NUR 220- Peripheral Vascular

What are the 2 systems comprised of this unit?

vascular & lymphatic

What makes up the vascular system?

arteries and veins

major arteries in the arms

* brachial artery (BP)
* ulnar artery (no palpate)
* radial artery

major arteries in the legs

* femoral artery
* popliteal artery
* anterior and posterior tibial artery
* dorsalis pedis

children considerations

* palpable lymph nodes occur often in healthy infants & children
* they should be small, firm, mobile, and nontender

pregnant women considerations

* expect bilateral pitting edema in the lower extremities, especially at the end of the day and into 3rd trimester
* varicose veins are often seen in the 3rd trimester as well

aging adult considerations

* pulses may becomes more difficult to find
* hair loss on the lower extremities occurs with aging and is not an absolute sign of arterial inefficiency

cultural considerations

African Americans have higher rates of PAD than whites and Hispanics

subjective data

* leg pain and cramps
* skin changes on arms and legs
* swelling
* lymph node enlargement
* medications
* smoking history

objective data

Preparation:

* check temp of room

Order of assessment:

* inspection
* palpation
* NO PERCUSSION OR AUSCULTATION

normal/moderate pulse grade

\+2

how should you palpate femoral and popliteal arteries?

with patient laying down

edema grading scale is

\+1 thru +4

\+1 edema

mild, pitting, slight indentation, no perceptible swelling

\+2 edema

moderate pitting, indentation subsides rapidly

\+3 edema

deep pitting, indentation remains, legs look swollen

\+4 edema

very deep pitting, indentation lasts long time, leg very swollen

Peripheral vascular disease

umbrella term for peripheral artery disease and peripheral venous disease

peripheral venous disease (PVD)

deoxygenated blood cant get back to the heart

* pooling of oxygenated blood in the extremities

Peripheral Artery Disease (PAD)

narrow artery where oxygenated blood can’t get to the distal extremities (hands and feet)

* ischemia and necrosis of the extremities → NO BLOOD = NO O2 (pain)

Causes of PVD & PAD

smoking, diabetes, high cholesterol, HTN

Diagnosis for PAD & PVD

doppler ultrasound or ankle branchial index (ABI)

PVD treatment

elevate veins, medications (aspirin & statins), surgery

* KEEP VEIN OPEN

What does PVD look like?

* V = very big pulses (bounding)
* E = edema because of pooling blood
* I = irregularly shaped sores
* N = NO sharp pain → will be dull and constant
* Y = yellow ankles

PAD Treatment

dangle arteries, stop smoking, avoid tight clothing, no heating pads, medications (vasodilators & antiplatelets)

* GET THE BLOOD MOVING

What does PAD look like?

* A = absent pulses: blood is not going to extremities
* R = round, red sores
* T = toes and feet eschar → pale and dying
* S = sharp calf pain with elevation or exercise

Risk factors for DVT

obesity, oral contraceptives, prolonged immobility, surgery

S/S of DVT

pain, redness, swelling, warm legs

DVT Treatment

* **d**on’t **d**islodge the clot
* massage, walk, apply heat
* Ele**V**ate above heart level
* An**T**icoagulants
* TED hose/SCD → dangerous if they already have a DVT (used in prevention)