{"id":1187,"date":"2022-11-05T14:16:19","date_gmt":"2022-11-05T18:16:19","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/subjective-assessment-2-2\/"},"modified":"2024-05-03T15:45:52","modified_gmt":"2024-05-03T19:45:52","slug":"subjective-assessment-2-2","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/subjective-assessment-2-2\/","title":{"raw":"Subjective Assessment","rendered":"Subjective Assessment"},"content":{"raw":"Subjective assessment of the peripheral vascular system (PVS) involves asking questions about the health of the client and symptoms that occur because of pathologies that affect the vasculature of the body. A full exploration of these pathologies is beyond the scope of this chapter, but common problems associated with this system include [pb_glossary id=\"1318\"]peripheral vascular disease[\/pb_glossary] (PVD), [pb_glossary id=\"1320\"]atherosclerosis[\/pb_glossary], [pb_glossary id=\"1322\"]arteriosclerosis[\/pb_glossary], [pb_glossary id=\"1324\"]venous stasis[\/pb_glossary], [pb_glossary id=\"1326\"]varicose veins[\/pb_glossary], and [pb_glossary id=\"1328\"]ulcers[\/pb_glossary].<\/span>\r\n
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Knowledge Bites<\/strong><\/h2>\r\n<\/header>\r\n
\r\n\r\nMany peripheral vascular symptoms are related and are caused by the same issue. See Table 2<\/strong>\u00a0for the signs and symptoms of arterial and venous issues and watch Video 1<\/strong>:\u00a0<\/span>\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=RE4GO56oEHA[\/embed]\r\n\r\nVideo 1<\/strong>:<\/span> \u200b\u200bArterial and venous issues [5:00]\r\n\r\nPeripheral arterial issues<\/strong> occur when there is a problem with perfusion (blood flow is restricted or blocked) in the arteries due to a blockage. This can be caused by atherosclerosis<\/strong> (narrowing of the arteries caused by plaque build up on the arterial walls) and arteriosclerosis<\/strong> (hardening, stiffening and loss of elasticity of the arterial walls); these are both forms of peripheral arterial disease. When blood flow is restricted, oxygen and nutrients are not efficiently delivered to body tissues. When tissues in the periphery do not get sufficient oxygen-rich blood, hypoxia can develop, leading to pain, numbness, ulcers, fatigue, and other symptoms and signs. However, it\u2019s important to note that many clients with arterial disease don\u2019t have symptoms, so your assessment of risk factors is important.<\/span>\r\n\r\nPeripheral venous issues<\/strong> are related to venous insufficiency: veins in the periphery (typically the legs) restrict the return of blood to the heart, causing venous stasis<\/strong> (collection or pooling of blood) in the peripheral limbs (typically the feet and lower legs). This is often caused when the one-way venous valves are not working properly and allow backflow of blood, as opposed to the forward movement of blood. It can also be caused by blood clots. [pb_glossary id=\"1332\"]Venous hypertension[\/pb_glossary] and varicose veins can arise secondary to venous insufficiency and venous stasis (Anwar et al., 2021). Varicose veins<\/strong> (see Figure 4<\/strong>) are dilated, bulging, and twisted veins that can be superficial (observed on the skin\u2019s surface) or deep within the leg and not visible upon inspection. You may hear the term tortuous veins, which refers to twisted veins. Varicose veins can have a genetic component and can also have primary causes that are relatively unknown (Anwar et al., 2021). Some varicose veins are painful and depending on the associated cause may result in blood clots. Another venous issue is spider veins <\/strong>(Figure 5<\/strong>), which appear as small flat dark red, blue, or purple venous patterns close to the surface. Spider veins can cause body image issues, but they are not painful and are not related to serious problems such as blood clots.\u00a0<\/span>\r\n\r\n\"Normal\r\n\r\nFigure 4<\/strong>: Comparison of a normal and varicose vein.<\/span>\r\n\r\n(Attribution: Photo by National Heart Lung and Blood Institute. - Varicose veins., Public Domain,<\/span> https:\/\/commons.wikimedia.org\/w\/index.php?curid=6885995<\/a>)\r\n\r\n\"Flat\r\n\r\nFigure 5<\/strong>: Spider veins.\r\n\r\n \r\n\r\nTable 2<\/strong>: Venous and arterial issues signs and symptoms.\r\n\r\n\r\n\r\n\r\n
Venous issues<\/strong><\/td>\r\nArterial issues<\/strong><\/td>\r\n<\/tr>\r\n
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    \r\n \t
  • Dull achy pain, tiredness, and a heavy and full feeling in the legs (typically worse toward end of day and when standing).<\/span><\/li>\r\n \t
  • [pb_glossary id=\"1334\"]Edematous[\/pb_glossary] feet and legs including [pb_glossary id=\"1336\"]pitting edema[\/pb_glossary].<\/span><\/li>\r\n \t
  • Warm skin temperatures in feet and legs.<\/span><\/li>\r\n \t
  • Coarse and thickened texture with flaky skin.<\/span><\/li>\r\n \t
  • Erythema, hyperpigmentation, and brownish\/yellowish skin discolouration. The discolouration is sometimes referred to as brawny (brown-reddish discolouration). Red blood cells accumulate in the interstitial space and cause hemosiderin staining from the blood leaking out of capillaries.\u00a0<\/span><\/li>\r\n \t
  • Pulses present, but may need to use a Doppler ultrasound device due to the quantity of edema.<\/span><\/li>\r\n \t
  • Irregularly shaped ulcers. Although they are often found anywhere on the lower limbs, they are typically on the medial (inside) [pb_glossary id=\"1338\"]malleoli[\/pb_glossary] and medial side of the leg with an exudative base and a shallow depth (London & Donnelly, 2000; Vivas et al., 2016). See Figure 6<\/strong>.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n
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