It is important for the nurse to ask questions about the symptoms that the client may consider inconsequential. It is also important for the nurse to ask about personal and family history of vascular disease. It is especially important to evaluate aspects of the client’s lifestyle and health factors that may impair peripheral vascular health.
History of present health concern
Have you noticed any color, temperature, or texture changes in your skin?
Do you experience pain or cramping in your legs? Describe the pain (aching, stabbing). how often does it occur? Does it occur with activity? Does it wake you from sleep?
Do you have any leg veins that are ropelike, bulging, or contorted? Do you have any sores or open wounds on your legs? Where are they located? Are they painful?
Do you have any swelling (edema) in your legs or feet? At what time of day is swelling worst? Any pain with swelling?
Do you have any swollen glands or lymph nodes? If so, do they feel tender, soft, or hard?
For male clients: Have you experienced a change in your usual sexual activity? Describe.
Past health history
Describe any problems you had in the past with the circulation in your arms and legs.
Have you had any heart or blood vessel surgeries or treatments such as coronary artery bypass grafting, repair of an aneurysm, or vein stripping?
Family history
Do you have a family history of diabetes, hypertension, coronary heart disease, or elevated cholesterol or triglyceride levels?
Lifestyle and health practices
Do you (or did you in the past) smoke cigarettes or use any form of tobacco? How much and for how long?
Do you exercise regularly?
For female clients: Do you take oral or transdermal contraceptives?
Describe the degree of stress you normally have.
How have problems with your circulation affected your ability to function?
Do leg ulcers or varicose veins affect how you feel about yourself?
Do you regularly take medications prescribed by your physician to improve your circulation?
Do you wear support hose to treat varicose veins?
Arms
Inspection
Observe arm size and venous pattern; also look for edema. Arms are bilaterally symmetric with minimal variation in size and shape. No edema or prominent venous patterning.
Observe the coloration of the hands and arms. Color varies depending on the client’s skin tone, although color should be the same bilaterally.
Palpation
Palpate the client’s fingers, hands, and arms, and note the temperature. Skin is warm to the touch bilaterally from fingertips to upper arms.
Palpate to assess capillary refill time. Compress the nailbed until it blanches. release the pressure and calculate the time it takes for the color to return.
Palpate the radial pulse. Gently press the radial artery against the radius. Note elasticity and strength.
Palpate the ulnar pulses. Apply pressure with your first three fingertips to the medial aspects of the inner wrists.
Palpate the brachial pulses if you suspect arterial insufficiency. Do this by placing the first three fingertips of each hand at the client’s right and left medial antecubital creases.
Palpate the epitrochlear lymph nodes. Take the client’s left hand in your right hand as if you were shaking hands. Flex the client’s elbow about 90 degrees. Use your left hand to palpate behind the elbow in the groove between the biceps and triceps muscles.
Perform the Allen test. The Allen test evaluates the patency of the radial or ulnar arteries. The test begins by assessing ulnar patency. Have the client rest the hand palm side-up on the examination table and make a fist. Then use your thumbs to occlude the radial and ulnar arteries. Note that the palm remains pale. Release the pressure on the ulnar artery and watch for color to return to the hand.
Legs
Inspection, Palpation, and Auscultation
Observe skin color while inspecting both legs from the toes to the groin. Ask the client to lie supine. Then drape the groin area and place a pillow under the client’s head for comfort.
Inspect the distribution of hair. Hair covers the skin on the legs and appears on the dorsal surface of the toes.
Inspect for lesions or ulcers. Legs are free of lesions or ulcerations.
Inspect for edema. Inspect the legs for unilateral and bilateral edema. Note veins, tendons, and bony prominences.
Palpate edema. If edema is noted during inspection, palpate the area to determine if it is pitting or nonpitting. Press the edematous area with the tips of your fingers, hold for a few seconds, then release.
Palpate bilaterally for the temperature of the feet and legs. Use the backs of your fingers. Compare your findings in the same areas bilaterally.
Palpate the superficial inguinal lymph nodes. First, expose the client’s inguinal area, keeping the genitals draped. Feel over the upper medial thigh for the vertical and horizontal groups of superficial inguinal lymph nodes.
Palpate the femoral pulses. Ask the client to bend the knee and move it out to the side. Press deeply and slowly below and medial to the inguinal ligament. Release pressure until you feel the pulse.
Auscultate the femoral pulses. If arterial occlusion is suspected in the femoral pulse, position the stethoscope over the femoral artery and listen for bruits.
Palpate the popliteal pulses. Ask the client to raise the knee partially. Place your thumbs on the knee while positioning your fingers deep in the bend of the knee. Apply pressure to locate the pulse.
Palpate the dorsalis pedis pulses. Dorsiflex the client’s foot and apply light pressure lateral to and along the side of the extensor tendon of the big toe.
Palpate the posterior tibial pulses. Palpate behind and just below the medial malleolus. Palpating both posterior tibial pulses at the same time aids in making comparisons.
Inspect for varicosities and thrombophlebitis. Ask the client to stand because varicose veins may not be visible when the client is supine and not as pronounced when the client is sitting. As the client is standing, inspect for superficial vein thrombophlebitis.
Check for Homan’s sign. First, flex the client’s knee about 5 degrees, place your hand under the client’s calf muscle, and quickly squeeze the muscle against the tibia. Ask the client to report any pain or tenderness.