.lesson-duration-container {
background-color: #f0f4f8; /* Szarawe tło dopasowane do reszty strony */
padding: 8px 15px; /* Wewnętrzny odstęp */
border-radius: 8px; /* Zaokrąglone rogi */
font-family: ‘Roboto’, Arial, sans-serif; /* Czcionka Roboto, jeśli dostępna */
font-size: 16px; /* Rozmiar tekstu */
color: #6c757d; /* Ciemny szary kolor tekstu */
display: inline-block; /* Wyświetlanie jako element blokowy */
margin-bottom: 20px; /* Odstęp na dole */
border: none; /* Bez obramowania */
}
.lesson-duration-label {
font-weight: 700; /* Pogrubienie dla etykiety */
color: #6c757d; /* Ciemny szary kolor dla etykiety */
margin-right: 5px; /* Odstęp od wartości */
}
.lesson-duration-value {
color: #6c757d; /* Ciemny szary kolor dla wartości */
font-weight: 700; /* Pogrubienie dla wartości */
}
Observation
During the initial inspection, carefully observe for signs that may suggest vascular diseases. This visual assessment provides crucial initial clues about the patient’s vascular health.
Peripheral Cyanosis: Look for a bluish discoloration of the extremities, which indicates inadequate oxygenation of the blood in the peripheral circulation. This is typically seen in severe arterial insufficiency or advanced heart failure. Pay close attention to the tips of the fingers, toes, and nail beds.
Pallor: Assess for pale skin, which may be a sign of reduced arterial blood flow due to occlusion or systemic conditions such as severe anemia. Check for pallor in areas such as the palms, nail beds, and mucous membranes.
Varicose Veins: Inspect the lower extremities for visible, tortuous, and dilated veins, indicating chronic venous insufficiency. Patients may also complain of heaviness, aching, or swelling in their legs, which worsens with prolonged standing or sitting.
Edema: Swelling in the lower extremities which may indicate chronic venous insufficiency, lymphatic obstruction, or systemic fluid overload.
Ulcers: Inspect the skin for non-healing ulcers:
Venous Ulcers: Irregular, shallow, and often found around the ankles, indicating chronic venous insufficiency.
Arterial Ulcers: Painful, well-demarcated, and typically located on the toes or bony prominences, suggesting severe arterial disease.
Palpation
Palpation provides essential information about both the arterial and venous systems. The goal is to assess the strength of pulses, the presence of tenderness, and signs of fluid retention or inflammation.
Peripheral Pulses (Arterial Assessment)
Palpate major arteries to evaluate the strength, rhythm, and symmetry of blood flow. Ensure to compare pulses bilaterally:
Carotid Pulse: Palpate one side at a time, being careful not to compress both carotid arteries simultaneously to avoid reducing blood flow to the brain. Assess for strength, symmetry, and the presence of any thrills, which may indicate turbulence.
Brachial Pulse: Located in the antecubital fossa, this pulse is useful for assessing blood pressure and detecting abnormalities in arterial flow to the upper extremities.
Radial Pulse: Evaluate the rate, rhythm, and amplitude. Weak or absent radial pulses may indicate arterial occlusion or reduced arterial blood flow to the hand.
Femoral Pulse: Located in the groin area, this pulse helps assess for adequate blood flow from the abdominal aorta to the lower extremities. A diminished or absent femoral pulse may be indicative of significant aortic or iliac artery disease.
Popliteal Pulse: Found behind the knee, the popliteal pulse is often difficult to palpate. A weak or absent pulse here may suggest femoral artery disease or other forms of arterial insufficiency.
Dorsalis Pedis and Posterior Tibial Pulses: These pulses are critical in evaluating peripheral arterial disease (PAD) in the lower extremities. Absence or asymmetry of these pulses can indicate compromised arterial circulation.
Capillary Refill Time (Arterial Indicator)
Normal: Less than 2 seconds, indicating adequate arterial blood flow to the extremities.
Delayed Refill: If capillary refill takes more than 2 seconds, it suggests poor peripheral perfusion, which may indicate conditions such as hypovolemia, shock, or peripheral arterial disease.
Venous System Palpation
Tenderness: Palpate along the veins for tenderness, which may indicate superficial thrombophlebitis, where a superficial vein becomes inflamed and painful due to a clot. Note the exact location of tenderness.
Edema: Assess for the type and distribution of edema:
Pitting Edema: Press the skin over the tibia or the top of the foot. If an indentation remains, it suggests fluid accumulation, commonly due to venous insufficiency or right-sided heart failure.
Non-Pitting Edema: Usually seen in conditions like lymphedema or hypothyroidism, where the skin does not leave an indentation when pressed.
Auscultation
Auscultation is crucial for detecting vascular abnormalities, such as bruits, which signify turbulent blood flow through narrowed or partially blocked arteries.
Common Sites for Auscultation of Bruits
Carotid Arteries: Use the bell of the stethoscope to listen for bruits, which may indicate carotid artery stenosis. Ask the patient to hold their breath briefly during auscultation to minimize noise.
Abdominal Aorta: Listen for bruits over the aorta in the abdomen, which may indicate an aortic aneurysm or stenosis of its branches.
Renal Arteries: Auscultate in the flank area for bruits, which can suggest renal artery stenosis, a cause of secondary hypertension.
Femoral Arteries: Listen for bruits in the groin area. Presence of a femoral bruit may indicate peripheral arterial disease.
Bruits
Description: A bruit is a whooshing or blowing sound heard over arteries, caused by turbulent blood flow. It may indicate vascular stenosis or an aneurysm.
Clinical Significance: The detection of bruits often warrants further imaging, such as Doppler ultrasound or angiography, to evaluate the underlying cause.
Blood Pressure Measurement
Accurate blood pressure measurement is vital for assessing vascular health and diagnosing hypertension or hypotension:
Cuff Placement: Use an appropriately sized cuff. Place it on the upper arm, ensuring the cuff is snug and positioned at heart level.
Auscultatory Method: Use a stethoscope and sphygmomanometer to measure systolic and diastolic pressures accurately.
Orthostatic Hypotension: Assess blood pressure changes when the patient transitions from lying down to standing. A drop in systolic pressure of 20 mm Hg or more, or in diastolic pressure of 10 mm Hg or more, may indicate orthostatic hypotension, commonly caused by dehydration, blood loss, or autonomic dysfunction.
Blood Pressure Values
Blood Pressure Category
Systolic (mm Hg)
and/or
Diastolic (mm Hg)
Normal
<120
and
<80
Elevated
120 – 129
and
<80
Hypertension Stage 1
130 – 139
or
80 – 89
Hypertension Stage 2
≥140
or
≥90
Isolated Systolic Hypertension
≥140
and
<90
Hypertensive Crisis
>180
and/or
>120
Hypotension
<90
and/or
<60
Hypertension: Often asymptomatic and called the “silent killer,” it requires treatment to prevent serious complications like stroke, heart attack, and kidney failure.
Hypotension: Can present with symptoms like dizziness, fainting, and, in severe cases, shock. Causes include dehydration, significant blood loss, and autonomic dysfunction.
Venous and Arterial System Examination
The following table summarizes the differences between the Venous System Examination and Arterial System Examination.
Aspect
Venous System Examination
Arterial System Examination
Purpose
Assess for signs of venous insufficiency, thrombosis, or valve incompetency.
Evaluate arterial blood flow, occlusion, or insufficiency.
Inspection
Look for varicose veins, stasis dermatitis, and venous ulcers.
Observe for pallor, cyanosis, dependent rubor, and arterial ulcers.
Palpation
Check for tenderness (e.g., along superficial veins for thrombophlebitis) and assess for pitting/non-pitting edema.
Palpate pulses (e.g., carotid, femoral, dorsalis pedis) and assess for cool skin, delayed capillary refill.