Assessment

HISTORY. Elicit a history of symptoms, with particular attention to pain and discomfort, changes in appearance of vessels and skin, and complaints of a sensation of fullness of the lower extremities. Ask the patient to describe the amount of time each day spent standing. Take an occupational history with particular attention to those jobs that require long hours of walking or standing. Question the patient about lifetime weight changes, such as changes during pregnancy and sustained periods of being overweight. Ask the patient if there is a personal or family history of heart disease, obesity, or varicose veins.

PHYSICAL EXAMINATION. The number, severity, and type of varicosities determine the symptoms experienced by the individual. With the patient standing, examine the legs from the groin to the foot in good lighting. Inspect the ankles, measure the calves for differences, and assess for edema. Time of examination is a factor because secondary varicosities are more symptomatic earlier in the day. Palpate both legs for dilated, bulbous, or corkscrew vessels. Patients may complain of heaviness, aching, edema, muscle cramps, increased fatigue of lower leg muscles, and itching. Severity of discomfort may be difficult to assess and is unrelated to the size of the varicosity.

PSYCHOSOCIAL. The patient with varicose veins has usually been dealing with a progressively worsening condition. Assess the patient for any problems with body image because of the changed appearance of skin surface that is caused by varicose veins. Question the patient to determine possible lifestyle adjustments to decrease symptoms. The patient may need job counseling or occupational retraining.

Diagnostic Highlights

General Comments: Incompetency of the deep and superficial veins can be diagnosed by several tests.

Normal Result

Abnormality with Condition

Explanation

Trendelenburg's test

Doppler ultrasound flow studies; duplex ultrasound

Venous plethysmography (cuff pressure test)

Veins fill from below in about 30 sec after the tourniquet is in place and the client stands; no further blood fills the veins from above after the tourniquet is released

Normal Doppler venous signal with spontaneous respirations; no evidence of occlusion

Patent venous system without evidence of thrombosis or occlusion

Additional blood flows into the vein from above, indicating a valve is incompetent and has allowed a backflow of blood

Reversal of blood flow is noted as a result of incompetent valves in varicose veins. Venous obstruction

Detects abnormal filling time and incompetent valves; veins normally fill from below; if the vein fills from above, the incompetent valve is allowing blood to flow backward.

Detects moving red blood cells (RBCs), thus demonstrating venous patency

Measures the volume of an extremity; rules out a deep vein thrombosis

Diagnostic Highlights (continued)

Test

Normal Result

Abnormality with Condition

Explanation

Magnetic resonance

Normal blood flow with

Reversal of blood flow

Examines blood flow in

venography (MRV)

out evidence of occlusion

noted

extremities

and magnetic reso-

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