Circulation and Pulses

Assess	Document: assessment, interventions, outcomes
Pulses	Equality and character of pulses, comparing right and left.
6 Ps	Pain, pallor, pulselessness, polar, paresthesia, paralysis.
S/S	Swelling, limb pain, change in sensation, fatigue.
Edema	Extremities and dependent areas for edema, varicosities.
Nails	Capillary refill, cyanosis, angle of attachment, clubbing.
History	PVD, DM, HTN, CHF, DVT, surgeries, lymphedema, meds.

Capillary Refill

Normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 seconds

Delayed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 seconds

Pulse Strength

0 ............................. Absent                    

1 ................................Weak

2 ............................ Normal

3 ................................... Full

4......................... Bounding

Right arm:	Left arm:
Right leg:	Left Leg:

Edema Scale

+ 1 Slight pitting with 2 mm of depression that disappears rapidly. No visible distortion of extremity.

+ 2 Deeper pitting with 4 mm of depression that disappears in about 10–15 seconds. No visible distortion of extremity.

+ 3 Depression of 6 mm that lasts more than a minute. Dependent extremity appears swollen.

+ 4 Very deep pitting with 8 mm of depression that lasts 2–3 minutes. Dependent extremity is grossly edematous.

Common Pulse Points

Temporal . . . . . just anterior to the upper third of the ear

Carotid . . . . . . . below the angle of the jaw on either side of the trachea

Apical . . . . . . . . left side of the chest at the 5th ICS, midclavicular line

Brachial . . . . . . medial antecubital fossa

Radial . . . . . . . . medial-ventral wrist below the base of the thumb

Femoral . . . . . . crease of the groin between pubis and hip bone

Popliteal . . . . . . popliteal fossa behind the knee

Dorsalis Pedis . medial dorsum of the foot

Posterior Tibial . slightly below the posterior malleolus of the foot