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Assessment of the VascularSystem

Peripheral vascular diasease iscommon among older and diabeticclients. It is characterized bydisturbances of blood ow throughthe pcripheral vessels.thesedistubances eventually damage

tissues as a result ofischemia,ecessive accumulation ofwaste and uid, or both.

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!IS"#$%

&hen assessing the client,note ris'factors foratherosclerosis,diabetes,and cardiacas well as arterial,venous,andlymphatic disorders. Some clients arereluctant to mention what they

believe to be minormanifestations(swelling, intermittentdiscomfort). *onse+uently, perform a

careful assessment, as' specic

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-iographical and emograraphic

ata

-iographical data include the client/sthe clients age.Atherosclerosis(hardening of the

arteries) is more prevalent in olderpeople. Venous disease, althoughalso more prevalent in older clients,

may be identied in younger people.As' about occuption, and clarifywhether the occupation increases the

ris' for vascular disease.

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*urrent !ealth

As' about fre+uency and duration ofclinical manifestations that mayindicate a vascular disorder. "he

following section describes thetypical chief complaints of clientswho have arterial and venous

disorders.

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*hief *omplaint

Arterial disorders. In arterial insu0ciency ofthe lower etremities, the chief complaint isoften cramping leg pain in the calf muscles

during ambulation that disappears with 1 to2 minutes of rest. "he pain is calledintermittent claudication. *laudication is

predicrable and reproducible, which means

that (1)the client can wal' the same distanceeach time before pain occurs and (2) the painoccurs each time that this distance is wal'ed

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Symptom Analysis

Vascular disease may be arterial, venous, or lymphatic.*ompares the clinical manifestations of arterial and venousdisorders in the lower etremities. "he client who has venousdisease may report chronicaching pain in the legs when theyare in a dependent position. *hronic venous insu0ciency

produces the following manifestations3 4dema

ependent cyanosis

-rown discoloration of the s'in at the an'le

5lcers

Pruritus

*hronic arterial insu0ciency produces the followingmanifestations 3

ecrease or absence of arterial pulses

"hin, shiny, hairless s'in

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Past !ealth !istory

6ote any history of vascular impairment.In+uire about changes that indicatevasospastic disorders, such as changes in

color or temperature of digits. As' specicallywhether the client has a history ofhypertension, diabetes, stro'e, transientischemic attac's("IAs), changes in vision, painin legs during activity, legs cramps, phlebitis,venous or arterial blood clots, pulmonaryemboli, edema, varicose veins, leg ulcers, oretremities that are cold, pale, or blue.

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7amily !ealth !istory

"he family health history helpsdetermine ris' factors and providesclues about reported and observed

manifestations.

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Psyhosocial !istory

$ecord the occupational history. Ifthe client/s occupation is unfamiliarto you. As' +uestions about the

number of hours spent in variouspositions or activies ( standing,prolonged sitting, wal'ing, using

vibrating machinery ). In addtion,some occupations involve contactwith chemicals or are associated with

cold or wet environments, note these

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$eview of systems

$eview each body system as itrelates to peripheral vascuraldisorders. In+uire about headaches,

dizziness, "IAs, stro'e, visualdisturbances, hypertension, diabetes,pulmonary emboli, phlebitis, blood

clots, leg pain or cramps, varicoseveins, leg or foot ulcers, and coldhands or feet.

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P!%SI*A8 49A:I6A"I#6

Inspection S'in color

!air estribution

*apillary $ell

:uscle Atrophy

4dema

Venous Pattern

5lcers

Additional Inspections

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Palpation

"emperature Pulses Allen/s "est

!omans/ Sign

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AuscultationLimb Blood Preasure

"he measurement of arterial bloodpressure is the most commonly

performed noninvasive test ofcardiac and vascular function

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DIAGNOSTIC TESTS

Noninvasive Vascular LaboratorTec!ni"ues

oppler 5ltrasonography

An'le;-rachial Inde 5ltrasonic uple Scanning

Air Plethysmography

Impedance Plethysmography

4ercise "esting

*omputed "omography

:agnetic $esonance Imaging

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Invasive Tec!ni"ues

Angiography

Venography

Vascular 4ndoscopy ( Angioscopy )

Intravascular 5ltrasonography