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

Raynaud’s 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.
Homan’s 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

– Trendelburg’s 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