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HISTORY:

 When assessing the client, note risk factors for atherosclerosis and vascular disease,
hypertension, diabetes mellitus and cardiac as well as lymphatic disorders.
 Some clients are reluctant to mention what they believe to be minor manifestations
(swelling, intermittent, discomfort).
 Consequently, perform a careful assessment, ask specific questions skilfully, and be alert
for information that indicate early manifestations if insidious conditions.
 Studies have found that the effects of peripheral arterial disease (PAD) have significant
psychosocial and emotional consequences.
 Assessment of quality of life as well as functional changes and symptoms manifestations is
needed to establish effective interventions. Seven themes emerged from one study
designed to evaluate the effects of PAD from client’s perspectives. These themes are the
following:
➢ PAD diagnosis and management
➢ Clinical manifestation experience
➢ Limitations in physical functioning
➢ Limitations in social functioning
➢ Compromise of self
➢ Uncertainty and fear
➢ Adaptation

CURRENT HEALTH STATUS:

 Ask about the following:


➢ Onset
➢ Precipitating factors
➢ Frequency
➢ Duration
➢ Persistence of clinical manifestations that may indicate a vascular disorder.
 The following section describes the typical complaints of clients who have ARTERIAL AND
VENOUS DISORDERS (Chief complaint).
➢ ARTERIAL DISORDERS may occur to the following body parts:
 Head
 Upper extremities
 Abdomen
 Chest
 Lower extremities
➢ Clinical manifestations related to head include the following:
 Visual disturbances
 Visual orientation
 Movement of extremities
 Facial symmetry
 Speech
 Swallowing
➢ These manifestations may be found in neurologic disorders as well as vascular
disorders.
➢ Document the activity required to cause pain when it is present. In lower extremity
arterial disorders the extent of disease involvement can be gauged by the distance the
client is able to walk without or claudication distance.
➢ VENOUS DISORDERS:
 CHRONIC VENOUS DISEASE has an insidious onset. Many client do not recall a
precipitating factors event like:
 Positive family history
 A job history involving standing in one place
 Multiple pregnancies
 Varicose veins
 History of phlebitis or obesity
 ACUTE VENOUS DISORDER usually present as a sudden swelling in a localized
area. Upper extremity superficial venous occlusion causes discomfort along the
course of the affected area.
 Suspect deep vein thrombosis in the upper extremity if there is significant edema in
the affected arm
➢ CLINICAL MANIFESTATIONS: Vascular disease may be arterial, venous or lymphatic,
but there are also neurologic conditions that cause similar manifestations.
➢ The following are some guide in evaluation a clinical manifestations related to vascular
disease:
 Pain
 Skin changes
 Sensory changes
 Edema
 Lower extremity ulcers

PAST MEDICAL HISTORY:

 Note any history of VASCULAR IMPAIRMENT. Inquire about changes that indicate
VASOSPATIC DISORDERS, such as:
➢ Changes in color or temperature digit.
 Ask specifically whether the client has a history of:
➢ Hypertension
➢ Diabetes
➢ Stroke
➢ Transient ischemic attacks (TIAs)
➢ Changes in vision
➢ Pain in legs during activity
➢ Leg cramps
➢ Phlebitis
➢ Venous or arterial blood clots
➢ Pulmonary emboli
➢ Edema
➢ Varicose veins
➢ Extremities that are cold, pale or blue
 Question any previous history of frostbite, which increases risk of VASOSPASM. Visual
changes and TIAs my indicate CAROTID ARTERY DISEASE.
 Ask about previous treatment for diabetes mellitus, collagen disorders or hypertension

PAST SURGICAL HISTORY

 Detail any previous operations that the client has endured, particularly VASCULAR BYPASS
SURGERY.
 Note if there has been any previous:
➢ Angiography
➢ Endovascular graft or stent placement
➢ Harvesting of arteries or veins from the lower extremities

FAMILY HISTORY

 It helps determine risk factors and provides clues about reported and observed
manifestations.
 Note any family history of:
➢ Diabetes
➢ Hypertension
➢ Coronary artery disease
➢ Collagen diseases
➢ Peripheral vascular disease

LIFESTYLE

Dietary Habits

 Determine the following:


➢ Client’s nutrient and fluid intake
 Ask the following:
➢ Usual intake of protein and calories
➢ Sodium intake
➢ Cholesterol intake
➢ Fat intake
 The client who is underweight or overweight can be at risk for compromised healing
progression of VASCULAR ULCER.
 Note if client reports shortness of breath or fatigue when eating.
 Overall dietary intake should support maintenance of ideal body weight
 Ask about recent weight loss or pain in the abdomen within 20 minutes of eating, this may
indicate MESENTERIC ARTERY ISCHEMIA.

Social History

 Record the following:


➢ Occupational history
➢ Number of hours spent in various positions or activities (standing, prolonged sitting,
walking, using vibrating machinery)
➢ Contact with chemicals or associated with cold or wet environment
 Nicotine is any form is a potent vasoconstrictor. A COMPLETE SMOKING HISTORY is
necessary as a part of vascular assessment.
 Discuss:
➢ Previous and current use of chewing tobacco
➢ Cigarettes
➢ Cigars
➢ Pipe tobacco
 Assess the following:
➢ Activity
➢ Rest
➢ Sleep habits
 Obtaining information about the frequency and duration of manifestations, precipitating
activities, and their influence in daily life enables determination of disease severity
 Disorders of AORTA and ILIAC VESSELS can lead to IMPOTENCE. If a male client has
aortoiliac disease ask about problems with ERECTILE DYSFUNCTION.
 Assessment of client’s stress level, emotional state, and coping mechanisms is important.
 Remain sensitive to the emotional effect of peripheral vascular disorders.
 Clients who have visible lesions may be embarrassed.
 Clients may have concern about the inability to perform self-care and about changes in role
and sexual performance.
 Fear of amputation or functional loss may be significant

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