NI - Peripheral Vascular system Less than 2 seconds

More than 2 seconds

Delayed
LEGS Hair Distribution
Color ● Even distribution
Pallor ● Hair loss
Cyanotic ● Sparse hair
Reddened ● No hair
Within normal limits (pink)
Jaundice Nails
Condition:
Skin Condition Clubbing
Intact Normal
Dry Spooning (Koilonychia)
Moist Brittle
Shiny Ridged
Scaly Color: normal, cyanotic, pale
Ulcerated Shape: normal, clubbed, spoon-shaped

Pulse Ulcers
Presence: present, absent, weak, strong ● Venous
Regularity: regular, irregular - Shallow
Symmetry: symmetrical, asymmetrical - Irregular edges
Grading: - Located on lower legs/ankles
0 (absent)
1+ (weak) ● Arterial
2+ (normal) - Deep
3+ (increased) - Punched out appearance
4+ (bounding) - Located on pressure points like toes
or heels
Temperature
- warm Superficial Inguinal Lymph Nodes
- cold ● Enlarged
- clammy ● Tender
- cool ● Non-palpable (normal)
- hot ● Palpable but non-tender

Sensation
- swelling Veins
- tingling Distention
- pain - Present
- numbness - absent (varicose veins)
- burning Tenderness
- thrombing - Present
- coldness - absent
Bruit
Lesions Present
- Surgical Absent
- Trauma
- Pressure Vein Appearance
● Distended
Edema ● Collapsed
Pitting Edema ● Varicosities
- Grade 1+ (mild) ● Normal
- Grade 2+ (moderate)
- Grade 3+ (severe) Range of Motion (L & R)
- Grade 4+ (very severe) Full
Non-pitting Edema Limited
- Localized Painful
- Generalized Normal
Pain Scale: (0-10)

Capillary refill Strength (L & R)

Symmetry
- Symmetrical
- Asymmetrical
Grading
0 (no movement)
1+ (trace movement)
2+ (poor)
3+ (fair)
4+ (good)
5+ (normal)

Muscle Mass and Tone

Atrophy
Hypertrophy
Normal muscle tone
Flaccid

Functional Ability (L & R)

Mobility
- Full
- limited
Gait
- Normal
- Antalgic
- shuffling

Homan’s Sign
Positive
Negative

Ankle Brachial Index (ABI)

● Normal: ABI of 1.0 to 1.4
● Borderline: ABI of 0.91 to 0.99
● Abnormal: ABI less than 0.90 (indicative of
PAD)
● Severe PAD: ABI less than 0.40

ARMS
Color
- pallor
- cyanotic
- reddened
- within normal limits (pink) Hair Distribution
- jaundice present, symmetrical
- pale absent, patchy, thin

Skin Condition Nails

Intact Condition:
Dry Clubbing
Moist Normal
Shiny Spooning (Koilonychia)
Scaly Brittle
Ulcerated Ridged
Color
Pulses - Normal
Absent - Cyanotic
Weak (1+) - Pale
Normal (2+) Shape:
Increased (3+) - normal
Bounding (4+) - Clubbed
- spoon-shaped
Epitrochlear Lymph Nodes
Enlarged Veins
Tender
Non-palpable (normal) Distention
Palpable but non-tender - Present
- absent (varicose veins)
Temperature Tenderness
warm - Present
cold - absent
clammy
cool Vein Appearance
hot ● Distended
● Collapsed
Ulcer (venous, arterial, neuropathic) ● Varicosities
Blisters ● Normal
Abrasions
Lacerations Bruit
Scabs Present
Bruises Absent
Petechiae
Ecchymosis Muscle Strength
Vesicles Normal
Reduced
Absent
Lesions Asymmetrical
- Surgical
- Trauma Range of Motion (L & R)
- Pressure Full
Limited
Edema Painful
Pitting Edema Normal
Grade 1+ (mild) Pain Scale: (0-10)
Grade 2+ (moderate)
Grade 3+ (severe) Sensory Examination (L & R)
Grade 4+ (very severe) Light touch (normal, decreased, absent)
Non-pitting Edema Pinprick (normal, decreased, absent)
Localized Vibration sense (normal, decreased, absent)
- Generalized
Functional Assessment (L & R)
Ability to grasp
Capillary refill Ability to lift
Less than 2 seconds Dexterity (fine motor skills)
More than 2 seconds
Delayed Allen Test
- Radial artery 3-5 secs
- Ulnar artery 3-5 secs
- Delayed
- Absent