Breasts, Lymphatics and Peripheral Vascular System Flashcards
1
Q
What kind of blood do arteries pump to tissues?
A
Oxygenated
2
Q
2 kinds of fibers arterial walls are comprised of and explain each
A
- Elastic
-Stretch with systole and recoil with diastole - Muscle
-Change diameter to control rate of blood flow and amount delivered to tissues
3
Q
What creates the pulse and what is it also called?
A
Also called a pressure wave
The recoil pushes blood forward
4
Q
Peripheral vascular arteries:
A
- Brachial
- Radial
- Ulnar
- Femoral
- Popliteal
- Posterior tibial
5
Q
What do peripheral veins do?
A
Return deoxygenated blood and it’s waste products to the heart
6
Q
Different characteristics between the walls of peripheral arteries vs. veins
A
The walls of veins are thinner, larger in diameter and more distensible
7
Q
What kind of pressure system are peripheral veins, and why is it beneficial?
A
Low pressure system which reduces stress on the heart
8
Q
Blood flow in the veins is ensured by:
A
- Contraction of skeletal muscles
- Pressure gradient created by breathing
- Intraluminal valves
9
Q
Explain the pressure gradient created by breathing
A
Inspiration = decreased thoracic pressure and increased abdominal pressure
10
Q
What are intraluminal valves?
A
They function to bias lymph flow back towards the heart
11
Q
Peripheral vascular veins:
A
- Great sapenous
- Small saphenous
12
Q
Main function of the lymphatic system
A
Retrieve excess fluid from tissue spaces, filter it and return it to the bloodstream
13
Q
Name the 2 main ducts of the lymphatic system
A
- Right lymphatic duct
- Thoracic duct
14
Q
Where does the right lymphatic duct empty and what parts of the body does it drain excess fluid from?
A
-Empties into right subclavian vein
-Drains the right side of the head, neck and heart; right arm, lung and pleura, right upper section of the liver
15
Q
Where does the thoracic duct empty and what pats of the body does it drain excess fluid from?
A
-Empties into the left subclavian vein
-Drains the rest of the body
16
Q
Name the 3 main functions of the lymphatic system?
A
- Conserve fluid and plasma proteins
- Forms a major part of the immune system
- Absorbs lipids from the intestinal tract
17
Q
Cervical node
A
Drains the head and neck
18
Q
Axillary node
A
Drains the upper arm and breast
19
Q
Epitrochlear node
A
Drains the hand and lower arm
20
Q
Inguinal node
A
Drains the lower extremities, anterior abdominal wall and genitals
21
Q
Name the 4 related lymphatic organs
A
- Spleen
- Tonsils
- Thymus gland
- Bone marrow
22
Q
Spleen location and functions
A
Location: LUQ
Functions:
-Destroy old RBC’s
-Create antibodies
-Store RBC’s
-Filter microorganisms from the blood
23
Q
Tonsils location and function
A
Location: Entrance of respiratory and GI tracts
Function: To respond to local inflammation
24
Q
Thymus gland location and function
A
Location: Superior mediastinum, dorsal to sternum and anterior to aorta
Function: None for adults (for children it helps in developing T-lymphocytes)
25
Bone marrow location and function
Location: Center of bones
Function: To create T and B lymphocytes
26
Arteriosclerosis
Peripheral vessels become rigid and thick, produces a rise in systolic BP
-Hardening of arteries!!!
27
Why does arteriosclerosis create a high BP?
Because the loss of elasticity of vessel walls creates the high BP
28
Peripheral Arterial Disease (PAD)
Includes atherosclerosis
-Silent CVD since it's often underdiagnosed, misdiagnosed and undertreated
-Major risk factor for lower extremity amputations
29
Why do advanced (PADs) need lower extremity amputations?
Because of poor to no perfusion so tissue necrosis occurs and will spread so have to amputate
30
Atherosclerosis (as part of PAD)
Deposit of fatty plaque in the arteries
-Narrowing of arteries!!!
31
What is an angioplasty?
A procedure to try to open your arteries
32
What is deep vein thrombosis (DVT) and it's risk factors?
-Blood clot formation in the deep veins
-Can lead to a pulmonary embolism
Risk factors:
-Progressive enlargement of intramuscular calf veins
-Increased bed-rest
-Decreased physical activity
-Heart failure
33
What is a pulmonary embolism?
A piece of a thrombus breaks off and travels to arteries/veins and the lungs and it can be big enough to fully block them
34
What does a loss of lymphatic tissue mean?
Less lymph nodes and decreased size of remaining nodes
35
PMHx of note for this system
Medications- type, dosage, new/old, side effects
Chronic conditions: Obesity, DM, CVD
Other factors: Prolonged standing for work, trauma, pregnancy, smoking, bed rest
36
Who are at greater risk of getting PAD?
Nurses and others who stand a lot for work and for prolonged periods of time
37
What medications can put you at an increased risk of blood clots?
Oral contraceptives and hormone replacements
38
Subjective date of note
-Leg pain/cramps (pain with movement, leg strength)
-Peripheral skin changes in colour, temp., enlarged/crooked veins (can indicate varicose veins), presence of sores or ulcers
-Peripheral edema
-Lymphodenopathy (swelling of any lymph nodes)
39
For this system check
ONLY inspect and auscultate, DON'T percuss or palpate
Circulation: (temp., color, cap refill, pulses, lymph nodes)
-Motor: (presence of pain with movement, strength of legs)
-Sensation: (presence of paresthesia and anesthesia)
-Symmetry: (in edema, atrophy)
-Derm: (hair distribution and venous pattern over the legs as an indication of perfusion, lesions that aren't healing etc.)
40
Difference between anesthsia and paresthesia
Paresthesia: Some/partial numbness, maybe pins and needles feeling
Anesthesia: Complete numbness - common in DM!!!
41
Common peripheral vascular conditions
-Edema
-Pitting
-Lymphedema
-Deep vein -Thrombophlebitis
-Arterial occlusions
-Arterial aneurysms
42
Definition of edema
Accumulation of excess fluid in tissue
43
Causes of edema
-Increased pressure in capillaries
-Decreased venous return
-Heart failure
-Certain medications
-Kidney disease
-Surgery
44
Can you have increased pressure in the capillaries and not have edema?
Yes, because other systems can compensate but it puts extra work on them and then they can start to slow/fail so then you would get edema
45
Measuring lymphedema
-Use nonstretchable tape measure
-Measure widest point
-Compare to same spot on other limb
-Arms: Wrist, forearm, upper arm
-Legs: Ankle, distal calf, knee, thigh
46
Measuring and grading pitting Edema
-Push on skin for 5 seconds
1+: Mild pitting, slight indentation, no perceptible swelling of leg
2+: Moderate pitting, indentation subsides rapidly
3+: Deep pitting, indentation remains for a short time, leg looks swollen
4+: Very deep pitting, indentation lasts a long time, leg is very swollen and distorted
47
Chronic means you have to have it for how long?
At least 3 months
48
Is lymphedema or pitting edema more acute?
Pitting edema
49
Lymphedema
Buildup of lymphatic fluid
-Common in breast cancer -More chronic than pitting
50
Signs and symptoms (subjective) to look out for from a patient with edema
-Tired (from carrying around excess weight)
-Paresthesia (pins and needles feeling)
-Clothes, shoes, jewlery don't fit (are tight)
51
Objective differences between pitting and lymphedema
Lymphedema skin will feel more tight/stretched
Pitting edema skin will feel more stretchy
52
Objective data of edema
Unilateral swelling (more common) sometimes bilateral swelling
53
Deep venous thrombophlebitis definition and effects
-Occulsion of deep vein by thrombus
-Resulting in:
-Inflammation
-Reduced venous return
-Cyanosis
-Edema
54
Risk factors for deep venous thrombophlebitis
-Stasis of blood
-Hyper-coagulability
-Endothelial dysfunction (Large blood vessels of the heart constrict rather than dilate)
55
Causes of deep venous thrombophlebitis
-Bed rest
-History of varicose veins
-Trauma
-Infection
-Cancer
-Certain medications
56
Subjective and objective data of deep venous thrombophlebitis
Subjective:
-Calf pain that comes on suddenly and is intermittent
-Sharp pain on dorsiflexion
Objective:
-Tenderness on palpation
-Possibly varicose veins
-Warmer skin around that area
57
Arterial occulsion definition and effects
-Occulsion of artery due to atherosclerosis or thrombus
-Results in reduced blood flow to distal areas
58
Risk factors of arterial occlusions
-Obesity
-Smoking
-Hypertension (HTN)
-Diabetes (DM)
-Sedentary lifestyle
-Family Hx of dyslipidemia
59
Subjective and objective data of arterial occlusions
Subjective:
-Pain
-Pins and needles
Objective:
-Pallor
-Pulseless
-Change in temperature
60
Arterial aneurysms definition and effects
Formation of "sac" due to dilation of arterial wall (commonly in the aorta)
-Can result in the rupture of an artery -> leading to internal bleeding -> death
61
Risk factors for arterial aneurysms
-Atherosclerosis
-Sex (males are 4-5X more likely to get)
62
Subjective and objective data of arterial aneurysms
Subjective:
-If in the brain:
-Sudden headache
-Pain behind the eyes
-double vision
-If in the thorax:
-Change in voice (more hoarse)
-Chest pain
-Dyspnea (SOB)
-If in the abdomen:
-Lower abdominal pain
-Dull back pain (referred)
Objective:
-Might start vomiting
-Pulsations that can be seen and felt in some cases in the abdomen
63
Extension of adipose tissue angling superolaterally from the primary breast into the axilla
Axillary tail of Spence
64
Quadrants of the breast
-Upper inner and outer quadrants
-Lower inner and outer quadrants
-Axillary tail of Spence
65
4 axillary lymph nodes of note
1. Central axillary
2. Pectoral anterior axillary
3. Subscapular posterior axillary
4. Lateral axillary
66
Older females and breasts
-Post-menopause estrogen and progesterone decrease = glandular tissue and fat atrophies -> decreased breast size and elasticity
-Decreased axillary hair
67
Older male breasts
-Disc of undeveloped tissue underlying the nipple
-Areola developed, nipple small
-Gynecomastia: Temporary tissue enlargement
68
Health Hx and subjective data for breast exam
-Breast disease or cancer
-Genetic factors (BRCA1 or 2) (self and familial)
Subjective:
-Breast pain (mastalgia)
-Lumps
-Discharge from nipples when not lactating (galactorrhea)
-Rash
-Swelling
-Axilla: tenderness, lump, swelling, rash
-Self-care behaviours (self-examination, last mammogram)
69
Urgent finding of breast exam
-Unexplained discharge/ bleeding from nipples
-Open or ulcerating non-traumatic lesions
-Breast mass in patient with previous breast cancer
70
T/F
Is it normal for the left breast to be larger than the right?
True
71
Physical breast exam normal findings
-Breast skin moves with arm movement
-For women with larger breasts want to make sure that their breasts hang down with gravity
72
Can you have extra nipples?
Yes you can have an extra nipple (supernumerary nipple) anywhere along the embryonic milk line
-Usually born with it
73
Palpation of the axilla
-Palpate with the opposite hand to the axilla you're palpating
-Bimanual palpation: squeeze breast tissue together of one breast with one hand on top and other on the bottom
74
Characteristics to chart if a breast lump is detected
-Location (use the clock as reference)
-Size
-Shape
-Consistency
-Movability
-Distinctness
-Nipple
-Skin over the lump
-Tenderness
-Lymphadenopathy (is there any swelling in the arm on the side of the lump)
75
Breast cancer screening
-2nd major cause of death from cancers in females
-Most common cancer in females
-Survival rate at 88%
-Screening risk factors separated in unmodifiable, modifiable and possible risk factors
-Ex. of unmodifiable: age, family Hx
-Ex. of modifiable: hormonal contraceptive, obesity, excessive alcohol
-Ex. of possible: physical inactivity, adult weight gain, smoking and second hand smoking exposure, high birth weight, night shift work)
76
What is the best tool for breast cancer risk assessment?
Asking the right history questions
77
Breast cancer
Solitary, unilateral nontender (may not even feel) mass
-Constant growth
78
Characteristics of a breast cancer mass
-Solid
-Hard
-Dense
-Fixed to underlying tissues or skin
-Irregular borders
-Poorly delineated (hard to describe, portray with accuracy)
79
What part of the breast is breast cancerous masses most commonly located?
-Commonly in upper outer quadrant
80
Advanced changes of breast cancer
-Firm or hard axillary nodes
-Dimpling of skin
-Nipple retraction
-Elevation
-Discharge
81
Abnormal findings
-Fixation (A)
-Orange skin is edema (B)
-Bloody discharge (C)
-Dimpling and retracted nipple (D)
