Bruits
Commonly an indicator of life- or limb-threatening vascular disease, bruits are swishing sounds caused by turbulent blood flow. They're characterized by location, duration, intensity, pitch, and the time of onset in the cardiac cycle. Loud bruits produce intense vibration and a palpable thrill. A thrill doesn't provide a further clue to the causative disorder or to its severity.
Bruits are most significant when heard over the abdominal aorta; the renal, carotid, femoral, popliteal, or subclavian artery; or the thyroid gland. (See Preventing false bruits.)
They're also significant when heard consistently despite changes in patient position and when heard during diastole.
History and physical examination
If you detect bruits over the abdominal aorta, check for a pulsating mass or a bluish discoloration around the umbilicus (Cullen's sign). Either of these signs—or severe, tearing pain in the abdomen, flank, or lower back—may signal life-threatening dissection of an aortic aneurysm. Check peripheral pulses, comparing intensity in the upper versus lower extremities.
If you suspect dissection, monitor the patient's vital signs constantly, and withhold food and fluids until a definitive diagnosis is made. Watch for signs and symptoms of hypovolemic shock, such as thirst; hypotension; tachycardia; a weak, thready pulse; tachypnea; an altered level of consciousness (LOC); mottled knees and elbows; and cool, clammy skin.
If you detect bruits over the thyroid gland, ask the patient if he has a history of hyperthyroidism or signs and symptoms of it, such as nervousness, tremors, weight loss, palpitations, heat intolerance, and (in females) amenorrhea. Watch for signs and symptoms of life-threatening thyroid storm, such as tremor, restlessness, diarrhea, abdominal pain, and hepatomegaly.
If you detect carotid artery bruits, be alert for signs and symptoms of a transient ischemic attack (TIA), including dizziness, diplopia, slurred speech, flashing lights, and syncope. These findings may indicate an impending stroke. Be sure to evaluate the patient frequently for changes in LOC and muscle function.
If you detect bruits over the femoral, popliteal, or subclavian artery, watch for signs and symptoms of decreased or absent peripheral circulation, such as edema, weakness, and paresthesia. Ask the patient if he has a history of intermittent claudication. Frequently check distal pulses and skin color and temperature. Watch for the sudden absence of pulse, pallor, or coolness, which may indicate a threat to the affected limb.
If you detect a bruit, make sure to check for further vascular damage and perform a thorough cardiac assessment.
Medical causes
Abdominal aortic aneurysm.A pulsating periumbilical mass accompanied by a systolic bruit over the aorta characterizes abdominal aortic aneurysm. Associated signs and symptoms include a rigid, tender abdomen; mottled skin; diminished peripheral pulses; and claudication. Sharp, tearing pain in the abdomen, flank, or lower back signals imminent dissection.
Abdominal aortic atherosclerosis.Loud systolic bruits in the epigastric and midabdominal areas are common with abdominal aortic atherosclerosis. They may be accompanied by leg weakness, numbness, paresthesia, or paralysis; leg pain; or decreased or absent femoral, popliteal, or pedal pulses. Abdominal pain is rarely present.
Anemia.In patients with severe anemia, short systolic bruits may be heard over both carotid arteries and may be accompanied by headache, fatigue, dizziness, pallor, jaundice, palpitations, mild tachycardia, dyspnea, nausea, anorexia, and glossitis.
Carotid artery stenosis.Systolic bruits can be heard over one or both carotid arteries with carotid artery stenosis. Other signs and symptoms may be absent. Dizziness, vertigo, headache, syncope, aphasia, dysarthria, sudden vision loss, hemiparesis, or hemiparalysis signals a TIA and may herald a stroke.
Carotid cavernous fistula.A carotid cavernous fistula causes characteristic continuous bruits heard over the eyeballs and temples. Vision disturbances and protruding, pulsating eyeballs are also common.
Peripheral arteriovenous fistula.A rough, continuous bruit with systolic accentuation may be heard over the fistula in a peripheral arteriovenous fistula. A palpable thrill is also common.
Peripheral vascular disease.Peripheral vascular disease characteristically produces bruits over the femoral artery and other arteries in the legs. It can also cause diminished or absent femoral, popliteal, or pedal pulses; intermittent claudication; numbness, weakness, pain, and cramping in the legs, feet, and hips; and cool, shiny skin and hair loss on the affected extremity. It also predisposes the patient to lower-extremity ulcers that heal with difficulty.
Renal artery stenosis.With renal artery stenosis, systolic bruits are commonly heard over the abdominal midline and flank on the affected side. Hypertension commonly accompanies stenosis. Headache, palpitations, tachycardia, anxiety, dizziness, retinopathy, hematuria, and mental sluggishness may also appear.
Subclavian steal syndrome.With subclavian steal syndrome, systolic bruits may be heard over one or both subclavian arteries as a result of arterial lumen narrowing. They may be accompanied by decreased blood pressure and claudication in the affected arm, hemiparesis, vision disturbances, vertigo, and dysarthria.
Thyrotoxicosis.With thyrotoxicosis, a systolic bruit is commonly heard over the thyroid gland. Accompanying signs and symptoms appear in all body systems, but the most characteristic ones include thyroid enlargement, fatigue, nervousness, tachycardia, heat intolerance, sweating, tremor, diarrhea, and weight loss despite increased appetite. Exophthalmos may also be present.
Nursing considerations
▪ Frequently check the patient's vital signs, auscultate over the affected arteries, and monitor peripheral pulses.
▪ Check for bruits that become louder or develop a diastolic component.
▪ Administer prescribed drugs, such as a vasodilator, an anticoagulant, an antiplatelet drug, or an antihypertensive, as needed.
▪ Prepare the patient for diagnostic tests, such as blood studies, X-rays, an electrocardiogram, cardiac catheterization, and ultrasonography.
Patient teaching
▪ Teach the patient signs and symptoms of a stroke and to seek immediate medical attention if they occur.
▪ Discuss lifestyle changes, such as smoking cessation, exercising regularly, and eating a balanced diet.
▪ Teach the patient about the cause of the specific bruit and the treatment plan after a diagnosis is established.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Vein symptoms
» Next page: Skin, mottled (Nursing: Interpreting Signs and Symptoms)
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