SAS 15

• The students will study and read Chapter 15 of their book about this lesson: The Health History.
• Common or Concerning Symptoms of Peripheral Vascular Diseases include pain in the arms or legs, intermittent claudication, cold, numbness, or pallor in the legs; hair loss, swelling in the calves, legs, or feet, and swelling with redness and tenderness.
• Asking specifically about the symptoms below is recommended, especially in patients older than 50 years and those with risk factors, especially smoking, diabetes, hypertension, elevated cholesterol, or coronary artery disease: Do you have pain or cramping in your legs during walking or exertion? (This is termed intermittent claudication.)
• These symptoms are caused by insufficient arterial supply to the legs, which may be caused by atherosclerosis.
• Is intermittent claudication relieved by rest within 10 minutes?
• If present, identify the location and the distance the patient walks before symptoms occur.
• Do you have coldness, numbness, or pallor in the legs or feet?
• Do you have hair on your shins?
• Do you have aching or pain at rest in the lower leg or foot?
• Is pain alleviated by elevating the legs?
• Paradoxical pulse is defined as an increased arterial pulse with a double systolic peak.
• When the patient has a pulsus alternans, the nurse must suspect for pericardial tamponade.
• Nurse Sasha should grade the patient’s bipedal edema as a 4+.
• Truck drivers, traffic enforcers, call center agents, and other jobs that involve prolonged sitting or standing increase the risk for the development of a peripheral vascular disease like varicosities.
• Pain or cramping in the legs during walking or exertion is a symptom of venous stasis.
• When asking the female patient about a possible risk for developing blood clots, the nurse should pay attention to the medications that the patient has previously taken, especially oral contraceptives.
• Pain that radiates into the left shoulder and arm is a symptom of arterial stasis.
• Hyperlipidemia is not a risk factor for the development of peripheral vascular disease.
• Edema, varicose veins, and aching in the legs are symptoms of arterial stasis.
• Nurse Mikasa should grade the patient’s radial pulse as a 3+.
• Pallor or cyanosis in the fingertips and toes is usually associated with Raynaud disease.
• Do you have fatigue or aching in the lower legs with prolonged standing?
• Do you have swelling of the feet or legs?
• Edema, varicose veins, and aching in the legs are symptoms of venous stasis.
• The locations of the peripheral pulses can be identified during a health assessment.
• An accurate history of the peripheral vascular system can be obtained during a health assessment.
• The structure and functions of arteries, veins, lymphatic vessels and lymph nodes can be described during a health assessment.
• The equipment necessary to perform a peripheral vascular examination can be evaluated and interpreted during a health assessment.
• Variations in heart rhythm, rate and amplitude can be evaluated and interpreted during a health assessment.
• Risk factors for peripheral artery disease, chronic venous status, and thromboembolic disease can be discussed during a health assessment.
• The Health Assessment includes a discussion of the locations of the peripheral pulses, obtaining an accurate history of the peripheral vascular system, describing the structure and functions of arteries, veins, lymphatic vessels and lymph nodes, describing the equipment necessary to perform a peripheral vascular examination, evaluating and interpreting variations in heart rhythm, rate and amplitude, discussing risk factors for peripheral artery disease, chronic venous status, and thromboembolic disease.
• Check for pigmentation, rashes, scars, or ulcers on the legs.
• Check for brownish areas (or increased pigmentation on dark-skinned clients) near the ankles, which are caused by hemosiderin released from the red blood cells that seep into the skin with edema and break down.
• Notice the venous pattern and any venous enlargement or varicosities on the legs.
• The popliteal pulse should be felt in a flexed patient’s knee, with the leg relaxed, behind the knee and pressed deeply into the popliteal fossa.
• Palpate the pulses to assess the arterial circulation.
• Palpate for edema by comparing one foot and leg with the other, noting their relative size and the prominence of veins, tendons, and bones.
• Normally there should be no pitting edema.
• The severity of edema is graded on a four-point scale.
• Notice the distribution of hair on the lower legs, feet, and toes.