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Discussion

How to document circulation assessment

What do I include in a client assessment for circulation?

So far I have color, temperature, edema, pedal pulse.

When assessing pedal pulse do I use a number like +3 or do I use words like weak or strong?

Thanks.

Featured Replies

Capillary refill as well.

I chart the pulses as +2 or +1, but you can also chart as weak, thready, bounding. It's up to you and what your teacher wants.

I would probably start with the heart. It's the primary organ of circulation and no evaluation of the entire circulatory system should take place without it (or at least that's what I think).

  • Experts

Assessment of the circulation includes observation and documentation of/for the following:

  • general
    • fatigue
    • syncope
    • symmetry of extremities

    [*]chest

    • chest pain
    • palpitations
    • dyspnea

    [*]skin and appendages (also note the nail beds and conjunctiva)

    • temperature
    • capillary refill
    • color changes (pallor, cyanosis, redness, brownishness)
    • shiny skin
    • presence of any ulcers
    • condition of the nails
    • presence or loss of hair
    • (dependent) edema (nonpitting or pitting)

    [*]numbness

    [*]tingling

    [*]blood pressure (lying, sitting and standing)

    • by palpation
    • by auscultation

    [*]pulses

    • rate and rhythm
    • pulsus alternans - alternating pattern of a weak and a strong pulse that occurs at regular intervals
    • pulsus bigeminus - same as pulsus alternans but occurs at irregular intervals
    • pulsus paradoxus - increased and decreased amplitude in pulse associated with respirations
    • thrills - vibrations you can feel over turbulence
    • bruits

    [*]heart sounds

    • normal
    • S3 ventricular gallop
    • S4 atrial gallop
    • friction rub
    • murmur
    • clicks
    • snaps

Pules are graded on a four-point scale as follows:

4+ = bounding

3+ = increased

2+ = normal

1+ = weak, diminished

0 = absent

You should also check the links on this sticky thread:

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