7.7 Peripheral vascular system Flashcards
When are arterial valves palpable?
When artery lies close to body surface
Three arm arteries we need to know
o Brachial
o Radius
o Ulnar
Three leg arteries we need to know
o Femoral
o Posterior tibial
o Dorsalis pedis
When does ischemia occur?
When there is a deficit of oxygenated blood
When does infraction occur?
When there’s a complete blockage. Can happen anywhere in the body.
Pressure in arteries vs. veins
o Arteries = High pressure system
o Veins = Low pressure system
Where are veins located? (2)
o Superficial veins: Usually in subq tissue
o Deeper veins: Along deeper arteries
What is a compensatory mechanism of the veins? What occurs if this happens long-term?
o Veins can distend if the heart isn’t ready for extra blood flow yet
o EDEMA occurs if this goes on long-term.
Three mechanisms of venous flow
o Skeletal muscles contract
o Intraluminal valves ensure unidirectional flow
o Patent lumen
Three functions of lymphatic system:
o To conserve fluid and proteins that leak out of capillaries
o To form a major part of the immune system
o To absorb lipids from the intestinal tract
What are the two main ducts? What do they drain?
o Right lymphatic duct: Drains right side of chest, right side of face
o Thoracic duct: Drains rest of body
What pattern do lymphatic ducts follow?
Venous system
How is the lymphatic different than the cardiovascular system?
It is NOT a closed system. Siphons extra fluids and waste products into itself; waste products get caught up in lymph nodes.
What is intermittent claudication? Who does this happen to?
o Intermittent ischemia to legs. Pain with walking, stops when they stop.
o Happens to long-term smokers.
What would you ask a patient to determine if they had Peripheral artery disease? (2)
o This causes intermittent claudication, so
o Ask, “Have you ever had pain or camping in the legs with walking or exercise?” “Does the spasm get better with rest?”
What would you ask a patient to determine if they had arterial spasm
“Do your fingertips or toes ever change color in cold weather or when you handle cold objects?
What would you ask a patient to determine if they had venous peripheral vascular disease? (2)
o Swelling of feet and legs?
o Ulcers on lower legs (often near ankles)?
Grading Amplitude of Pulses
3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent / Unable to palpate
Possible causes of edema (5):
o Deep venous thrombosis (DVT) o Chronic Venous insufficiency o Lymphedema (does not pit) o Orthostatic edema o Congestive Heart Failure
Describe the Allen Test.
o What does it test for?
o How is it done?
o What is normal / abnormal?
o Tests for occluded ulnar artery
o Depress radial artery. Have patient open and close fist.
o Normal: Blood returns via ulnar artery
o Occluded: No blood return
Four S/S of arterial insufficiency
o Thick toenails
o Red when foot is down, pale when up.
o Poor / absent capillary refill
o No hair on toes
What does Homan’s sign assess for?
Deep Venous Thrombosis
What are the signs and symptoms of DVT? (5)
o Swelling o Edema o Erythema o Hotness o Pain in the calf
How do you elicit Homan’s sign? What is a positive Homan’s sign?
o Support the patient’s thigh in one hand, foot with the other, and bend leg slightly at the knee.
o Firmly and abruptly dorsiflex the ankle.
o Positive: Deep calf pain, resistance of ankle dorsiflexion or involuntary knee flexion
Characteristics of Chronic Arterial Insufficiency (11)
o Intermittent claudication progressing to pain at rest
o Decreased or absent pulses
o Pale color (esp on elevation); dusky red on dependency.
o Temperature is cool
o Edema is absent or mild (may develop as patient tries to relieve rest pain by lowering the leg)
o Trophic changes: Thin, shiny, atrophic skin.
o Loss of hair over foot and toes
o Nails thickened and ridged
o Ulceration in toes or points of trauma on feet (if present)
o Gangrene may develop
Characteristics of Chronic Venous Insufficiency (9)
o No pain to aching pain on dependency
o Normal pulses (though difficult to feel through edema)
o Normal or cyanotic color on dependency. Petechiae and then brown pigmentation appear with chronicity. “Brawny.”
o Temperature is normal
o Marked edema
o Brown pigmentation around ankle
o Statis dermatitis and possible thickening of the skin and narrowing of the leg as scarring develops
o Ulceration present at sides of ankles (especially medially)
o Gangrene does not develop
