Topics

• Peripheral Vascular System
• Lymphatic System
• Pediatric Variations

NDNP 819: Advanced Health Assessment Across the Lifespan

Module: Peripheral Vascular and Lymphatic System

Peripheral Vascular System

History Components

With the peripheral vascular system, it is important to remember that arterial and venous insufficiency present differently and therefore in your history taking it is essential to ask about pain, edema, color and temperature changes in skin. Arterial insufficiency usually presents with less edema, more pain, a cool temperature and pallor with elevation, whereas venous insufficiency has more edema, less pain, a normal temperature and hyperpigmented color. Always ask about pain at rest and/or with activity. Pain with ambulation that is relieved by rest is intermittent claudication.

Medication History:

Specifically think about- Aspirin, Anticoagulants, AntihypertensivesNitro patch or spray, Clopidogrel (Plavix), Beta-Blockers, Calcium channel blockers, Digoxin, Statins, Oral contraceptive pills, Hormone replacement therapy.

Past Medical History:

Has the patient ever been told or diagnosed with: history of coronary artery disease, atrial fibrillation, heart failure, hypertension, stroke, hyperlipidemia, diabetes, cancer, previous infarcts. Any history of kidney disease (kidney failure causes fluid retention), or liver disease (may cause ascites that contributes to peripheral edema). Is this pt. pregnant or been diagnosed with a hypercoagulable state such as Factor V Leiden? Other Risk factors for PVD include smoking, immobilization such as bed rest, long car rides or plane trips.

Surgical History:

Has the patient ever had a cardiac bypass graft, stent, angioplasty, or pacemaker? Any recent surgery?

Family Medical History:

Does the patient know if their mom, dad, siblings or grandparents had any of these conditions?

Hypercoagulable states, congenital heart disease, murmurs, palpitations, abnormal EKG, High blood pressure, MI, high cholesterol, stroke, heart failure, peripheral vascular disease (poor circulation), dialysis, diabetes or cancers? Did anyone die < age 50 or did anyone die suddenly without a known cause? Did any first degree relatives have an abdominal aortic aneurysm?

Social History:

Smoking (pack-years), alcohol use, illicit drug use, stress.

Diet and Exercise?

Usual foods, typical day. Diet high in fat or cholesterol? What do you do for exercise?

Occupational and Travel History:

What do they do for work? Any exposures that would be a risk factor for heart disease? (Long distance driver, NFL coach, pilot etc.). Any recent long car or plane rides?

Review of Systems: 

These systems need to be included in the PV ROS: Remember to use lay terms when asking your patient.

General: Weakness, fatigue, weight change, fever, night sweats

Skin: loss of hair on extremities or head? Any thinning of skin, ulcers or necrosis, skin color changes?

CV: Any high blood pressure, chest pains, palpitations, orthopnea, paroxysmal nocturnal dyspnea?

Pulmonary: Any cough or sputum (color or quantity)? trouble breathing (dyspnea), wheezing.

Abdomen: Any Abdominal pain, trouble swallowing, heartburn, appetite, nausea, change in bowels, diarrhea, red or black stools

Extremities: Any swelling or pain including cramp like pain, color changes in fingertips or toes during cold weather? Does pain in extremity occur at rest or activity or both?

GU: Any impotence?

Physical Exam of the PV System

Please see this link and click on each bar for review. Start with General and end at Special tests.