Assessment of the Peripheral Vascular System

Peripheral Vascular System

Consists of a system of intertwining veins and arteries which carry blood to
and from the heart and lungs
Also involves the capillaries and lymph system
Peripheral Vascular Disease

Disorders which alter the normal flow of blood through the arteries and
veins

Effects the lower extremities more frequently the the upper

A client with a diagnosis of PVD implies arterial disease rather than

venous

Some client have both arterial and venous disease

Focus of Assessment

Assessment of

skin

hair

nails

pulses

temperature
pain and sensation

Raynauds Disease

Caused by vasospasms of the arterioles and arteries of the upper and

lower extremities

Affects hands but can be on toes and tip of nose

S/S chronic, intermittent, numbness, coldness, pain and pallor

Women 16-40 years of age

Cause is unknown

After spasm the skin becomes reddened and hyperemic

Nursing care

Pain control

Teach client to avoid stimuli which may trigger episode (stress, cold
air temp, smoking)

Keep extremity warm

Use hair dryer, warm H2O, etc

Protect area from trauma

Review of Assessment of Arterial Pulses

Palpate the central and peripheral pulses

Carotid

brachial

radial

femoral

popliteal

dorsalis pedis

posterior tibial

Subjective data:

Leg pain or cramps

Where, type of pain
Aggravating factors

Skin changes on arms or legs

Color: redness, blue, brownish discoloration

Temp: any changes in temperature

Vein bulging or crooked

Sores

Swelling in arms or legs

When did it start, when is it worse, relief

Lymph node enlargement

Medications

What medications is the patient taking?

Focus of Assessment

Upper extremities: Arms and hands

Inspection:

skin

nails

hair

Palpation:

pulses (describe),

capillary refill time

palpate arms for temperature, moisture and edema

Radial Pulses

Focus of Assessment

Palpate pulses noting:

Rate

Rhythm

Elasticity

Force

Pulses

Grade force (four-point scale)

4+ bounding

3+ increased

2+ normal

1+ weak

0 absent

Lower extremities

Inspection:

skin

nails

hair

presence of varicosities on legs

Palpation:

pulses, capillary refill time

Objective Data
The Physical Exam, continuation

Legs- Inspect & palpate

Skin & hair

Symmetry

Temperature

Calf muscle

Inguinal lymph nodes

Legs- Inspect & palpate, continuation

Femoral pulse

Popliteal pulse

Posterior tibial pulse

Dorsalis pedal pulse

Femoral Pulse

Popliteal Pulse
Review of Assessment of Arterial Pulses

Auscultate the carotid and femoral arteries

Auscultate for bruits, using the bell

of the stethoscope

(the bell detects low pitch sound)

Auscultate for bruit

Perform the allen test (optional)

Allen test- the allen test evaluates patency of the radial or ulnar arteries. It is
implemented when patency is questionable or before such procedures as a
radial artery puncture.

Homans Sign

To determine whether a deep vein thrombosis is present

Varicose Veins

Dilated, tortuous leg veins with back flow of blood caused by incompetent
valve closure, which results in venous congestion and vein enlargement

Usually affects the saphenous vein and its branches

Causes

Unknown but may be R/T congenital weakness of valve

Thrombophlebitis

Venous stasis pregnancy, prolonged standing

Familial tendency

Diagnosis

History and physical

Venogram

Trendelburgs test demonstrates the backward flow of the blood in

the venous system

Catandaunes State Colleges

COLLEGE OF HEALTH SCIENCES
Virac, Catnduanes

Submitted by:
Patricia Dawn G. Molina
BSN I-A

Submitted to:
Mary Elaine Tapel RN MAN
Clinical Instructor