Assessment of the Vascular

System
Peripheral vascular diasease is
common among older and diabetic
clients. It is characterized by
disturbances of blood flow through
the pcripheral vessels.these
distubances eventually damage
tissues as a result of
ischemia,excessive accumulation of
waste and fluid, or both.

HISTORY
When assessing the client,note risk
factors for
atherosclerosis,diabetes,and cardiac
as well as arterial,venous,and
lymphatic disorders. Some clients are
reluctant to mention what they
believe to be minor
manifestations(swelling, intermittent
discomfort). Consequently, perform a
careful assessment, ask specific

Biographical and Demograraphic

Data
Biographical data include the clients
the clients age.
Atherosclerosis(hardening of the
arteries) is more prevalent in older
people. Venous disease, although
also more prevalent in older clients,
may be identified in younger people.
Ask about occuption, and clarify
whether the occupation increases the
risk for vascular disease.

Current Health
Ask about frequency and duration of
clinical manifestations that may
indicate a vascular disorder. The
following section describes the
typical chief complaints of clients
who have arterial and venous
disorders.

Chief Complaint
Arterial disorders. In arterial insufficiency of
the lower extremities, the chief complaint is
often cramping leg pain in the calf muscles
during ambulation that disappears with 1 to
2 minutes of rest. The pain is called
intermittent claudication. Claudication is
predicrable and reproducible, which means
that (1)the client can walk the same distance
each time before pain occurs and (2) the pain
occurs each time that this distance is walked

Symptom Analysis
Vascular disease may be arterial, venous, or lymphatic.
Compares the clinical manifestations of arterial and venous
disorders in the lower extremities. The client who has venous
disease may report chronicaching pain in the legs when they
are in a dependent position. Chronic venous insufficiency
produces the following manifestations:
Edema
Dependent cyanosis
Brown discoloration of the skin at the ankle
Ulcers
Pruritus
Chronic arterial insufficiency produces the following
manifestations :
Decrease or absence of arterial pulses
Thin, shiny, hairless skin

Past Health History

Note any history of vascular impairment.
Inquire about changes that indicate
vasospastic disorders, such as changes in
color or temperature of digits. Ask specifically
whether the client has a history of
hypertension, diabetes, stroke, transient
ischemic attacks(TIAs), changes in vision, pain
in legs during activity, legs cramps, phlebitis,
venous or arterial blood clots, pulmonary
emboli, edema, varicose veins, leg ulcers, or
extremities that are cold, pale, or blue.

Family Health History

The family health history helps
determine risk factors and provides
clues about reported and observed
manifestations.

Psyhosocial History
Record the occupational history. If
the clients occupation is unfamiliar
to you. Ask questions about the
number of hours spent in various
positions or activies ( standing,
prolonged sitting, walking, using
vibrating machinery ). In addtion,
some occupations involve contact
with chemicals or are associated with
cold or wet environments, note these

Review of systems
Review each body system as it
relates to peripheral vascural
disorders. Inquire about headaches,
dizziness, TIAs, stroke, visual
disturbances, hypertension, diabetes,
pulmonary emboli, phlebitis, blood
clots, leg pain or cramps, varicose
veins, leg or foot ulcers, and cold
hands or feet.

PHYSICAL EXAMINATION
Inspection
Skin color
Hair Destribution
Capillary Refill
Muscle Atrophy
Edema
Venous Pattern
Ulcers
Additional Inspections

Palpation

Temperature
Pulses
Allens Test
Homans Sign

Auscultation
Limb Blood Preasure
The measurement of arterial blood
pressure is the most commonly
performed noninvasive test of
cardiac and vascular function

DIAGNOSTIC TESTS
Noninvasive Vascular Laboratory
Techniques
Doppler Ultrasonography
Ankle-Brachial Index
Ultrasonic Duplex Scanning
Air Plethysmography
Impedance Plethysmography
Exercise Testing
Computed Tomography
Magnetic Resonance Imaging

Invasive Techniques

Angiography
Venography
Vascular Endoscopy ( Angioscopy )
Intravascular Ultrasonography