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(BQ) Part 2 book “Advanced practicenursingin the care of older adults” has contents: Peripheral vascular disorders, abdominal disorders, musculoskeletal disorders, psychosocial disorders, hematological and immune system disorders, and other contents. | CHAPTER 9 Peripheral Vascular Disorders Catherine Ratliff and David Strider ASSESSMENT A comprehensive vascular assessment may be integrated into the general history and physical examination for the patient with vascular disease. A systematic head-to-toe examination, done consistently for each vascular patient, will minimize the chance of missing subtle signs related to vascular deficits. The clinician should begin with auscultation of the carotid arteries bilaterally. Cardiac murmurs will usually radiate into the carotid arteries, and an underlying bruit may not be discerned. The subclavian arteries should then be auscultated over the upper anteromedial chest area. During this phase of the examination, the jugular veins should be inspected for jugular vein distention. This can best be appreciated when the patient is lying down with the head of the bed elevated 15 degrees. The clinician should proceed 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; 3 = easily palpable with full triphasic pulse; 2 = biphasic pulse that may be a bit harder to locate initially; 1 = monophasic pulse that may come and go depending on position of fingertips; and 0 = absent pulse by palpation, which may be detected by Doppler ultrasound). All palpable pulses should be graded in the assessment and documented. The clinician should evaluate any pain, coolness, paresthesia, motor weakness, discoloration, or tissue loss in the hands. Careful inspection of the distal fingers and the nail beds may reveal signs of end tissue malperfusion. The finger joints should be inspected for cyanosis and/or petechiae. 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. The heart should then be auscultated to permit delineation of rhythm regularity,