Chapter 21- Peripheral Vascular 319

hard to palpate, need to search for it, may fade in and out, and easily obliterated by pressure. Associated with decreased cardiac output, peripheral arterial disease (PAD), and aortic valve stenosis. 

weak pulse

Easily palpable, pounds under your fingertips. Associated with Hyperkinetic states, anemia, and hyperthyroidism

full-bounding pulse

**Abrupt**, progressive tricolor change of the fingers in response to cold, vibration, or stress. 1-white (pallor) tips of fingers from vasoconstriction, 2-blue (cyanosis) relaxation of spasm resulting in small trickle of blood back to the hand 3-red (rubor) in from return of blood or reactive hyperemia. May have cold, numbness, or pain w/pallor or cyanosis stage, then burning, throbbing pain, swelling w/rubor. Attack usually lasts 15-20 minutes. Treatment: Slowly rewarming hands and avoiding cold.

raynaud phenomenon

Accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment. Once protein-rich lymph builds up in the interstitial spaces, it further promotes more fluid leakage.   

This is reversible if treated within the first 18 months; if not, it can become chronic. Symptoms include unilateral swelling, nonpitting brawny edema, overlying skin indurated (hardened). 

lymphedema

**Throbbing pain** with sudden onset (within 1 hr), ***pallor, pulseless****, paresthesia, poikilothermic (coldness), paralysis (indicates severe). ***EMERGENT** 

 

PAD- arterial acute

**deep muscle pain in calf**, lower leg, or dorsum of the foot. **Intermittent** **claudication** feels like cramp, numbness, and tingling, and feeling of cold. **Onset after exertion like activity (walking, stairs) or elevation. Rest (standing) and dangling relieve it.** Symptoms include low-ankle-brachial index; cool, pale skin; diminished pulses, pallor on elevation. African Americans, smokers, and older/middle-aged adults are all at a higher risk.

PAD- arterial chronic

Located in the calf- Moderate to intense, sharp, deep muscle **tender to touch.** Sudden onset within an hour. **Pain may increase with palpation**, pain meds alleviate. Associated symptoms include red, warm, swollen leg. ***DVT**

PVD- venous acute

Located in the calf or lower leg, moderate to intense, sharp; deep muscle tender to touch. **Pain increases throughout the day and it is aggravated by prolonged standing or sitting.** Pain may increase with palpation and relieved with elevation, lying, walking and pain meds. Symptoms include edema, varicosities, weeping ulcers at ankles, red, warm, and swollen leg. 

PVD- venous chronic

Buildup of fatty plaques on intima **(atherosclerosis)**, plus hardening calcification of arterial wall. Normally occurs on the toes, metatarsal heads, heels, and lateral ankle. Characterized by pale ischemic base, well defined edges, and no bleeding; looks dry and punched out

Subjective data: deep muscle pain the calf or foot, pain with leg elevation, and pain at rest. 

 Objective data: coolness in only one foot or leg, pallor, **diminished pulses, shiny skin, and thick rigid nails.**

\

arterial (ischemic) ulcer

Aching pain in calf or lower leg, worse at end of day, worse with prolonged standing or sitting; pain lessens with leg elevation. Itching with stasis dermatitis. **Firm, brawny edema; coarse, thickened skin; pulses normal; brown pigment discoloration; petechiae**; dermatitis. A weepy, pruritic stasis dermatitis may be present. 

venous stasis ulcer

Symptoms include **numbness and tingling**, pain, weakness, loss of balance, falling, allodynia. Signs include decreased reflexes, loss of proprioception, loss of vibration sensation, small muscle wasting, loss of warm and cold sensation and pinprick, decreased reflexes, poor blood flow, and cold feet. Without careful vigilance of pressure points on feet, ulcer may go unnoticed. 

**neuro**pathic ulcer

leg veins have dilated as a result of chronic increased venous pressure and incompetent valves that permit reflux of blood back toward leg. Red to blue or purple. Symptoms: aching, heaviness in calf, easily fatigued, restless legs, burning, throbbing, cramping. Objected: dilated veins that sit on top of muscle or bone. Older varicose veins are deep and feel spongy 

superficial varicose veins

\-A deep vein is occluded by a thrombus (example: blood clot), causing inflammation, blocked venous return, cyanosis, and edema. 

\-Cause may be prolonged bed rest, history of varicose veins, trauma, infection, cancer, obesity, immobility, heart failure, or the use of estrogen hormones. 

\- S: Sudden onset of intense, sharp, deep muscle pain. 

O: Increased warmth; swelling; redness; dependent cyanosis is mild or may be absent; tender to palpation 

deep vein thrombophlebitis

Caused by atherosclerosis, chronic buildup of fatty streaks, fibroid plaque, calcification of the vessel walls, and thrombus formation. Reduces blood flow with vital oxygen and nutrients. Risk factors for atherosclerosis include obesity, cigarette smoking, hypertension, diabetes mellitus, elevated serum cholesterol, sedentary lifestyle, and family history of hyperlipidemia. 

occlusions

dilation in the artery wall. Atherosclerosis weakens the middle layer (media) of the vessel wall. This stretches the inner and outer layers (intima and adventitia), and the effect of blood pressure creates the balloon enlargement.

**most common site is the aorta**

aneurysms