Blood Vessels (Chapter 16) Flashcards
How does the structure of the arteries and veins differ?
Arteries are composed of a thicker smooth muscle layer and allow for less give from internal pressure.
Veins are more distensible. They also contain valves that prevent the backflow of blood.
Amplitude of a pulse
0 - nonpalpable
1 - diminished, barely palpable
2 - normal pulsation
3 - Full, increased
4 - bounding, aneurysmal
What is the Allen test? How is it performed? When is it performed?
The Allen test is an assessment of the ulnar artery patency. It is performed prior to ABG draws or insertion of a radial artery catheter.
1. Have the patient hold their hand up.
2. Occlude both the radial and ulnar arteries.
3. Have the patient open and close their hand five times then leave the palm open. It should be blanched from decreased blood flow.
4. Release pressure held on the ulnar artery allowing blood flow to return to the hand.
5. If the hand does not reperfuse within 4-5 seconds then the ulnar artery is assumed insufficient and the ABG or ART line insertion should be avoided.
What is a bruit or arterial hum?
Bruits/ arterial hums are abnormal sounds auscultated over arteries that indicate turbulent blood flow.
What is …
1. Hemophilia
2. Sickle cell disease
3. Thalassemia
- Hemophilia is a genetic disease where blood does not clot well
- Sickle cell disease is a inherited disorder that causes the RBC to become misshapen which negatively affects their functioning.
- Thalassemia is an inherited blood disorder that causes there to be less than normal amount of hemoglobin.
What is claudication?
Claudication is pain felt due to muscle ischemia. Common symptom of peripheral artery disease
What are the 5 P’s of peripheral artery disease?
- Pallor - the extremity will be cool
- Pain - decreased blood flow (ischemia) is painful. Claudication is an example.
- Paresthesia
- Pulselessness
- Polklothermia
How is severity of PAD assessed in the office visit?
- The patient is laid supine (if tolerated) and the tested extremity is elevated above the level of the heart.
- After a good while, the patient is then asked to bring the tested extremity down below the level of the heart.
- The tested extremity is then assessed for capillary refill time.
- The amount of time it takes for the tested extremity to have return of color determines the severity of the disease.
Hepatojugular reflux
- A useful measurement to perform to assess for right heart failure. It is assessed by holding firm pressure in the middle of the abdomen for roughly 10 seconds while observing the jugular vein for distention. The distention is caused by a back up of blood due to the pressure held in the abdominal region
How does the infant blood vessel differ from adults?
- Capillary refill time in infants is almost immediate. Times longer than two seconds can indicate hypovolemia or shock.
What is unique about the blood vessels of children?
- A venous hum, best heard with the bell of the stethoscope (low frequency sound) over the jugular veins, has no significance and is a common finding.
- Venous thrombosis is a rare occurrence in children, most commonly associated with venous access devices (IVs)
What causes a venous hum in children? Is this pathological?
Venous hums indicate turbulent blood flow over a portion of the blood vessels. This can be a normal finding in children over the jugular veins.
What is unique about blood vessels during pregnancy period?
Blood vessels during pregnancy are carrying 40-50% more blood than preprgenancy. Peripheral edema is a common finding in pregnancy as it progresses.
Formation of varicose veins are common as the body deals with increased blood volume and hormones weakening the blood vessel walls.
What is pitting edema? What causes it? How is pitting edema ranked?
Pitting edema is caused by increased fluid volume in the blood vessels. This increased volume increases the hydrostatic pressure in the vascular space, causing edema in dependent parts of the body.
Pitting edema is ranked based on how long the area compressed stays compressed after pressure is released and how deep the compression is.
+1 = Slight and disappears rapidly
+2 = Deeper pit, disappears in 10-15 seconds
+3 = Deep pit that lasts more than a minute
+4 = Very deep pit, lasts as long as 2-5 minutes before returning to baseline
Describe the assessment for blood vessels
- Inspection - looking at the patient skin, looking for any edema or related findings
- Palpation - palpate arterial pulses located over the radial, carotid, popliteal, dorsalis pedis, and posterior tibial. During palpation the provider should determine the rate and rhythm of the patient’s heart beat. The provider can detect symmetry of pulsations in the left and right to look for impaired circulation. The Allen test can be performed.
- Auscultation for venous hums and bruits indicating turbulent blood flow.
