Exam of the Lower Extremities
The discussion which follows focuses on the search for evidence of arterial and venous insufficiency as well as edema. These are the most common serious ailments which affect the lower extremities and therefore merit the greatest attention. Joint and neurologic examinations are covered elsewhere. Show
The Femoral Region:As with examination of any other area of the body, exposure is key. Socks, stockings, pants and skirts should all be removed.
Vascular Anatomy The Popliteal Region:
Below The Knee: Now, turn your attention to the lower leg (i.e. from the knee to the foot). First, examine with your eyes, paying attention to:
Feel the skin, noting in particular:
For Additional Information See: Digital DDx: Nonhealing Wounds and Ulcers The Distal Pulses:Pulses are assessed to identify the presence of arterial vascular disease. In general, the less prominent the pulses, the greater the chance that there is occlusive arterial disease. This is not a perfect correlation, however, as pulses may be palpable even when significant disease is present (e.g. may be affecting predominantly smaller, more distal blood vessels). A history of pain/cramps with activity suggestive of arterial insufficiency is also of great importance. The location of the blockage(s) will dictate the symptoms and findings. Aorto-iliac disease, for example, will cause symptoms in the hips/buttocks and a loss of the femoral pulse while disease affecting the more distal vessels will cause symptoms in the calves and feet.
Which pulse site would the nurse assess for circulation of blood to the foot?Dorsalis Pedis Pulse – pulse taken on the upper surface of the foot, also used to measure circulation to the foot.
Which site is preferred for assessing the heart rate in a patient?Clinicians measure the carotid pulse in the neck. In day-to-day practice, the radial pulse is the most frequently used site for checking the peripheral pulse, where the pulse is palpated on the radial aspect of the forearm, just proximal to the wrist joint.
Which pulse is most often used for measuring pulse rate?The radial artery is most commonly used to check the pulse. Several fingers are placed on the artery close to the wrist joint.
Which of the following pulses is assessed in obtaining a blood pressure by palpation?Brachial artery pulse - The brachial artery is palpated on the anterior aspect of the elbow by gently pressing the artery against the underlying bone with the middle and index fingers. The brachial artery pulse is commonly used to measure blood pressure with a stethoscope and sphygmomanometer.
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