Lab Peripheral Vascular PDF

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CHAPTER 20

Peripheral Vascular System and Lymphatic System

183

REGIONAL WRITE-UP—PERIPHERAL VASCULAR SYSTEM Date __________________________________ Examiner ______________________________ Patient _______________________________________ Age _______________ Gender ______________ Reason for visit ________________________________________________________________________ I. Health History 1. Any leg pain (cramps)? No Yes, explain Where? 2. Any skin changes in arms or legs? 3. Any sores or lesions in arms or legs? 4. Any swelling in the legs? 5. Any swollen glands? Where? 6. What medications are you taking? 7. Do you smoke cigarettes? How many per day? Ever tried to quit? II. Physical Examination A. Arms, Inspect: Color of skin and nail beds _________________________________________________________ Symmetry ______________________________________________________________________ Lesions _________________________________________________________________________ Edema _________________________________ Clubbing _______________________________ Palpate Temperature __________________________ Texture _________________________________ Capillary refill ________________________________________________________________ Locate and grade pulses (record below) Check epitrochlear lymph nodes __________________________________________________ Modified Allen test (if indicated) _________________________________________________ B. Legs, Inspect: Color ______________________________ Hair distribution _____________________________ Venous pattern, varicosities ________________________________________________________ Swelling, edema _________________________ Atrophy _________________________________ If so, measure calf circumference in centimeters: R _________ L ________ Skin lesions or ulcers ______________________________________________________________ Palpate Temperature __________________________________________________________________ Calf tenderness _______________________________________________________________ Inguinal lymph nodes __________________________________________________________ Locate and grade pulses (record below) __________________________________________ Check pretibial edema (grade if present) ___________________________________________ Auscultate for bruit (if indicated) ________________________________________________

REGIONAL WRITE-UP—PERIPHERAL VASCULAR SYSTEM Brachial

Radial

Femoral

Popliteal

Dorsalis pedis

R L 0 = absent, 1+ = weak, 2+ = normal, 3+ = full, bounding Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition, Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.

P. tibial

184

UNIT III

Physical Examination

C. Ankle-Brachial Index (ABI) Use Doppler ultrasonic probe and locate pulse sites: brachial, dorsalis, pedis, posteriortibial. Compute ABI.

Ankle-Brachial Index Interpretation Above 0.90: Normal or borderline 0.71 – 0.89: Mild PAD 0.41 – 0.70: Moderate PAD 0.00 – 0.40: Severe PAD

Right arm: Systolic pressure

Right ankle: Systolic pressure Posterior tibial (PT) Dorsalis pedis (DP)

mm Hg

mm Hg mm Hg

Right ABI equals ratio of: Higher of the right ankle pressures (PT or DP) Higher arm pressure (right or left arm)

Left ABI equals ratio of: Higher of the left ankle pressures (PT or DP) Higher arm pressure (right or left arm)

Left arm: Systolic pressure

mm Hg

Left ankle: Systolic pressure Posterior tibial (PT) Dorsalis pedis (DP)

mm Hg mm Hg

mm Hg !

.

!

.

mm Hg

mm Hg mm Hg

From AACN (2009). AACN Advanced Critical Care Nursing (ed. 1). Philadelphia: Saunders.

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition, Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved.

CHAPTER 20

Peripheral Vascular System and Lymphatic System

185

REGIONAL WRITE-UP—PERIPHERAL VASCULAR SYSTEM Summarize your findings using the SOAP format. Subjective (reason for seeking care, health history)

Objective (physical examination findings)

Record pulses on diagram below.

Assessment (assessment of health state or problem, diagnosis)

Plan (diagnostic evaluation, follow-up care, teaching)

Jarvis, Carolyn: PHYSICAL EXAMINATION AND HEALTH ASSESSMENT: Seventh Edition, Laboratory Manual. Copyright © 2016, 2012, 2008, 2004, 2000, 1996 by Saunders, an imprint of Elsevier Inc. All rights reserved....