6020 vascular exam |206 questions and answers 2023(verified for accuracy)

What are the 3 arteries in the arms we need to know for the exam? Brachial, Radial and Ulnar (RUB) What are the 4 arteries we need to know in the legs for the exam? Femoral (check in cardiac patients for pulse), Popliteal (behind knee and need to press deep and use both hands to feel), Dorsalis Pedis (top of the foot), Posterior Tibial (behind ankle; medial) What are two other arteries we need to know for exam? Temoral Artery (for temperature reasons) and Carotid Artery If someone has Peripheral Artery Disease (PAD) what should you always do? Check all of the arteries for pulses in case there is an occlusion. What artery allows you to feel the largest pulse and if it's weak, it's a huge problem? Femoral What do you do if you cannot feel a pulse lower in the body? Keep going up the body to feel for other pulses If you feel a pulse in the lower extremity on a routine patient, what do you do? Nothing. There is already a pulse, so you don't need to check for more. You can feel a pulse in a vein: true or false? False What do you check for in assessing veins? Jugular Venous Distention (JVD) What kinds of veins have one-way valves? Deep, Superficial and Perforating What are the names of some superficial veins? Great Saphenous, Small Saphenous, Anastomotic Veins (Connect two saphenous veins) and Perforating (Connect superficial (saphenous system) with deep system). Can you palpate veins? No. This is why observation of the Jugular Vein is important. What is the difference (anatomically) between an artery and a vein? Veins have valves and have a larger diameter. There are also more veins than arteries. What is a major problem with veins? They may have faulty valves that become limp and leak and will no longer keep unidirectional flow. What are some arterial issues with our older population? -Arteries calcify and lose elasticity and vasomotor tone. -Peripheral arteries lengthen, become tortuous (crooked) and are less resilient (can kink and decrease flow) -Many people can get Atherosclerosis -Increased peripheral vascular resistance which increases BP due to decrease in artery lumen size -Loss of vessel elasticity can lead to HTN What are two pulses that are difficult to find in older adults and what do you do? Dorsalis pedis and Tibial Pulses are difficult to find, so you would have to dopple. (*These are at extremities, so it makes sense) True or False: Leg Edema is an arterial problem. False...leg edema is always a venous problem What is Claudication? Episodic muscular ischemia induced by exercise due to atherosclerosis of large or medium-size arteries. How is claudication brought on and how is it relieved? Brought on by walking and exercising; relieved with rest. *Patients can have claudication with rest also, but it intensifies with activity* If someone has claudication, where do they usually have pain? In their calves What are the three types of pain patients who have claudication normally experience? Aching, Throbbing and Burning in calf muscle. What happens to the systemic vascular resistance when a woman is pregnant? Decreases due to increased systemic dilation. What happens to a woman's BP when she is pregnant? Decreases a little bit due to increased systemic dilation and decreased vascular resistance. What happens if a woman's BP increases while she is pregnant? She may have pre-eclampsia Why will you see edema during pregnancy? The enlarged uterus compresses the vena cava and there is impaired venous return. When does the BP rise back to normal during childbearing? 20 Weeks Post-Partum If BP rises to 140/90 and is sustained during childbearing, what may this indicate? Pregnancy Induced Hypertension What are two other findings may you observe in a pregnant woman? Varicose Veins (blood pooling to dependent areas) and Hemorrhoids. What are two important findings of when a newborn changes from fetal circulation to an individual circulation? Clamping the umbilical changes the pressure and the lungs expand. What age are radial pulses for HR accurate in an infant? 2 Years What is the most reliable pulse to check in an infant? Apical True or False: Radial Pulses are more palpable than Brachial Pulses in Infants? False remember brachial is best closest to birth What are the three pulses that can be found easily in infants? Radial, Brachial (better than Radial) and Femoral. If you find someone has a cap refill that is 2 seconds, what is this indicative of? Decreased blood flow (fluid volume) which decreases tissue perfusion. What is the best age to begin taking BPs in children? Age 3, unless they are hospitalized (then you would take them all the time) What happens to a child with a venous hum? Nothing. It is actually a normal finding in infants and has no pathologic significance b/c vasculature isn't as stiff. *In an adult, this would be abnormal* What is a venous hum and how do you listen for it? A venous hum is turbulent flow in the internal jugular veins and you listen for it with the bell portion of the stethoscope. True or False: Venous thrombosis is more common in children? False 1-3% of children in the US have hypertension. What is it normally caused by? Children- often caused by Renal Disease Teen- often caused by or r/t Obesity What is Raynaud's Syndrome and where do you find more problems with it? It is a vascular flow problem r/t nerve control. It is found more in the legs than arms b/c legs are further from your heart (where there is more blood). What are some vascular things to look for in a Health History? -Pain in arms/legs -Intermittent Claudication -Cold, numbness, pallor, hair loss -Swelling in calves, legs, feet -Color change in fingertips or toes in cold weather -Swelling w/ redness or tenderness What do we look for in past medical history to note if someone has a peripheral problem? Peripheral Artery Disease (PAD), Venous Peripheral Disease (PVD), HTN, Diabetes...etc.. *Remember there is a huge difference between PAD and PVD** Which artery has the highest risk for an aneurysm and why? The Aorta b/c it has increased pressure When is an Abdominal Aortic Aneurysm (AAA or "triple A") a HUGE problem? When the aneurysm is 5-5.5 cm How do you fix an AAA? You need to repair or patch it when than 5-5.5 cm or it is like a time bomb b/c it will blow and blood loss is massive. What happens when you have varicose veins and what are you at risk for? The valves in the veins are engorged and don't work right anymore. Blood doesn't get back up to the great veins and remains pooled. Patients are at risk for clotting or DVT. In which populations would you observe the most varicose veins and what could be done to prevent them? They are seen in nurses, pregnant women and obese individuals. To prevent them, you would wear compression stockings. What are spider veins? Spider veins are smaller varicose veins. What is "normal" on the edema scale? "0" means no edema. John has SEVERE edema in his legs. When you press your thumb on his legs for five seconds you notice pitting that is at least 8 cm. What is his edema score? 4+ - indicates 8 mm It is Sarah's first time coming to see you in the clinic. What arteries would you palpate and how would you work the process? Palpate: Carotid (in the neck) Brachial and Radial (the arms) Femoral, Popliteal, Dorsalis pedis and Posterior Tibial (the legs.) -Compare the strength of the arteries bilaterally and the rate and rhythm throughout. Compare upper to lower and left to right. -Never palpate both carotids simultaneously, or someone will pass out. Lucy has a normal arterial pulse. What is her grade? 2+ Brisk, expected (Normal) Jerry comes to the clinic and you cannot feel his carotid pulse. What is his grade on the scale and what should you do? His grade is a 0 - Absent, unable to palpate. You would go to dopple to try to find a pulse that way. When do you auscultate the arteries? After you have inspected and palpated them. What is a bruit and what may it indicate? A bruit is a blowing, swishing sound that is heard with the bell of the stethoscope and indicates an atherosclerotic narrowing due to turbulent sound. What does the Allen Test evaluate? Arterial insufficiency of the hand What is the process for doing an Allen Test? -Compress both radial and ulnar arteries -Close and open fist 5 times -Release ulnar artery ONLY and check for reperfusion If you want to know someone's BP constantly, what do you do? You want to do an arterial line (cath ran into arterial space to check BP constantly) What are the three "Ps" to look for with Peripheral Artery Disease (PAD)? Pain, Pallor and Pulselessness What is an acute process that may result from injury, external compression or thrombophlebitis? Venous Obstruction/Insufficiency What are the symptoms for Thrombosis (clot)? Swelling, Pain, Warmth, Redness