Chapter 22: Assessing Peripheral Vascular System
A nurse experiences difficulty with palpation of the dorsalis pedis pulse in a client with arterial insufficiency. What is an appropriate action by the nurse based on this finding? a) Assess adequacy of blood flow using a Doppler device. b) Attempt to palpate the posterior tibial pulse. c) Check the extremity for findings of decreased blood flow. d) Obtain an order for ankle brachial index test to be performed
a) Assess adequacy of blood flow using a Doppler device. Arterial insufficiency causes a decrease in the amount of blood flow to an extremity. If the blood flow is diminished significantly, the adequacy of the pulse may also diminish. Therefore, if a pulse cannot be palpated, the nurse's best action is to obtain a Doppler device to assess for adequate blood flow. A Doppler device works by transmitting ultra-high-frequency sound waves in a way that they strike red blood cells in an artery or vein. This rebounding ultrasound waves produces a whooshing sound that is transmitted through the Doppler. Attempting to palpate the posterior tibial pulse does not provide information about the dorsalis pedis pulse. Checking the extremity for findings of decreased blood flow is not necessary because the nurse is already aware that the client has arterial insufficiency and needs to determine the extent, not the presence, of the disease. The ankle brachial index is a much more complex test that can be performed after the Doppler determines whether or not a pulse is present.
A client with peripheral vascular disease is discharged from the health care facility. Which risk reduction teaching tip should the nurse discuss during discharge teaching? a) Avoid smoking. b) Decrease dietary fiber intake. c) Limit physical activity. d) Eat a low-protein diet.
a) Avoid smoking. The nurse should encourage the client to stop smoking, because it causes vasoconstriction (also contributes to further plaque formation), which increases the complications brought about by peripheral vascular disease. The nurse should ask the client to increase, not decrease, dietary fiber intake, and to eat a low-fat diet, not a low-protein diet. The nurse should ask the client to get regular exercise and maintain a moderate level of physical activity rather than avoid physical activity. Regular exercise improves peripheral vascular circulation and decreases stress, pulse rate, and blood pressure, thereby decreasing the risk for developing peripheral vascular disease.
A nurse palpates a client's hands and fingers. Which of the following findings would be consistent with arterial insufficiency? a) Cool skin b) Epitrochlear lymph nodes not palpable c) Capillary refill time of 2 seconds d) Bilateral radial pulses of 2+
a) Cool skin A cool extremity may be a sign of arterial insufficiency. The other findings listed are all normal.
On questioning a client with peripheral edema during an interview, the nurse learns that the client has a sedentary job and drinks little water throughout the day. What underlying condition is the client most likely to have, based on these findings? a) Deep vein thrombosis b) Varicose veins c) Systemic bacterial infection d) Peripheral artery disease
a) Deep vein thrombosis Peripheral edema (swelling) results from an obstruction of the lymphatic flow or from venous insufficiency from such conditions as incompetent valves or decreased osmotic pressure in the capillaries. It may also occur with deep vein thrombosis (DVT). Risk factors for DVT include reduced mobility, dehydration, increased viscosity of the blood, and venous stasis, such as would occur with a sedentary job. Neither a systematic bacterial infection nor peripheral artery disease would result in peripheral edema, nor would they be associated with the risk factors listed. Varicose veins are associated with the risk factors listed but, by themselves, do not result in peripheral edema.
In assessing a client, a nurse palpates her epitrochlear lymph nodes and notes that the client may have an infection in the hand or forearm. The nurse understands that which of the following are functions of the lymphatic system? Select all that apply. a) Drains excess fluid and plasma proteins from tissues and returns them to the venous system b) Delivers oxygen, water, and nutrients to the tissues c) Returns blood to the heart d) Traps and destroys microorganisms and foreign materials filtered from lymph e) Absorbs fats from the small intestine into the bloodstream
a) Drains excess fluid and plasma proteins from tissues and returns them to the venous system, d) Traps and destroys microorganisms and foreign materials filtered from lymph, e) Absorbs fats from the small intestine into the bloodstream The primary function of the lymphatic system is to drain excess fluid and plasma proteins from bodily tissues and return them to the venous system. These capillaries join to form larger vessels that pass through filters known as lymph nodes. The filtering, trapping, and destruction of microorganisms, foreign materials, dead blood cells, and abnormal cells by the lymph nodes allows the lymphatic system to perform a second function as a major part of the immune system defending the body against microorganisms. A third function of the lymphatic system is to absorb fats (lipids) from the small intestine into the bloodstream. The capillaries, not the lymphatic system, deliver oxygen, water, and nutrients to the tissues. Veins, not the lymphatic system, return blood to the heart.
A nurse performs the Allen test to evaluate the patency of the radial and ulnar arteries for a client who is to undergo a radial artery puncture. What precaution should the nurse take to prevent a false-positive test? a) Ensure that the client's hand is not opened in exaggerated extension b) Have the client rest the hand palm side up and make a fist c) Use the thumbs to occlude the radial and ulnar arteries d) Keep both arteries occluded and have the client release the fist
a) Ensure that the client's hand is not opened in exaggerated extension Opening the hand into exaggerated extension may cause persistent pallor, giving a false-positive test; the nurse should ensure that the client's hand is not opened in exaggerated extension. To perform the test, the nurse is required to have the client rest the hand palm side up and make a fist, use the thumbs to occlude the radial and ulnar arteries, and keep both arteries occluded and have the client release the fist.
A nurse has just inspected a standing client's legs for varicosities. The nurse would now like to assess for suspected phlebitis. Which of the following should the nurse do next? a) Lightly palpate the client's leg veins for tenderness b) Use a Doppler ultrasound device on the client's leg c) Dorsiflex the client's foot and apply light pressure lateral to and along the side of the extensor tendon of the big toe d) Have the client sit down
a) Lightly palpate the client's leg veins for tenderness To fully assess for a suspected phlebitis, lightly palpate for tenderness. The client should still be standing from the inspection of the legs. A Doppler ultrasound device is used to assess for pulses when they are difficult to palpate. Dorsiflexing the client's foot and applying light pressure along the extensor tendon of the big toe are done when palpating for the dorsalis pedis pulses.
A nurse recognizes that what change is considered normal in the lymphatic system of the elderly? a) Lymph nodes are smaller and fewer in number. b) Tenderness is common, especially in the lower extremities. c) Irregularity of shape and size increase with age. d) Swelling occurs more frequently and lasts longer.
a) Lymph nodes are smaller and fewer in number. The lymph nodes of the elderly client are smaller in size and fewer in number because lymphatic tissue is lost with advancing age. Tenderness, swelling, and irregular shape are indications of abnormal lymph nodes and should be fully assessed and reported to the health care provider.
Before beginning the assessment of the peripheral vascular system, a nurse should take what action to best facilitate the exam and ensure accurate results? a) Make sure the temperature in the room is comfortable. b) Place the client in a position of comfort for the entire exam. c) Ensure proper lighting in the room. d) Allow client to empty the bladder.
a) Make sure the temperature in the room is comfortable. The nurse should assist the client into a gown and make sure the room temperature is comfortable. If the client becomes cold, vasoconstriction may occur, which causes a decrease in circulation. If the room is too warm, vasodilation may occur, which increases circulation. An empty bladder is not necessary to the examination of the peripheral vascular system but may make the client more comfortable during the entire exam. Proper lighting is important for examination of the skin. The client may sit for examination of the upper extremities but will be asked to lie down for the examination of the lower extremities.
A nurse assists the client to perform the position change test for arterial insufficiency. While the client is dangling the legs, the nurse observes a return of color to the feet in 8 seconds. How should the nurse document the finding for this test? a) Normal b) Brisk c) Delayed d) Inconclusive
a) Normal Return of a pink color to the legs after dangling them should take less than 10 seconds. Thus, this result is normal and does not indicate arterial insufficiency. Delayed would be greater than 10 seconds for color to return
A client complains of pain in the calves, thighs, and buttocks whenever he climbs more than a flight of stairs. This pain, however, is quickly relieved as soon as he sits down and rests. The nurse should suspect which of the following conditions in this client? a) Peripheral arterial disease b) Advanced chronic arterial occlusive disease c) Neuropathy secondary to diabetes d) Venous disease
a) Peripheral arterial disease Intermittent claudication is characterized by weakness, cramping, aching, fatigue, or frank pain located in the calves, thighs, or buttocks but rarely in the feet with activity. These symptoms are quickly relieved by rest but reproducible with same degree of exercise and may indicate peripheral arterial disease (PAD). Leg pain that awakens a client from sleep is often associated with advanced chronic arterial occlusive disease. A lack of pain sensation may signal neuropathy in such disorders as diabetes. Heaviness and an aching sensation aggravated by standing or sitting for long periods of time and relieved by rest are associated with venous disease.
On inspection of a client's legs, the nurse has found varicose veins. Which test should the nurse next perform to determine the competence of the saphenous vein valves? a) Trendelenburg test b) Position change test c) Ankle-brachial pressure index (ABPI) d) Allen test
a) Trendelenburg test If the client has varicose veins, perform the Trendelenburg test to determine the competence of the saphenous vein valves and the retrograde (backward) filling of the superficial veins. The ABPI is considered an accurate objective assessment for determining the degree of peripheral arterial disease. The position change test is done to further assess for arterial insufficiency in the legs following the determination of weak pulses. The Allen test evaluates patency of the radial or ulnar arteries. It is implemented when patency is questionable or before such procedures as a radial artery puncture.
Which statement demonstrates correct technique by a nurse when using the Doppler device to locate peripheral pulses? a) Warming the gel will help to avoid vasoconstriction at the site. b) Avoid marking the skin because this will interfere with sound transmission. c) Press the device firmly against the skin to ensure good contact. d) Use a 90-degree angle to avoid dampening the sound waves.
a) Warming the gel will help to avoid vasoconstriction at the site. Warming the gel will help to avoid vasoconstriction at the site. Vasoconstriction will make it more difficult to obtain a signal. The Doppler device should be held at a 45- to 60-degree angle and placed lightly on the area to avoid occluding the vessel being assessed. If repeated assessments are needed, marking the site with a waterproof pen is helpful.
A nurse assesses the peripheral vascular system of a client who is in the supine position. What further assessment should the nurse perform if unable to palpate the left popliteal pulse? a) Palpate the right leg with the client in supine position. b) Assist the client to the prone position and palpate again. c) Elevate and palpate the left leg in supine position. d) Place the client in the lateral position and palpate.
b) Assist the client to the prone position and palpate again. If the nurse is unable to palpate the popliteal artery with the client in supine position, the nurse should assist the client to prone position and palpate again. If the nurse is still unable to palpate, a Doppler should be used. The nurse may partially raise the client's leg and place the fingers deep in the bend of the knee when in prone position, not in supine position. The nurse need not assist the client to lateral position and palpate.
A nurse cares for a client who is postoperative cholecystectomy. Which action by the nurse is appropriate to help prevent the occurrence of venous stasis? a) Assist in active range-of-motion exercise of the upper body. b) Assist the client to walk as soon and as often as possible. c) Massage lower extremities vigorously every 6 hours. d) Raise the foot of the bed for an hour and then lower it.
b) Assist the client to walk as soon and as often as possible. Immobility creates an environment in which clotting (embolism formation) can be caused by venous stasis. Active exercise such as having the client ambulate as soon as possible will stimulate circulation and venous return. This reduces the possibility of clot formation. Raising the foot of the bed, vigorous massage, and active range of motion of the upper body may not prevent venous stasis.
A client presents with lymphedema in one arm, with nonpitting edema. Which of the following should the nurse assess for, based on this finding? a) Presence of deep vein thrombosis b) History of breast surgery c) Presence of peripheral artery disease d) History of Raynaud's disorder
b) History of breast surgery Lymphedema results from blocked lymphatic circulation, which may be caused by breast surgery. It usually affects one extremity, causing induration and nonpitting edema. Raynaud's disorder is a vascular disorder caused by vasoconstriction or vasospasm of the fingers or toes and is typically bilateral. Peripheral artery disease involves reduced blood flow to the limbs and is characterized primarily by intermittent claudication, not by edema. Deep vein thrombosis is caused by obstruction of the veins and is not associated with lymphedema.
A nurse performs the Trendelenburg test for a client with varicose veins. Which action should the nurse take when performing this test? a) Have the client stand upright after tourniquet removal b) Legs should be elevated for 15 seconds c) Tourniquet should be put on before leg elevation d) Ensure that the client's legs are over the side of the bed
b) Legs should be elevated for 15 seconds When performing the Trendelenburg test, the nurse should elevate the client's leg for 15 seconds to empty the veins. The tourniquet should be put on after leg elevation. The client should stand upright with the tourniquet on the leg. The client is not asked to sit with the leg hanging down when performing the Trendelenburg test.
A nurse palpates the presence of an enlarged epitrochlear lymph node. Which area of the client's body should the nurse thoroughly examine to assess for the source of this finding? a) Abdomen, noting any organ enlargement or tenderness b) Lower arm and hand for erythema and swelling c) Head and neck for recent ear infection or sore throat d) Cervical lymph nodes for tenderness and swelling
b) Lower arm and hand for erythema and swelling The epitrochlear nodes are located in the upper inside of the arm. Enlargement of these nodes may indicate infection in the hand or forearm or they may occur with generalized lymphadenopathy. Cervical lymph nodes are part of the system that drains the head and neck, and enlargement would be due to a recent ear infection, sore throat, or other upper respiratory tract infection. Inflammation or infection in the abdomen would drain into the inguinal nodes located in the groin area.
A client is admitted with leg ulcers to the health care facility. During the collection of objective data, which assessment finding should indicate to the nurse that the client's leg ulcers are due to arterial insufficiency? a) Reports of aching, cramping pain b) Pallor of foot occurs with elevation c) Irregular-shaped ulcer on the inner aspect of the ankle d) Ulcer located on medial malleolus
b) Pallor of foot occurs with elevation Ulcers due to arterial insufficiency would have elevation pallor of the foot due to poor blood supply. Aching and cramping pain is present in ulcers caused by venous insufficiency. Irregular-shaped ulcers and ulcers located on the medial malleolus are characteristics of venous insufficiency ulcers.
A nurse recognizes which finding as an indication of an ulcer due to arterial insufficiency? a) Painful ulcer with irregular border b) Moderate to severe leg edema c) Deep ulcers that often involve joint space d) Ulcer commonly located in anterior tibial area
c) Deep ulcers that often involve joint space Clients with ulcers due to arterial insufficiency usually have deep ulcers that often involve joint space. Ulcers due to venous insufficiency may be located in the anterior tibial area, have irregular borders, and are associated with moderate to severe edema. Ulcers due to arterial insufficiency are located on tips of toes, toe webs, heels, or other pressure areas if confined to bed. These ulcers are painful and circular in shape.
A client presents to the health care clinic with a 3-week history of pain and swelling of the right foot. A nurse inspects the foot and observes swelling and a large ulcer on the heel. The client reports the right heel is very painful and he has trouble walking. Which nursing diagnosis should the nurse confirm from these data? a) Risk for Skin Breakdown b) Fear of Loss of Extremity c) Impaired Skin Integrity d) Imbalanced Nutrition
c) Impaired Skin Integrity This client demonstrates Impaired Skin Integrity as evidenced by the ulcer on his heel. With the location and the presence of pain, this is most likely to be an ulcer of arterial insufficiency. The client has not verbalized any fear at this time. With the existing skin breakdown, he is not at risk because it is present. No nutritional imbalances are documented.
A nurse recognizes that a common complication of vascular surgery may manifest as which assessment finding? a) Tenderness on plantar flexion b) Pallor of the leg on elevation c) Pain in the calf muscles d) Cramping pain in both thighs
c) Pain in the calf muscles Clients undergoing vascular surgery are at increased risk for the development of deep vein thrombosis. The Homan's test has traditionally been used to detect the presence of a blood clot within a vessel. Homan's sign is positive if the client experiences tenderness or pain in the calf muscles on flexing the knee, and aching or cramping on dorsiflexion of the foot. Cramping pain in thighs may not be elicited by Homan's sign. Pallor of the leg on elevation is not elicited by Homan's test. Tenderness on plantar flexion of foot indicates negative Homan's sign.
A nurse palpates a weak left radial artery on a client. What should the nurse do next? a) Palpate the left ulnar artery. b) Document the finding in the client's record. c) Palpate both radial arteries for symmetry. d) Assess the left hand for pallor and coolness.
c) Palpate both radial arteries for symmetry. Extremities should always be assessed simultaneously for symmetry. If the radial arteries are both weak, this may indicate a problem with peripheral circulation. The nurse should then assess the ulnar artery pulses to determine the presence of arterial insufficiency. The hands should be assessed for pallor and coolness, which would also be present with arterial insufficiency. All findings should be documented in the client's record.
A nurse asks a supine client to raise his knee partially. The nurse then places the thumbs on the knee while positioning the fingers deep in the bend of the knee. The nurse is palpating the pulse of which artery? a) Femoral b) Dorsalis pedis c) Popliteal d) Posterior tibial
c) Popliteal The femoral artery is the major supplier of blood to the legs. Its pulse can be palpated just under the inguinal ligament. This artery travels down the front of the thigh then crosses to the back of the thigh, where it is termed the popliteal artery. The popliteal pulse can be palpated behind the knee. The popliteal artery divides below the knee into anterior and posterior branches. The anterior branch descends down the top of the foot, where it becomes the dorsalis pedis artery. Its pulse can be palpated on the great toe side of the top of the foot. The posterior branch is called the posterior tibial artery.
Which statement describes the correct technique by a nurse when performing the ankle-brachial pressure index test? a) Inflate the blood pressure cuff 40-50 mm Hg beyond where the last signal was heard. b) Quickly deflate the blood pressure cuff to allow blood to return to the extremity. c) Use a blood pressure cuff that is 20% wider than the diameter of the client's limb. d) Record the last signal that is auscultated as the ankle pressure.
c) Use a blood pressure cuff that is 20% wider than the diameter of the client's limb. The correct technique involves using a blood pressure cuff that is 20% wider than the diameter of the limb being measured, inflating the cuff to no more than 20-30 mm Hg beyond when the last arterial signal was detected, slowly deflating the cuff so as to not miss the highest pressure. This first signal is the arterial pressure and is the number recorded, not the last sound heard.
A client has been diagnosed with venous insufficiency. Which of the following findings should the nurse expect on interviewing this client? a) Shiny skin, with loss of hair over the lower legs b) Cold, pale skin on the extremities c) Warm skin and brown pigmentation around the ankles d) Clammy skin on the extremities
c) Warm skin and brown pigmentation around the ankles Warm skin and brown pigmentation around the ankles are associated with venous insufficiency. Cold, pale, clammy skin on the extremities and thin, shiny skin with loss of hair, especially over the lower legs, are associated with arterial insufficiency.
A client tells a nurse that she has been experiencing intermittent episodes of numbness, tingling, pain, and burning in the fingertips, especially after being cold. What is an appropriate question for the nurse to ask the client to further assess this occurrence? a) "Have you started any new medications?" b) "Are you exercising when this occurs?" c) "Do you have a history of cardiovascular disease?" d) "Do you notice your fingers changing colors?"
d) "Do you notice your fingers changing colors?" Numbness, tingling, pain, and burning in the fingertips are findings of Raynaud's disease. Vasospasms or vasoconstriction occur in the fingers or toes and cause rapid changes in the color of the digits (pallor, cyanosis, redness). These vasospasms cause the numbness, tingling, and burning pain. New medications, cardiovascular disease, and exercise do not influence this process.
Which reading of the ankle-brachial pressure index (ABPI) should the nurse recognize as indicative of a normal healthy person? a) 0.75 b) 0.15 c) 0.25 d) 1.00
d) 1.00 The ankle pressure in a healthy person is the same or slightly higher than the brachial pressure, resulting in an ABPI of approximately 1.00 or no arterial insufficiency. An ABPI of 0.25 or lower indicates severe stenosis leading to ischemia and tissue damage. An ABPI of 0.5 to 0.95 indicates mild to moderate arterial insufficiency.
A client presents with pitting edema to the left foot, which a nurse observes as a noticeably deep pit when the area is depressed and the extremity looks larger than the right. How should the nurse accurately document this amount of edema? a) 1+ b) 2+ c) 4+ d) 3+
d) 3+ Pitting edema that produces a noticeably deep pit when the area is depressed and the extremity looks larger than the other is documented as 3+. A 1+ pitting edema is edema that produces slight pitting when the area is depressed. A 2+ is deeper than 1+. A 4+ pitting edema is a very deep pit in the area when depressed, and there is gross edema in the extremity
A nurse assesses capillary refill time in a client and finds it to be less than 2 seconds. What is an appropriate action by the nurse? a) Dangle the arms and recheck in 5 minutes. b) Apply a warm compress to both hands. c) Obtain a blood pressure in both arms. d) Document the finding as normal.
d) Document the finding as normal. Capillary refill is the time it takes the color to return to the nail beds after the release of applied pressure. This test is a reflection of cardiac output and peripheral perfusion. Normal capillary refill time is 1 to 2 seconds. The nurse needs to document this finding as normal. Because this time is normal, there is no further action needed by the nurse.
A nurse observes a decrease in hair on the lower extremities of an elderly client. What is an appropriate action by the nurse in regards to this finding? a) Ask the client about the presence of edema in the feet. b) Check for ulcers on the medial aspect of the ankles. c) Document this as a normal process of aging. d) Elevate the legs and observe for the onset of pallor.
d) Elevate the legs and observe for the onset of pallor. Loss of hair can be a normal finding in the elderly client, but the nurse should perform further assessment before making this judgment. Loss of hair is seen with arterial insufficiency. Ulcers on the medial aspect of the ankle are a sign of venous stasis as is the presence of edema. Pallor, or loss of color, is seen in arterial insufficiency, especially when the legs are elevated.
A nurse receives an order to perform a compression test to assess the competence of the valves in a client's varicose veins. Which action by the nurse demonstrates the correct way to perform this test? a) Feel for a pulsation to the fingers in the lower hand b) Ask the client to sit on a chair for the examination c) Place the second hand 3 to 4 inches above the first hand d) Firmly compress the lower portion of the varicose vein
d) Firmly compress the lower portion of the varicose vein The nurse should firmly compress the lower portion of the varicose vein with one hand. The nurse should ask the client to stand, not sit, on a chair for the examination. The second hand should be placed 6 to 8 inches, not 3 to 4 inches, above the first hand. The nurse should feel for a pulsation to the fingers in the upper hand.
A nurse inspects the lower extremities of a client and notices that the legs appear asymmetric. What should the nurse do first in regards to this finding? a) Notify the health care provider b) Assess for the presence of pitting edema c) Palpate for temperature in the feet d) Measure the diameter of the calves
d) Measure the diameter of the calves The nurse should complete the inspection process before going on to the other physical assessment techniques. After inspecting asymmetry of the legs, the nurse should measure the calves to determine the exact difference in diameter. Then the nurse can palpate for edema and temperature and notify the health care provider with the information once it is all gathered.
A client reports pain in the legs that begins with walking but is relieved by rest. Which condition should the nurse assess the client for? a) Diabetes mellitus b) Obstruction in the femoral artery c) Calcium deficiency d) Peripheral vascular problems
d) Peripheral vascular problems The nurse should assess the client for peripheral vascular problems in both the legs. Intermittent claudication is a condition that indicates vascular deficiencies in the peripheral vascular system. In case of an acute obstruction, the leg pain would persist even when the client stopped walking. Diabetes can cause pain as a result of diabetic neuropathy, which is unrelated to walking. Low calcium level may cause leg cramps but would not necessarily be related to walking
A nurse performs an ankle-brachial pressure index (ABPI) and obtains these results: R arm Blood Pressure 140/90 mm Hg, L arm Blood Pressure 150/90 mm Hg; R ankle 80 mm Hg, L ankle 85 mm Hg. Determine the right and left ABPI. a) Right 0.88; Left 0.94 b) Right 1.75; Left 1.76 c) Right 0.57: Left 0.60 d) Right 0.53; Left 0.56
d) Right 0.53; Left 0.56 The ABPI determines the degree of arterial insufficiency in a person with peripheral arterial disease. It detects decreased systolic pressure distal to the area of stenosis or arterial narrowing, allowing the nurse to quantify this measurement. It can be calculated by dividing the higher ankle pressure for each foot by the higher brachial pressure. Right ABPI: 80/150 = 0.53; Left ABPI: 85/150 = 0.56.
A nurse is working with a client who demonstrates venous stasis in his legs. The nurse understands that there must be a problem with one of the mechanisms of venous function that help to propel blood back to the heart. Which of the following are included among these mechanisms? Select all that apply. a) Pressure gradient produced by inspiration b) Skeletal muscle contraction c) Gravity d) Pumping action of the heart e) One-way valves in the veins
e) One-way valves in the veins, b) Skeletal muscle contraction, a) Pressure gradient produced by inspiration Three mechanisms of venous function help to propel blood back to the heart. The first mechanism has to do with the structure of the veins. Deep, superficial, and perforator veins all contain one-way valves. These valves permit blood to pass through them on the way to the heart and prevent blood from returning through them in the opposite direction. The second mechanism is muscular contraction. Skeletal muscles contract with movement and, in effect, squeeze blood toward the heart through the oneway valves. The third mechanism is the creation of a pressure gradient through the act of breathing. Inspiration decreases intrathoracic pressure while increasing abdominal pressure, thus producing a pressure gradient. Veins differ from arteries in that there is no force that propels forward blood flow; the venous system is a low-pressure system. This fact is of special concern in the veins of the leg. Blood from the legs and lower trunk must flow upward with no help from the pumping action of the heart or from gravity.
A client presents to the health care clinic with reports of swelling, pain, and coolness of the lower extremities. The nurse should recognize that which of these lifestyle practices are risk factors for peripheral vascular disease? Select all that apply. a) Previous use of hormones b) Stress-reduction techniques c) Low alcohol intake d) Regular exercise e) High-fat diet f) Cigarette smoking
f) Cigarette smoking, a) Previous use of hormones, e) High-fat diet The risk factors for the development of peripheral vascular disease include smoking, lack of exercise, high stress, moderate to high alcohol intake, previous use of hormonal birth control (females), and a high-fat diet.