Peripheral vascular and lymphatics system

Subjective questions: past medical history and family history

• Past medical history

  • Any history of PAD, heart disease, stroke, diabetes, and high BP?

    • Any of these increase risk for PAD

  • Do you have a high cholesterol?

    • Lead to PAD

• Family history

  • Any history of atherosclerosis, PVD, varicose veins, or diabetes?

    • Increases risk 

Subjective questions: psycosocial history and meds

• Sit for prolonged periods of times?

• Travel for long periods of time?

  • Less mobile patients are risk for developing blood clots and decreased venous return

• Do you smoke?

  • Most contributing factor to PVD and PAD

  • Casues vasoconstriction

• Medications

  • What medications are you taking?

    • Certain meds are prescribed to prevent blood clots

    • Oral contraceptive increase blood clots

Subjective questions: Tingling and edema

• Pain/tingling/numbness

  • Do you experience any pain or leg cramps wile walking or while sleeping

    • Indicate PAD, worsens when walking

    • PVD worsens at rest

  • Do you experience tingling or numbness in extremities?

    • Indicates PAD or tissue ischemia

• edema/swelling

  • Ever notice swelling or edema in arms or legs?

    • Could be lymphedema or due to cardia, renal, peripheral vascular or liver disease

    • Unilateral edema can indicate deep vein thrombosis

Subjective questions: Lymph nodes and skin color changes

• Lymph node enlargement

  • Any swollen or tender lymph nodes? 

    • Could be due to presence of bacteria or cancer, helps narrow down problem area

• Skin color changes

  • Any skin color changes? During temp changes?

    • Peripheral vascular insufficiency

    • Redness and warmth could be infection/imflammation

  • Loss of hair?

    • Decreased circulation cause hair loss + flaky, scaly skin

Physical exam

1. Inspect arms for color, size and lesions

2. Palpate pulses: radial, brachial

3. Epitrochlear node

4. Inspect legs for color, size, lesions,  trophic skin changes (thinning, shiny, muscle atrophy, slowed wound healing)

5. Palpate temp

6. Inguinal nodes

7. Pulses: femoral, popliteal, post tibial, dorsalis pedis

8. Touch sole of foot with microfilament (sensation)