Cardiac Conduction and Peripheral Vascular Assessment

The volume of blood pumped by the heart in one minute

the amount of blood entering the aorta with each contraction

HR x SV= CO

The normal stroke volume is 60-70 mL/ min

• Less than 60 bpm
• Athletes, some cardiac meds, complications with the SA and AV node, hypothyroidism

• higher than 100
• fever, exercise, anemia, hyperthyroidism, anxiety, fluid deficit, hemorrhage, need for increased CO

blood loss, decreased CO, and peripheral arterial disease

fever, anxiety, fluid excess

• temporal: on the temple
• Carotid: on the neck
• brachial: on the ulnar side of the inner elbow
• ulnar: the interior side of the wrist
• radial: the exterior side of the wrist
• femoral: near the ileac crest near the groin
• popliteal: the inner side of the knee
• dorsalis pedis: on the Dorsal side of the foot
• Posterior tibial: underneath the ankle bone

thoracic pressure decreases while abdominal pressure increases

• blood clots
• increase blood flow

• small saphenous vein (right behind the knee)
• popliteal vein ( also right behind knee)
• femoral (not as frequent)

the epitrochlear node drains the hand and lower arm so there may be infection and edema in the hand and lower arm

ischemic rest pain of peripheral vascular disease

• 0= absent
• 1=weak
• 2=normal
• 3= increased
• 4= bounding

to check for clots in the ulnar artery

arterial disease

• A positive sign is present when there is pain in the calf or popliteal region with examiner's abrupt dorsiflexion of the patient's foot at the ankle while the knee is flexed to 90 degrees.
• A positive Homan's sign does not mean the pt has definite phlebitis (inflammation of a vein)

1 cm

You may dislodge the clot and it can travel elsewhere

Medial Malleolus

• +1 is 2 mm
• +2 is 4 mm
• +3 is 6 mm
• +4 is 8 mm

• Raise legs about 12 in from bed, ask pt to pump feet for 30 seconds. Pallor occurs. Lower legs and color should return in about 15 seconds.
• This test is used to check arterial blood flow to the legs

ABI% = ankle systolic pressure/ arm systolic pressure

An ABI of less than 90% indicates PVD (peripheral vascular disease)

• atherosclerosis is plaque in the blood vessels
• arteriosclerosis is rigid peripheral blood vessels

Venous thrombosis

shiny and has a loss of hair

• When the valves in veins don't work well and veins get wide.
• 3x as more likely in women.
• Usually occur after age 45
• Extra weight = increased risk of varicose veins

• While the person is still standing, test the length of the varicose vein to determine whether its valves are competent. Place one hand on the lower part of the varicose vein, and compress the vein with your other hand about 15 to 20 cm higher.
• Wave is not felt= competent valves
• Wave is felt: incompetent valves

detect a weak pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity

• Episodes of abrupt progressive tricolor change of the fingers in response to cold, vibration, or stress
• first white (pallor) from arteriospasm and resulting deficit in supply;
• then blue (cyanosis) from slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of hemoglobin;
• finally red (rubor) due to return of blood into the dilated capillary bed

• Removal of lymph nodes with breast surgery, or damage to lymph nodes and channels with radiation therapy for breast cancer; can impede drainage of lymph
• Stagnant lymph fluid can lead to infection, delayed wound healing, chronic inflamation, and fibrosis of surrounding tissue

• shiny, cool, pale, thin and hairless
• This patient will not have a pulse in the lower extremities.

blood leaks out out of the vein and goes into subcutaneous tissue

• bronzy or brownish red color of skin, scaley, thick
• This patient will have a pulse in lower extremities