7.7 Peripheral vascular system

Question 1

When are arterial valves palpable?

Answer 1

When artery lies close to body surface

Question 2

Three arm arteries we need to know

Answer 2

o Brachial
o Radius
o Ulnar

Question 3

Three leg arteries we need to know

Answer 3

o Femoral
o Posterior tibial
o Dorsalis pedis

Question 4

When does ischemia occur?

Answer 4

When there is a deficit of oxygenated blood

Question 5

When does infraction occur?

Answer 5

When there’s a complete blockage. Can happen anywhere in the body.

Question 6

Pressure in arteries vs. veins

Answer 6

o Arteries = High pressure system

o Veins = Low pressure system

Question 7

Where are veins located? (2)

Answer 7

o Superficial veins: Usually in subq tissue

o Deeper veins: Along deeper arteries

Question 8

What is a compensatory mechanism of the veins? What occurs if this happens long-term?

Answer 8

o Veins can distend if the heart isn’t ready for extra blood flow yet
o EDEMA occurs if this goes on long-term.

Question 9

Three mechanisms of venous flow

Answer 9

o Skeletal muscles contract
o Intraluminal valves ensure unidirectional flow
o Patent lumen

Question 10

Three functions of lymphatic system:

Answer 10

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

Question 11

What are the two main ducts? What do they drain?

Answer 11

o Right lymphatic duct: Drains right side of chest, right side of face
o Thoracic duct: Drains rest of body

Question 12

What pattern do lymphatic ducts follow?

Answer 12

Venous system

Question 13

How is the lymphatic different than the cardiovascular system?

Answer 13

It is NOT a closed system. Siphons extra fluids and waste products into itself; waste products get caught up in lymph nodes.

Question 14

What is intermittent claudication? Who does this happen to?

Answer 14

o Intermittent ischemia to legs. Pain with walking, stops when they stop.
o Happens to long-term smokers.

Question 15

What would you ask a patient to determine if they had Peripheral artery disease? (2)

Answer 15

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?”

Question 16

What would you ask a patient to determine if they had arterial spasm

Answer 16

“Do your fingertips or toes ever change color in cold weather or when you handle cold objects?

Question 17

What would you ask a patient to determine if they had venous peripheral vascular disease? (2)

Answer 17

o Swelling of feet and legs?

o Ulcers on lower legs (often near ankles)?

Question 18

Grading Amplitude of Pulses

Answer 18

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent / Unable to palpate

Question 19

Possible causes of edema (5):

Answer 19

o	Deep venous thrombosis (DVT)
o	Chronic Venous insufficiency
o	Lymphedema (does not pit)
o	Orthostatic edema
o	Congestive Heart Failure

Question 20

Describe the Allen Test.
o What does it test for?
o How is it done?
o What is normal / abnormal?

Answer 20

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

Question 21

Four S/S of arterial insufficiency

Answer 21

o Thick toenails
o Red when foot is down, pale when up.
o Poor / absent capillary refill
o No hair on toes

Question 22

What does Homan’s sign assess for?

Answer 22

Deep Venous Thrombosis

Question 23

What are the signs and symptoms of DVT? (5)

Answer 23

o	Swelling
o	Edema
o	Erythema
o	Hotness
o	Pain in the calf

Question 24

How do you elicit Homan’s sign? What is a positive Homan’s sign?

Answer 24

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

Question 25

Characteristics of Chronic Arterial Insufficiency (11)

Answer 25

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

Question 26

Characteristics of Chronic Venous Insufficiency (9)

Answer 26

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