Nursing Process for Peripheral Vascular Circulation

Health history
Elicit a description of the client’s present illness and chief complaints, including onset, course, duration, location, and precipitating and alleviating factors. Assesses exercise tolerance (especially important in arterial disorders) and for pain caused by tissue ischemia. Cardinal signs and symptoms indicating altered peripheral vascular function include arterial insufficiency (e.g. pain with exercise, rest pain, absent or diminished pulses, dependent rubor) and venous insufficiency (e.g. aching, cramping, pulses are present, peripheral edema)

Explore the client’s history for modifiable risk factors, including smoking, hypertension, obesity, sedentary lifestyle, stress, diabetes mellitus. Also assess for nonmodificable risk factors, including heredity, gender and age.

Physical Examination
Inspection. An adequate supply of arterial blood to the extremities produces normal appearing skin and nails and good tissue healing.
• Assess skin color and temperature changes
• Coolness, possibly indicting deficient blood supply
• Pallor, associated with diminished blood supply
• Blenching, which may indicate diminished arterial pressure in a body part
• Rubor, which may occur with chronic ischemia
• Cyanosis, resulting from insufficient blood oxygen and if localized, indicating poor circulation in that area.
• Necrosis and ulceration, which can occur in arterial and venous disorders, with symptoms depending on cause.
• Assess for muscle atrophy and loss of strength and joint mobility, which occurs in chronic ischemia.

Palpation. Measure pulse volume using the peripheral pulse grading system: 0 (absent); 1+ (weak); 2+ (normal); 3+ (full); 4+ (bounding)

• Assess for bruits, which are heard most easily during systole, pitch correlates with degree of stenosis.
• Assess capillary refill time, which indicates peripheral perfusion and cardiac output; acceptable time is lesthan 3 seconds.
• Measure blood pressure, using the standard arm pressure measurement and ankle-arm index (i.e. ankle systolic pressure divided by arm systolic pressure). A normal ankle-arm index is greater than 1. An ankle-arm index of 0.5 to 0.8 indicates moderate outflow disease; an ankle-arm index of less than -.5 indicates severe outflow disease.

• Laboratory and diagnostic studies
• Doppler ultrasound is a simple, inexpensive, highly reliable procedure used to obtain qualitative and quantitative information electronically about blood flow in arteries or veins.
• Plethysmography is a procedure involving measurable changes in calf volume that correspond to changes in blood volume. This test procedure is used to assess changes in venous volume and carotid artery blood flow.
• The treadmill test is an exercise test done to evaluate total extremity blood flow after exercise and to detect pain occurring with exercise or signs of activity intolerance, such as shortness of breath.
• Digital subtraction angiography or digital IV angiography is a radiologic technique that uses an image-intensifier video system to display vessels on a television monitor.
• Phleboraphy (venography) is a procedure involving radiographic visualization of veins after injection of contrast medium.
• Angiography is a procedure involving radiologic visualization of arteries after injection of contrast medium.

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