Prepared by: Angelo P.

Angeles, RN MAN
REVIEW OF STRUCTURES AND FUNCTIONS
ARTERIES
Carry oxygenated
blood
Receives high
pressure from the LV
of the heart


Brachial Artery
Radial artery
Ulnar artery



Femoral Artery
Popliteal
Anterior branch
Dorsalis Pedis a.
Posterior branch -
Posterior Tibial a.


VEINS
Carry deoxygenated
blood, and wastes
SVC: head, arms,
upper trunk, head
and neck
IVC: lower trunk and
legs
Larger and can
expand in diameter


Deep veins
Femoral vein
Popliteal vein

Superficial veins
Great saphenous
(longest)
Small saphenous

Perforator veins

Mechanisms that propel
blood back to the
heart:
1. Presence of One-way
Valves
2. Muscular contraction
3. Creation of pressure
gradient (though
breathing)

Composed of lymphatic capillaries, lymphatic
vessels, and lymph nodes
Functions:
1. It drains excess fluid and plasma proteins from
body tissues and return them to venous
system
2. Aids in defending the body against MO
3. Absorbs fat from the small intestine into the
bloodstream
Superficial lymph
nodes of the arms and
legs
Epitrochlear lymph
nodes

Inguinal lymph
nodes
Horizontal
Vertical
NURSING HEALTH HISTORY
Change in Skin color, temperature or texture
ARTERIAL INSUFFICIENCY cold, pale, clammy
skin; thin shiny skin with loss of hair
VENOUS INSUFFICIENCY warm skin, brown
pigmentation around the ankles
Leg Pains or Cramps
Intermittent Claudication cramping in the calves,
thighs, or buttocks and weakness upon activity
(ARTERIAL disease)
Heaviness and aching sensation aggravated by
standing or sitting for longer periods (VENOUS
disease)
Leg pain at night (CHRONIC ARTERIAL dse)
Numbness (NEUROPATHY)
Varicose veins
Hereditary
Venous pressure and venous pooling
Leg Ulcers
Arterial painful
Venous painless
Edema (with/without pain)
Obstruction of lymphatic flow, incompetent valves,
osmotic pressure, DVT
Swollen lymph nodes
Infection
Male clients: Change in sexual activity
Leriches syndrome Impotence/Erectile
Dysfunction




PAST HEALTH HISTORY
History of Peripheral Vascular Diseases
History of Cardiovascular surgeries

FAMILY HISTORY
DM, HPN, Coronary Heart Disease,
Hypercholestrolemia







LIFESTYLE AND HEALTH PRACTICES
Cigarette smoking

Exercise

Female clients: Intake of Oral/ transdermal
contraceptives

Stress

Wearing of supportive hose







P H Y S I C A L E X A M I N A T I O N
Preparation
Have client wear examination gown
Upright position
Adjust room temperature
Explain exposure of parts to be assessed
Explain position changes
Equipment
Centimeter tape
Stethoscope
Doppler UTZ device
Conductivity gel
Gauze/tissue
Water proof pen
Blood pressure cuff

Procedure Normal Findings Abnormal Findings
Observe for the arm
size and venous
pattern; look also
for edema
Arms are bilaterally
symmetric; no
edema or
prominent venous
patterning
Lymphedema
(blocked lymphatic
circulation)
Procedure Normal Findings Abnormal Findings
Observe for
coloration of the
hands and arms
Color varies
depending on
clients skin tone
Rapid changes in
color (pallor,
cyanosis, redness)
Raynauds disease
Procedure Normal Findings Abnormal Findings
Palpate for clients
fingers, hands and
arms. Note temp.
Warm bilaterally
from fingertips to
upper arms
Cool extremity/
Cold fingers and
hands
Assess Capillary
Refill
Capillary beds refill
(color returns in 1-2
seconds)
> 2 secs
(vasoconstriction,
CO, shock, arterial
occulsion)
Palpate for the
radial pulse
Equal strength
bilaterally (2+)
Increased
hyperkinetic
Diminished or
absent occlusion
Procedure Normal Findings Abnormal Findings
Palpate for the
ulnar pulses
Equal strength;
may not be
detectable
Lack or resilience
or inelasticity
(arteriosclerosis)
Palpate the brachial
pulse (if suspected
for arterial
insufficiency)
Equal strength
bilaterally
Increased,
diminished, absent
Procedure Normal Findings Abnormal Findings
Palpate for the
epitrochlear lymph
node
Not palpable Enlarged/swollen
Procedure Normal Findings Abnormal Findings
Perform Allen test Pink coloration
return to palms
within 3-5 seconds
Pallor persists
Procedure Normal Findings Abnormal Findings
Observe skin color
while inspecting both
legs from toes to groin
Uniform pigmentation Pallor (elevated) &
rubor (dependent)
A.I.
Brownish V.I
Inspect distribution
of hair
Hair cover the skin
and appears on the
dorsal surface
Loss of hair (A.I)
Inspect for lesions Legs are free of
lesions/ulcers
Ulcers

Procedure Normal Findings Abnormal Findings
Inspect for Edema Identical
size/shape; no
swelling
Bilateral edema
Palpate for Edema No edema Pitting or non
pitting edema
Edema Grading:

1+ = slight pitting
2+ = deeper than 1+
3+ = noticeably deep pit;
looks larger
4+ = very deep pit; gross
edema in extremity

Procedure Normal Findings Abnormal Findings
Palpate bilaterally
for temp of feet and
legs
Equally warm Generalized
coolness (A.I.),
Warmth
(thrombophlebitis)
Palpate superficial
inguinal lymph n.
Nontender, maybe
movable
Swelling >2cm
Procedure Normal Findings Abnormal Findings
Palpate:
Femoral
Popliteal P.
Dorsalis Pedis P.
Posterior Tibial P.


Strong and equal
bilaterally


Weak or absent
Procedure Normal Findings Abnormal Findings
Inspect for
varicosities and
thrombophlebitis
Veins are flat and
barely seen under
the skin
Distended, nodular,
bulging and
tortuous veins
Procedure Normal Findings Abnormal Findings
Check for the
Homans sign
(-) Homanssign
No pain or
tenderness elicited
(+) Homans sign
Calf pain and
tenderness
Procedure Normal Findings Abnormal Findings
Position
change test
Feet: pink to slightly pale in
color (elevation); pinkish
color returns to toes and feet
in 10 secs, 15 secs for
superficial veins on top of
feet. (dangled)
Marked pallor

> 10 secs and > 15
secs (A.I.)

Persistent rubor
Procedure Normal Findings Abnormal Findings
Ankle- brachial
pressure index
(ABPI) ratio of
ankle systolic BP
to brachial systolic
BP.
Ankle pressure is
same or slightly
higher than the
brachial pressure
(ABPI: 1)
ABPI: 0.5 to 0.95
(mild to mod A.I.)
ABPI: 0.25 or lower
(severe stenosis)
Procedure Normal Findings Abnormal Findings
Manual
Compression test
No pulsation is
palpated (competent
valves)
Pulsation with the
upper fingers
(incomptent valves)
Procedure Normal Findings Abnormal Findings
Brodie-
Trendelenburg
test
Saphenous vein fills
from below in 30
seconds; no rapid
filling of veins from
above after removal
of torniquet
Filling from above
with the tourniquet
in place (while
client is standing)
incompetent valves