PERIPHERAL VASCULAR

SYSTEM
Alcuizar, Nicole F.
Cabahug, Mikhaela Faye A.
Fernan, Myrrh Fae DR.
Ignacio, Trisha Mae S.
Labayog, Zyzyrzyl M.
Punzalan, Olcen Rianjun B.
Suan, Alyssa Margaret C.
 HISTORY OF PRESENT HEALTH
CONCERN

QUESTION RATIONALE/QUESTIONS
Have you noticed any changes in color, temperature, Rationale: Cold (polar sensation), pallor (paleness), thin and shiny skin with loss of hair,
or texture of your skin? especially in the lower extremities, are associated with arterial insufficiency. Warm skin, edema,
and brown pigmentation in the ankles are associated with venous insufficiency.

Do you experience pain, cramping, or stabbing pain
in your legs? If so, how often does it occur? Is the
pain relieved by rest? Is it reproducible with the
same amount of exercise?
Do you experience heaviness, and an aching
sensation in your legs aggravated by standing or
sitting for a long period of time? Have you observed
edema or varicosities in your legs?
Rationale: Peripheral arterial disease (PAD) is the narrowing or blocking of the vessels in the
lower extremities or legs. Intermittent claudication is usually the first symptom, and it is
characterized by problems including weakness, cramping, aching, fatigue, numbness, and pain
during activity or exercise that can happen in the calves, thighs, or buttocks but rarely in the feet.
These symptoms are quickly relieved by rest but are reproducible with the same degree of
exercise and may also indicate PAD.
Rationale: Peripheral Venous Disease (PVD) refers to problems with veins. An early symptom of
PVD on the milder end can lead to spider veins wherein the blood vessels are small, raised, and
swollen. With more severe, veins can appear twisted and large (varicose veins), and also
symptoms such as heaviness in the legs, an aching sensation in the legs aggravated by standing or
sitting for long periods, leg edema, or varicosities.
 PERSONAL HEALTH HISTORY

QUESTION RATIONALE/QUESTIONS

Have you had an Rationale: Peripheral Vascular Disease is a circulatory disorder caused by narrowing, blockage, or spasms in a
experience of high blood vessel. Cholesterol is a fatty substance that develops in the circulatory system, where it specifically builds
cholesterol – what up in the blood, a person with high cholesterol can be of risk to this.
about high blood sugar
levels, are you Having high cholesterol promotes plaque (a waxy material made of cholesterol) buildup. The risk of PVD is
diabetic? increased in diabetic patients, this happens earlier and is often more severe.

Endothelial dysfunction, vascular smooth muscle cell dysfunction, inflammation and hypercoagulability are the
key factors in diabetic arteriopathy. Knowing that Diabetes is a disease which does not use or proper produce
insulin, a hormone needed to convert glucose, high blood sugar levels are then acquired.

High blood sugar levels make the walls of the vessel rough, which then leads to the formation of plaque as well.
When such plaque is too much, this causes the blood vessel to become narrowed which then limits blood flow.
 FAMILY HISTORY
QUESTION
1.Is there a history of Peripheral Arterial
Disease (PAD) in the family—any relatives
that had PAD and those currently diagnosed
with PAD?
2.Is there a history of other vascular diseases
in the family, such as stroke and Myocardial
Infarction (MI)/heart attack? As well as
dyslipidemia, diabetes mellitus, and
hypertension?
RATIONALE/QUESTIONS
Rationale: The genetic factor makes the patient more susceptible to acquiring PAD.
Hence, the prevalence of PAD at doubled risk is for patients aged less than 68 years
old, as well as those with multiple relatives diagnosed with PAD—compared to those
with no family history of the condition.
Rationale: The possibility of acquiring heart attack, stroke, high blood pressure, heart
diseases, and other related disorders are most likely influenced by genetic factors. A
family history of any of the aforementioned diseases may indicate the increased
chances due to sharing the same environment and other risk factors.
History of dyslipidemia, diabetes mellitus, and hypertension are genetic
predispositions to PAD.
 LIFESTYLE AND HEALTH PRACTICES
QUESTION
1.Does the patient have any vices,
primarily smoking?
2.Does the patient’s occupation require
long hours of prolonged sitting or
standing? Or do they have sedentary
behavior
3.Does the patient exercise regularly?
RATIONALE/QUESTIONS
Rationale: Tobacco smoking has been attributed to causing vasoconstriction in the
peripheral arteries this may lead to predispositions to poor vascularity in the hands and legs
(R. Labayog MD, personal communication, January 27, 2022). Raynaud’s disease is a
similar condition that causes less blood flow into the arms and legs, with worse cases
causing them to necrose.
Rationale: Work environments that usually require prolonged sitting or standing, such as
ones of a truck driver hauling cargo or a factory worker at an assembly line often make it
troublesome for blood in the veins of the leg to return to the heart, this can often lead into
formation of varicose veins that result in either pain or tingling sensations (Hopkins’
Medicine, n.d.).
Rationale: Daily exercise keeps the heart and cardiovascular system as a whole healthy
and strong, promoting circulation throughout the entire body. This question is asked to
probe the patient’s overall vascular health.
TOOLS NEEDED FOR PHYSICAL
ASSESSMENT

Flexible metric measuring tape

Sphygmomanometer and stethoscope
Measure size of extremities for edema
Measure blood pressure and auscultate vascular sounds

Circumferential Method Figure-of-Eight method

Doppler ultrasound
Detect pressure and weak pulses
 INSPECTION

ASSESSMENT NORMAL ABNORMAL

•Skin color uniform •Delayed capillary refill time
•Fingernails of equal thickness •Edema
Inspect Upper •Positive brisk capillary refill less than 2-3 seconds •Intermittent pallor and cyanosis of hands and fingers
Extremities •No edema, erythema, red streaks, or skin lesions •Ischemic changes and gangrene of hands and fingers
•Streaky redness, tenderness, warmth along course of a vein

•Abdominal contour flat, concave, and or round •Tense, shiny abdominal skin
•Abdominal veins barely visible. •Visible, large, diffuse pulsations
Inspect Abdomen •Arterial pulsation at midline over aorta in thin adults

•Leg hair distributed evenly. Older patients may have •Hair loss, think shiny skin and thick nails
thinner, drier skin with less hair and altered pigmentation •Eczema, stasis dermatitis
Inspect Lower •No varicosities or only superficial ones •Prominent leg veins, possibly with ropelike, dilated appearance or
Extremities •No swelling or edema purplish spider-like appearance
•No lesions •Edema
•Skin ulcers
AUSCULTATION

ASSESSMENT NORMAL ABNORMAL

Bowel sounds (Borborygmus) Presence of bruit sound that may be associated

Auscultate Abdominal Aorta
Arteries
Auscultate Carotid Arteries
Auscultate Renal Arteries
Auscultate Femoral Pulses
with an abdominal aortic aneurysm (could
burst overtime and cause life-threatening
internal bleeding)
Pulse is normal heard but without sounds Presence of bruit sound is a sign of having
during systole carotid stenosis and it can lead to ischaemic
stroke
Normal bowel sounds Presence of bruit sound that may be associated
(Soft gurgles or very loud growls) with renal artery stenosis ( may result in end
stage of renal failure)
Pulse is normal heard but without sounds Presence of bruit sound that may be associated
during systole with femoral or also known as iliac stenosis
PALPATION

ASSESSMENT NORMAL ABNORMAL

Palpate the Peripheral Pulses on  2+ or 3+ intensity of pulse  The intensity of the pulse is 0, 1+, and 4+
both sides of patient  Regular pulse rhythm; has 60 to 100  Irregularity of pulse rhythm; has 100
 Radial bpm above bpm or below 60 bpm
 Brachial  Symmetrical pulse volume of upper  Asymmetrical pulse volume of upper and
 Posterior tibial and lower extremity lower extremity
 Dorsalis pedis
 Popliteal
 Femoral
 Firm muscles  Tension of the muscles
Palpate the calves and dorsum of  No signs of tenderness  Pain is present upon palpation
foot  Warm dorsum  Edema over the dorsum of the foot
 Cold dorsum
ABNORMALITIES

Arterial Insufficiency

Arterial Insufficiency is a type of condition which slows or stops

the flow of the blood in the arteries. Hardening of the arteries or also
known as atherosclerosis is one of the common causes of arterial
insufficiency.
ABNORMALITIES

Venous Insufficiency

Venous Insufficiency is a condition when the venous wall or

valves have trouble sending blood from the limbs back to the
heart. This is commonly caused from having a previous
history of acquiring varicose veins and having blood clots.
ABNORMALITIES

Edema
Edema is the swelling of the body’s tissue that is caused by the excess fluid that is
trapped in it. Certain diseases such as congestive heart failure, kidney, lung,
thyroid, and liver diseases can cause edema and might worsen it.

Symptoms of edema:
 Body area is swollen
 The affected area has a stretched and shiny look
 When pushing or pinching the area for 5 seconds and after removing it a dimple mark can be
seen
 If the edema is in the lungs trouble breathing and coughing is experienced by the patient.

To test for edema, you gently press or palpate your thumb over the foot, ankle or leg with slow, steady
pressure. If a patient has edema, you will see an indentation where you pressed or if it took time for the
skin to return to its original appearance.
ABNORMALITIES

Raynaud Disease

Raynaud Disease is a problem that causes decreased blood

flow in the fingers, often due to cold weather or stressful
situations. Some cases cause less blood flow in other areas
like the ears, toes, nipples, knees, and nose.
ABNORMALITIES

Varicose Veins
Varicose Veins are enlarged and twisted veins. The veins in the human
leg are the commonly affected areas due to standing and walking which
increases the pressure of the veins in the lower body. The weak and
damaged valves cause the blood to flow backward and pool in the vein
which leads the veins to twist and stretch.

Risk Factors:
 Age
 Sex
 Pregnancy
 Family History
 Obesity
 Standing/Sitting( Long period of time)
ABNORMALITIES

Thrombophlebitis

Thrombophlebitis is the formation of a

blood clot in one or more veins, causing a
partial or total blockage in the blood flow
—particularly on the legs.

Superficial thrombophlebitis Deep thrombophlebitis

appears to be reddish, tender, causes more pain, tenderness,
warm, and swollen. and swelling in the area. In
most cases, patients develop a
fever.
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