspect for edema, unilateral or bilateral (if calves are asymmetric, measure calf circumference). » If client has edema, determine whether it is pitting or nonpitting. if client has pitting+ etn ecm +2 pitting edema a : : oe Grade Definition 1+ (Trace) Mild pitting, slight indentation, rapid return to normal ir 2+ (Mild) Moderate pitting, 4mm indent, rebounds in a few seconds 34 (Moderate) Deep pitting, 6mm indent, 30 seconds 4+ (Severe) Very deep pitting, 2mm indent, > 30 seconds to return to normal» Palpate skin temperature (cool, warm, hot). Use dorsal surface of hands. Palpate the superficial inguinal lymph nodes while keeping the genitals draped. If detected, note size, mobility or tenderness. k | + pie «| pamatiig ( Enema vnguel tng aieAssess Legs » Palpate and auscultate femoral pulses over artery. Listen for bruits. » Palpate popliteal, dorsalis pedis, and posterior tibial pulses. Fares! artery pate within Shee larora argh ‘Fopiteal artery palpated wth the sostteat toss outer inal areery best palpate bosteroe ta the merhal male a | erst pets artery best pazatedton | te coma of the tootAg De par fan and roped De ates Assess Legs Shae » Inspect for varicosities and thrombophlebitis by asking client to stand. Perform position change test for arterial insufficiericy while client is in the supine positions placing both hands client’s ankles, Raise legs for 30.48 cm (12 in) above heart level, and ask client to pump feet up and down for 1 minute. Have client to sit up and dangle legs. Note color of feet. Time the interval for to return.Assess Legs » If varicosities are present, perform the manual compression test by having client stand. Firmly compress the lower portion of the varicose vein witks one hand. Place other hand 15.2 to 20.3 cm (6 to 8 in) above hand. Feel for pulsation in the upper hand. —» If varicosities are present, perform Trendelenburg Test with client in supine position. Elevate leg 90 degrees for 15 seconds. With legs elevated, apply a tourniquet to the upper thigh. Assist client to a standing position, and observe venous filling. Remove;tourniquet after 30 seconds, and watch for sudden filling of the varicose veins from above. B) Trendelenburg test - Te determine the underlying cause of superficial venous insufficiencyAnalysis of Data » Formulate nursing diagnoses + Formulate collaborative problems » Make a necessary referrals in NURSING DIAGNOSIS Ws COLLABORATIVE PROBLEMS (Calabar pda are “vein py sg souplcaice 9 hen the cue uri pm ements kegs ia kes 2 sition or eesig agnosia petkan + Chllabeenie prcies evve peal complication, they mma be ened eanly Gur te preventive deg cae ca he anatucat ety,Reference videos & https: / /www.youtube.com /watch?v=D1tjOOR W9UM » https://www.youtube.com/watch?v=I_qqQub 4cSQ » https:/ /www.youtube.com/watch?v=6beOTEK xlek |