(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
CHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2al history and physical examination for the patient with vascular disease. A systematic hcad-lo-loe examination, done consistently for each vascular patient, will minimize the chance OÍ missing subtle signs related to vascular deficits.The clinician should begin with auscultation OÍ the carotid arte (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2ries bilaterally. Cardiac murmurs will usually radiate into the carotid arteries, and an underlying bruit may not be discerned. The subclavian arterie(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
s should then be auscultated (ATT the upper anteromedial chest area. During this phase ol the examination, the jugular wins should be inspected lor juCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2roceed to the palpation of the brachial. radial, and ulnar arteries. Such palpation should be scored on a scale of 0 to 4 (4 = pulsatile, bounding: Ỉ = easily palpable with full triphasic pulse: 2 = biphasic pulse that may be a bit harder to locate initially: I = monophask' pulse that may come and g (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2o depending on position of fingertips: and 0 = absent pulse by palpation, which may be detected byDoppler ultrasound). All palpable pulses should be g(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
raded in the assessment and documented.The clinician should evaluate any pain, coolness, paresthesia. motor weakness, discoloration, or tissue loss InCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2ted for cyanosis and/or petcchlae. The fingernails should be checked for clubbing, which portends chronic hypoxemia. Routinely, in any patient confirmed or suspected to have vascular disease, blood pressure should be checked in both arms at this point.'flic heart should then be auscultated to permit (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2 delineation of rhythm regularity. S|. Sj. and any cxtrasystolic sounds such as S|. S,|. or pericardial rub. Murmurs should be noted and classified as(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
per the cardiac assessment guidelines. The abdomen should be auscultated for celiac artery, superior mesenteric artery, and renal artery bruits, whicCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2 artery In each groin for the presence of bruits. Following this, the abdomen should be lightly palpated lust to the left of midline, approximately 4 cm above the umbilicus, to evaluate for a pulsatile abdominal aorta. In slender Individuals, the abdominal aorta is often fairly easy to palpate. A bo (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2unding, pulsatile abdominal aorta In an individual may suggest aneurysmal formation. The clinician should note and document any tenderness or guarding(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
associated with the abdominal palpation. There arc many other causes for abdominal tenderness that the clinician should be aware of. in addition to aCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2roenteritis, peptic ulcer, and small bowel obstruction.Once the abdominal examination is complete, the clinician should progress to the vascular assessment of the lower extremities. The femoral arteries should be palpated over the groin area and documented on the scale of 0 to 4. Any pulse deficits (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2should be followed up with a Doppler examination. The popliteal fossil should be inspected and palpated bilaterally In order to locate the popliteal a(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
rtery and assess for the possibility of popliteal artery aneurysms. The clinician should Inspect the calves and feet for edema, skin turgor, and skin CHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2skin is more consistent with peripheral arterial insufficiency. The dorsalis pedis and posterior tibial pulses should be palpated. If those pulses arc not palpable. Doppler ultrasound should be used. Any Doppler signals should be located and identified with an indelible marker pen. Al this lime, the (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2 heel, the medial and lateral mallcoll, and the toes of each fool should be Inspected for breakdown. As in the hands, any pedal pain. coolness, parest(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
hesia, motor weakness, discoloration, or tissue loss should be documented. Dorsal and plantar flexion of the feet should be assessed and recorded withCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2ng on CN II to CN XII. Evaluation of pupillary light and accommodation response (CN II and III): following the eyes in a lateral, medial, superior, and inferior gaze (CNs III. IV. and VI): and evaluation of facial smile, scowl, and opening eyes against215216 Chapter 9 ■ Peripheral Vascular Disorders (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2pressure (CNs V and VIII should be completed. Gross hearing assessment, with follow-up by Weber and Rinne testing, may ascertain any CN VIII dclicits.(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
Evaluating the tongue protrusion. uvula rise, cough reflex. gag reflex, and shoulder shrug will provide Information on the integrity of CNs IX. X, XICHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2etion of the CN examination provides (he healthcare team with an excellent neurological baseline before interventions for carotid artery disease. Assessment findings related to vertebrobasilar insufficiency may include balance problems. dizziness, and coordination deficits. Ifocal neurological defic (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2its such as arm. leg. and/or facial weakness on one side of the body: loss ol speech: difficulty speaking or swallowing: and unilateral or partial vis(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
ion loss signify transient cerebral ischemia that may be related to severe carotid artery stenosis (l)ua. Romanelli. & Upchurch. 2016).Following the nCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2 in the feel, calves, thighs, and CM- buttocks, cither at rest CM- with ambulation (peripheral arterial disease |I>\D|)■Any open wounds or blisters on the distal aspects of feet and/or hands (PAI) or chronic venous stasis ulcers)■Abdominal pain, nausea, vomiting, and/or diarrhea after a meal (mesent (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2eric Ischemia)■Persistent abdominal/back pain (abdominal aortic aneurysms or dissection)■Acute unilateral UN delk'lts (carotid artery disease)■Acute b(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
alancc/coíMdination deficits (possible vertebrobasilar malperlusion)■Acute chest and/or back pain (after ruling out myocardial Ischemia and pulmonary CHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2ssessment and abbreviated history are completed, the clinician will have achieved a very-sound baseline with which to guide future interventions to delineate and treat vascular lesions.ABDOMINAL AORTIC ANEURYSMSignal Symptoms: Persistent or intermittent pain in the middle or lower abdomen, often rad (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2iating to the lower back, which is characteristic of a rapidly expanding, leaking, or ruptured abdominal aortic aneurysm (AAA). Most A A As arc asympt(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
omatic.Description: The abdominal aorta is the large artery that provides blood to the digestive organs, liver, kidneys, spleen, and lower extremitiesCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2imes greater than the size of the nondilaled proximal or distal aorta. The AAA involves all three layers of the arterial wall.Etiology: Most AAAs arc atherosclerotic in nature: other causes include trauma. Infection, and inllammation. Connective tissue disorders, such as Ehlcrs-Danlos syndrome and M (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2arfan syndrome, predispose the patient to AAA formation (Slrider cl al.. 201 3: Yip & Sawalxky. 2014). Most AAAs arc intrarenal (65%). occurring below(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
the renal arteries. Patients with AAAs are more likely to hare arterial aneurysms in other locations such as the thoracic aorta, the common iliac artCHAPTERPeripheral Vascular DisordersCatherine Ratliff and David StriderASSESSMENTA comprehensive vascular assessment may be Integrated Into the genera (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2ity rates for ruptured aneurysms arc 70% to 90%. compared with 5% operative mortality for elective open surgical repair and 2% to 3% for endovascular stent AAA exclusion.Age: More frequent in adults over 50 years old: prevalence rate Is 2% to 4%.Gender: Onset occurs around age 50 years for men and 6 (mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 20 years lor women. Incidence steadily increases with age and peaks at age 80 years. AAA is live times more likely In men than in women.Ethnicity: Ther(mebooksfree.com)advamp;praamp;nuramp;caramp;oldamp;aduamp;kenamp;malamp;maramp;plaamp;dufamp;2nd 2
e is no dominant ethnic group that develops AAA. but there is a familial history associated with AAA development.Contributing Factor*: Risk factors foGọi ngay
Chat zalo
Facebook