Nursing Final Examination AL 2023 with Correctly Answered Questions, Exams of Nursing

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NURSING FINAL

EXAMINATION

AL 2023 WITH

CORRECTLY

ANSWERED

QUESTION

Chapter 12

The Peripheral Vascular System Anatomy and Physiology - Arteries Arteries must respond to the variations that cardiac systole and diastole generate in cardiac output Anatomy and size vary according to their distance from the heart Arterial pulses are palpable when artery lies close to body surface Arms

Brachial: at bend of elbow just medial to biceps tendon Radial: lateral flexor surface at wrist Ulnar: medial flexor surface (overlying tissues may obscure) Legs Femoral: below inguinal ligament Popliteal: passes medially behind the femur; palpable behind knee

Dorsalis pedis: dorsum of foot; lateral to extensor tendon of big toe Posterior tibial: behind medial malleolus of ankle Anatomy and Physiology - Veins Veins are thin-walled and highly distensible Deep veins Carry ~90% venous return from lower extremities and are well- supported by surrounding tissues Superficial veins

Subcutaneous with poor tissue support Include great saphenous and small saphenous veins Anastomotic veins connect two saphenous veins Perforating veins connect superficial (saphenous) system with deep system Deep, superficial, and perforating veins have one-way valves

Propel blood toward heart, preventing pooling, venous stasis, and backward flow Anatomy and Physiology – Lymphatic System Extensive vascular network that drains lymph from body tissues and returns it to venous circulation

Lymph nodes Round, oval, or bean-shaped structures Vary in size according to location Important role in body’s immune system Cells in lymph nodes engulf cellular debris/bacteria and produce antibodies Only superficial lymph nodes accessible to physical examination

Health History Common or concerning symptoms Pain in arms/legs Intermittent claudication Cold, numbness, pallor in legs, hair loss Swelling in calves, legs, or feet Color change in fingertips or toes in cold weather Swelling with redness or tenderness

Peripheral arterial disease (PAD) Intermittent claudication Ask patients, “Have you ever had any pain or cramping in the legs when walking or with exercise?” “Does the pain get better with rest?” Arterial spasm: fingers and toes Ask patients, “Do your fingertips or toes ever change color in cold weather or when you handle cold objects?” Venous peripheral vascular disease

Swelling of feet and legs Ask about ulcers on lower legs, often near ankles Health Promotion and Counseling Most patients with peripheral arterial disease (PAD) have no symptoms or non-specific symptoms Triad of exercise-induced calf pain that causes patient to stop exercise and experience relief of pain in 10 minutes is present in only 10% of affected patients

Screen for subclinical PAD Aggressive risk factor intervention Ankle-Brachial Index (ABI) Detects stenosis of 50% or more in major vessels of legs Measure systolic blood pressure (with Doppler ultrasonography) in each arm and in pedal pulses Calculate reading for right and left Divide arm pressure by ankle pressure

ABI 0.90-1.30: normal ABI 0.41-.90: mild to moderate disease ABI 0.00-0.40: severe disease with critical stenosis Techniques of Examination Important areas of examination Arms Size, symmetry, skin color Radial pulse, brachial pulse

Epitrochlear lymph nodes Legs Size, symmetry, skin color Femoral pulse and inguinal lymph nodes Popliteal, dorsalis pedis, and posterior tibial pulses Peripheral edema Techniques of Examination - Arms Inspect both arms from fingertips to shoulders

Note the following: Size, symmetry, and any swelling Venous pattern Color of skin and nail beds; texture of skin Palpate radial pulse

Use finger pads on flexor surface of wrist Partially flex patient’s wrist Compare pulse in both arms Palpate brachial pulse Flex elbow slightly Palpate artery medial to biceps tendon in antecubital crease Epitrochlear nodes

Flex elbow 90° Support forearm Feel in groove between biceps and triceps muscle, 3 cm above medial epicondyle Techniques of Examination - Legs Patient should lay down, draped so external genitalia is covered and legs are fully exposed MUST remove patient’s stockings or socks Inspect both legs from groin and

buttocks to feet Note the following: Size, symmetry, and any swelling Venous pattern/venous enlargement Pigmentation, rashes, scars, or ulcers Color and texture of skin, color of nail beds, distribution of hair on lower legs, feet, and toes Palpate superficial inguinal nodes

Horizontal/vertical groups Note size, consistency, and discreteness and tenderness Nontender, discrete nodes up to 1- cm are palpable in normal people Techniques of Examination – Palpate Pulses Femoral pulse Press deeply below inguinal ligament, midway between anterior superior iliac spine and symphysis pubis Popliteal pulse

Flex knee some, leg relaxed Place fingertips of both hands to meet midline behind knee and press deeply into popliteal fossa Dorsalis pedis pulse Feel dorsum of foot, lateral to extensor tendon of great toe Posterior tibial pulse Curve fingers behind and slightly below medial malleolus of ankle Grading Amplitude of Arterial Pulses



•



Bounding 

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Brisk, expected (normal) 



Diminish ed, weaker than expected 



0

Absent, unable to palpate Techniques of Examination - Edema

Compare one foot and leg with the other Note relative size and prominence of veins, tendons, and bones Check for pitting edema Press firmly with thumb for 5 seconds over dorsum of each foot, behind medial malleolus and shins Severity of edema graded on four- point scale (slight to very marked) If edema is present, look for causes

Recent deep venous thrombosis Chronic venous insufficiency Lymphedema Note color of skin Local area of redness Brownish areas near ankles Ulcers and where Thickness of skin Special Techniques

Evaluate arterial supply of the hand if you suspect arterial insufficiency Check radial, brachial, and ulnar pulses Perform Allen test If chronic arterial insufficiency is suspected (pain/ diminished pulses), check for postural color changes Evaluate competency of venous valves Assess retrograde filling

(Trendelenburg) test Question A patient you are seeing complains of a sore on his lower leg that does not seem to get better. Based on examination findings, you suspect venous insufficiency. Which of the clinical findings below would suggest venous insufficiency as the cause of his problem? Leg discomfort is exacerbated by dependency Hyperpigmentation is present around

the lower calf area Ulceration is present on the medial side of the ankle Affected leg feels warm to the touch All the above Answer e. All the above Question A patient you are seeing complains of severe pain in her right foot. Based on examination findings, you suspect arterial insufficiency. Which of the clinical findings below would