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Collecting a Health History for Peripheral Venous Disease

by Amy Lomas

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Collecting a Health History for Peripheral Venous Disease
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Amy Lomas, BSN, RN-BC
Introduction: What is peripheral venous disease?
Veins are the blood vessels that bring blood from the distal points of the body back to the heart. Veins have thin walls that allow for stretching when large volumes of blood must flow back to the heart. However, this means that veins can become weak and inelastic, which predisposes them towards disease (Bickley 2021).
Peripheral venous disease occurs when blood backs up in the veins (Bickley 2021). Patients with peripheral venous disease often suffer from "pain or aching, throbbing, tightness, heaviness, feeling of swelling, muscle tiredness, itching, cramps, burning sensations, restless legs, tingling and venous claudication" (Barros et al. 2019).
Peripheral venous disease may also present as a deep vein thrombosis (DVT) in the arms or legs or a pulmonary embolism (PE) in the lungs. It is estimated that over two million Americans suffer from DVTs each year. If these clots embolize, or break free from the vein, they can prove fatal (Bickley 2021).
What difference can a health history make?
A thorough health history can provide valuable information needed about the patient's condition and allow the provider to order the appropriate tests. In addition to asking about the patient's current symptoms, a health history for peripheral venous disease should include questions about other medical problems and medications that the patient takes (Barros et al. 2019). It is particularly important to assess the peripheral vascular system because it is responsible for providing oxygen to all parts of the body (Bickley 2021).
Healthcare providers have a responsibility
to get a thorough and accurate health history.
Providers and nurses should correlate symptoms and history with pathophysiology.
I've noticed that both of my legs are swollen.
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Venous hypertension can cause dilated capillaries, leading to fluid leaking out of the blood vessel and into tissues (Barros et al. 2019).
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A fracture in the lower extremity puts the patient at a higher risk for developing a blood clot, also known as a DVT, and surgery further increases the risk (Chang et al. 2021).
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I broke my foot two weeks ago - can you believe I had to get surgery to fix it?!
Speech Bubble
Image from Shutterstock.com
Manifestations of Peripheral Venous Disease
Deep Vein Thrombosis (DVT)
Varicose Veins
Image from NHS.uk
Image from Advanced Heart & Vascular Associates
  • Occurs when clot forms in the veins, most commonly the calves
  • Most common symptoms: pain, swelling, warmth, or tenderness on one leg
  • May also present with skin discoloration
  • Risk: if clot dislodges from deep vein, it may travel to the lungs and become a pulmonary embolism, which can be fatal (Mayo Clinic 2023)

  • Occurs when the superficial veins of the legs experience increased pressure over time... damaged veins are unable to pump blood back to the heart, so blood pools in the vein near the surface of the skin
  • Symptoms: veins that appear to be "twisted" near the surface of the skin, blue or purple appearance of veins - usually painless
  • May also present with muscle aches, skin discoloration, or itchiness (Mayo Clinic 2023)

Discussion: Evaluation for Peripheral Venous Disease through Health History
When performing a health history to evaluate for peripheral venous disease, clinicians should consider that certain demographics and conditions put patients at a higher risk for the disease. Female sex and advanced age are the two highest risk factors for peripheral venous disease. Obesity, defined as a body mass index (BMI) of 30 or greater, is a contributing factor, as is a previous diagnosis of hypertension, diabetes mellitus, or hyperlipidemia (Babaei et al. 2023). Because patients may not always comprehend their medical history, clinicians should always ask about prescription medication use to see if the patient has additional chronic health concerns. For example, a patient taking atorvastatin may not state that they have high cholesterol, because the drug brings their lipids down to an acceptable level. Past medical history of pregnancy and family medical history of venous disease also increase the patient's risk for venous disease (Labropoulous 2019).
The patient's habits should also be a part of the questionnaire. Physical activity levels should be assessed, as weekly exercise below the threshold of 150 minutes of moderate exercise per week is correlated with increased risk of venous disease. Cigarette smoking is strongly correlated with the risk of venous disease (Babaei et al. 2023).
Should the patient have concerns related to their legs, clinicians should ask question the symptoms further. Complaints such as muscle aches, pain, fatigue, swelling, or skin discoloration could be related to the peripheral vascular system (Barros et al. 2019). If the patient states they are experiencing pain and swelling unilaterally rather than bilaterally, the provider should be informed immediately, as this is a red flag for a blood clot, or deep vein thrombosis (Mayo Clinic 2023).
References
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S., Baay, M., Alemzadeh-Ansari, M. J., Hosseini, Z., Boudagh, S., Khalilipur, E.,
Ghaemmaghami, Z., Pasebani, Y., Firoozbakhsh, P., Pouraliakbar, H., Bakhshandeh, H.,
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disease among the modern Iranian urban population. Journal of Vascular Surgery: Venous
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Barros, B. S., Kakkos, S. K., de Maeseneer, M., & Nicolaides, A. N. (2019 June). Chronic venous
disease: From symptoms to microcirculation. Edizioni Minerva Medica 38(3), 211-218.
https://doi.org/10.23736/S0392-9590.19.04116-6
Bickley, L. S. (2021). Bates' guide to physical examination and history taking, thirteenth edition.
Wolters Kluwer.
Chang, W., Wang, B., Li, Q., Zhang, Y., & Xie, W. (2021 February 22). Study on the risk factors of
preoperative deep vein thrombosis (DVT) in patients with lower extremity fracture.
Clinical and Applied Thrombosis/Hemostasis 27(1).
https://doi.org/10.1177/10760296211002900
Labropoulous, N. (2019 February 13). How does chronic venous disease progress from the first
symptoms to the advanced stages? A review. Advances in Therapy 36(1), 13-19.
https://doi.org/10.1007/s12325-019-0885-3
Mayo Clinic. (2023). Deep vein thrombosis (DVT). MayoClinic.org.
https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-
20352557
Mayo Clinic. (2023). Varicose veins. MayoClinic.org. https://www.mayoclinic.org/diseases-
conditions/varicose-veins/symptoms-causes/syc-20350643
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