Ch 18: Peripheral vascular and lymphatic assessment Flashcards

1
Q

What is the function of the arteries

What kind of blood do they carry and to where

What makes arteries expand and recoil and how does it generate this

A

To supply oxygen and nutrients to tissues

Arteries carry oxygenated blood through arteries away from the heart to tissues

Each heartbeat (Pulse) creates a pressure wave making arteries expand and recoil

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2
Q

Give Alton pulse sites and group them to corresponding body structures (broad)

A
Temporal 
carotid -head/neck
apical 
brachial
 radial 
ulnar-arm
 femoral 
popliteal 
dorsalis pedis 
posterior tibial-feet and legs
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3
Q

Give the three layers of an arterial/ arterioles walls

A

Tunica INtima
tunica MEDia
tunica EXTERNa

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4
Q

What do capillaries exchange between where

What do we use to test the capillaries

Give a brief description of the technique used to test
Give norm

A

Capillaries exchange nutrients gases between vessels and tissues

Capillaries tested using Capillaries refill

You press the Bed of the finger nail for 5 seconds let go watch the finger pink

Norm: Less than 3 seconds

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5
Q

What does smooth epithelial cells line and prevent from inside

What happens if there’s injury to the smooth epithelial cells

A

Smooth epithelial cells line blood vessels, prevent platelet adhesion and thrombus formation

Injury to sells creates arteriosclerosis

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6
Q

What are the elastic fibers in the heart allow

A

Allow arteries to constrict and recoil

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7
Q

What is an important fact about veins that are farther from the hear and why

A

The more distal the vein from the heart the greater number of valves it has because of gravity‘s pull beibg stronger

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8
Q

What is another name for veins

What kind of blood do veins carry and to where

What does it mean to say veins are capacitance vessels and why

A

Veins a.k.a. capacitance vessels

Veins carry deoxygenated blood To the heart

To say beans are capacitance vessels means that they collect the most blood in them because they hold a major portion of the intramuscular blood volume and lower muscles

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9
Q

What do Veins rely on to combat the pull of gravity and what do they promote

A

Veins rely on muscle pump to combat the pull of gravity and promote venous return

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10
Q

What do calf and leg muscle contractions promote and to where

Give an example of when calf and leg muscles promote this

A

Calf and leg muscle contractions promote venous blood flow (venous return) to body and brain

 A great example is when you go from sitting to standing too fast and you get dizzy the calf and leg muscles have to contract to increase that venous blood flow

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11
Q

What is a hospital application (2) that imitate walking to prevent DVT and in who

A

hospitals people use
SCD(sequential compression devices)
Tedhole socks

that pulsate the calf to imitate walking in those were bedbound to prevent DVT‘s

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12
Q

What is the pressure gradient

Why do veins have valves

A

Pressure gradient = The force pushing blood through the blood vessels

valves to prevent the pull of gravity so they have uni directional flow

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13
Q

What do you develop if you have an interruption in the pressure gradient

What are risk factors for this development

A

Mainly: women’s standing for long periods

-pregnant

  • Women +50
  • sitting or standing for too long
  • Being overweight
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14
Q

What is the direction the lymphatic system runs 

What is The lymphatic system function

A

The lymphatic system runs parallel to arteries and veins

The lymphatic system maintains fluid and protein balance AND Works with immune system V inf

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15
Q

What does lymph nodes carry into where

Where does a lymph flow in the arm drain to

Where does lymph from your lower extremities drain into

A

Lymph nodes carry lymph tissue back to the bloodstream

Lymph flow in the arms drains to

  • Epi-trochlear
  • axillary (central)
  • infraclavicular

Lymph from lower extremities drains into:
-inguinal “horizontal” nodes 

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16
Q

What is another name for inguinal nodes

If you have a patient whos superficial lymph nodes are accessible what do you want to asses for 

A

Inguinal nodes= horizontal

If a patient has superficial notes accessible assess if cancerous

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17
Q

Give the location of the epitrochlear note

A

Epi-trochlear node found 1 inch above the elbow on medial (inner side)

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18
Q

Where are the thoracic ducts located And where do they return lymph fluid to

A

Thoracic docks located between the subclavian and internal jugular veins

Thoracic veins return lymph to the circulation

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19
Q

What is the definition of arterial sclerotic disease

(give the one medical term and explain it)

A

Arterial sclerotic disease is claudication

=narrow blocked arteries causing very little blood flow to pass through

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20
Q

Give the definition of arteriosclerosis

Why does systolic blood pressure increase in your older population

A

Arterial sclerosis is The Hardening and less compliance of arteries
-(arterial calcification)

You seen increase in salt blood pressure in your older population because of decreased arterial compliance 

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21
Q

What are the two main factors in peripheral artery disease (PAD)

A

Peripheral artery disease = arteriosclerosis + arteriosclerotic disease

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22
Q

In a patient who has arteriosclerotic disease what is going to be their main complaint and why does this happen

A

The main complaint of someone with arteriosclerotic diseas
complain about Bilat pain while walking short distances

due to claudication

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23
Q

Who is peripheral artery disease (PAD) dramatically seen in

Give gender statistic

A

PAD dramatically seen in 70-80 year-olds

= in men and woman

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24
Q

What cultural populations has the highest risk for hypertension and peripheral arterial disease

A

African-American and Mexican women have the highest risk for hypertension and peripheral arterial disease

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25
How much blood volume does a pregnant woman typically have What does this extra blood volume cause What are the results from this extra blood volume
Pregnant women have 2x the blood volume The extra blood volume obstruct the iliac vein in the inferior vena cava ``` Resulting in: -dependent edema -varicose veins -Hemorrhoids  ```
26
Who is arteriosclerosis more commonly found in now what does ir correlate to
Now it’s usual to see children and teens with arteriosclerosis closely associated with: - high cholesterol - obesity - physical activity - high-fat diet - hereditary 
27
What is a complete arterial occlusion What kind of assessment is needed for a complete arterial occlusion What are signs and symptoms 
Complete arterial occlusion is no blood flow to the limb Complete arterial occlusion is a urgent assessment (threatens the limb) ``` Signs and symptoms include: -coldness -Color change in extremity -pain -numbing ```
28
What do you do if you are assessing in your encounter deep vein trombosis (DVT) Give signs and symptoms for DVT Give the immediate interventions for DVT
If encountered DVT, stop assessment get help for anticoagulants NOW! - warmness in affected extremity - Erythema - pain - edema 1. Start anticoags 2. Get D dimer 3. Heparin stat (5-10k units) 4. Heparin drip (1-1.5k units)
29
What are risk factors for DVT +2
Vascular epithelial injuries Venous stasis -bedrest - Postop hip/ knee surgery with anesthesia - Contraceptives/pregnancy - Patient with respiratory issues (intubated/coma)
30
What is a pulmonary embolism  What type of assessment is a pulmonary embolism Give signs and symptoms of a pulmonary embolism What is the #1 diagnostic test to conduct for PE
Pulmonary embolism is a blood clot from the legs that traveled to the lungs PE is an emergency assessment Signs and symptoms: - Extreme anxiety (flailing of doom) - acute dyspnea -  unilateral chest pain - tachycardia - petichae on chest  #1 diagnostic test for PE = D dimer
31
What does a D timer test reflect What is the value of the D dimer test when there is a clot
Didama test reflects coagulation (rapid degradation of Fibrin) D dimer result of  +500 ng/mL = clot
32
What is a Venus Doppler used for How do you conduct a contrast venography
Doppler: To locate a clot Contract venography: -cannulate (inject) patient with contrast day and take x-ray
33
Give abnormal ARTERIAL findings
-PAD - acute atrial occlusion - AAA - raynauds disease
34
Who is abdominal aortic aneurysms more commonly found in and what are they considered Give a few signs and symptoms
Abdominal aortic aneurysms are 9x more often seen in men and are often fatal Signs and symptoms: - bruits - lateral pulsating mass
35
What type of disorder is raynauds disease and who is it often seen in
raynauds dis is a connective tissue disorder often seen in women with lupus
36
Give abnormal VENOUS findings  | And just a breif discription of each
``` -DVT huge unilateral edema -chronic venous insufficiency Extreme edema -thrombophlebitis Coors like vein do to IV infections -neuropathy Burning pain and or numbness ```
37
Give the differences between: IV thrombophlebITIS and IV infiltration
IV thrombophlebitis: - WARM - cord like vein because of INF - pain IV infiltration: - COLD - leaking of fluid out of vein
38
What were the patient who has DVT complain of 3 things
- pain/aches - Erythema - warmth
39
What causes a Venus ulcer  Give the major characteristics of a venous ulcer What is bormal about a venous ulcer Interventions used for a venus ulcers
Venous ulcers are due to poor blood flow out of leg (blood return) ``` Characteristics of Venus ulcers: - BROWN / RED Iron deposit/breaking RBC (Hermosidrosis) -SUPER WET with slough -edema -shallow -itchy ``` Has normal cap refill nirmal perfusion Interventions: -elevate and compress
40
What causes an arterial ulcer what do pulses look like Give the major characteristics of a arterial ulcer Who do you typically see arterial ulcers in? What interventions do you not want to use? What
Arterial ulcers due to lack of blood flow Pulses absent or weak ``` Major characteristics: -DEEP -necrotic/gangrene tissue -sharply defined -pale wound -minimal exudate (very dry) ``` Typically seen in those with diabetes DO NOT ELEVATE
41
What must tou check for someone with PVD | What do you do if you dont palpate a pulse 2 things
In someone with PVD check pulses If you cannot get a pulse check for cap reful and get doppler
42
Name the seven Ps for assessing PVD or any peripheral assessment
1. Pain 2. Pallor 3.Poikilothermia: And ability to regulate core body temperature  (A colder or hotter extremity v other) 4. Paresthesia: numbness /tingling 5. Pulselessness : pulse? 6. Paralysis : cant move 7. Perfusion: cap refill
43
 Give personal risk factors for the peripheral vascular in lymphatic assessment
smoking High cholesterol/fat/hypertension Sedintary lifestyle Obesity
44
Give relevant family history as subjective data for The peripheral and lymphaticassessments
``` PAD AAA CAD arteriosclerotic disease chronic venous disease Lymphedema ```
45
What are the health goals related to the peripheral vascular and lymphatic assessment What are ways we can help our patients achieve the health goal related to the peripheral vascular and lymohatic system 
Controlling factors for heart disease and stroke  ``` •Manage HTN, high cholesterol,DM •Improve/teach diet -low-fat, sugar, salt, calorie -highg fresh fruits/veggies -smoking cessation  ```
46
 when you seen the DVT Well score : what score is indicative of likely DVT What score is indicative of unlikely DVD
Likely DVT: 2+ Unlikely DVT: below 2
47
What are risk factors in relation to risk reduction and health promotion for the peripheral vascular and lymphatic system Nonmodifiable
Age, gender, family history
48
Modifiable risk factors in relation to risk reduction for PAD What do you want to do for patient to support them in reducing risk factors especially if HTN/DM Why do you complete the daily assessment of feet and how do you do it and especially in who?
Modifiable: - smoking - High fat diet - sedentary lifestyle - HTN/ DM  for patients especially with HTN/DM have available resources for patient like pamphlets and support groups  daily feet assessments completed to prevent ulcers, done with mirror -especially in patients with DM
49
For a patient with venous disease what should you indicate as a risk factor by means of education
For patients with penis disease do you want to educate on decreasing venous pressure 
50
In a patient with venous disease what are prophylactic ways to aid the patient LMWH
1. the use of Novalox (LMWH) - as it last long and is easy to manage 2. The use of SCD & Ted hose stockings - assess all pulses the patient has eternal stocking around - Antiembolism
51
What are risk factors for DVT
Bed rest surgery of hip/knee with anesthesia Contraceptive/pregnancy *Patients with respiratory issues (intubated/coma) Suffered MI 
52
What are nursing interventions done to prevent DVT that you can teach the patient
1. Elevate legs  2. Complete Dorsi plantar flexion -exercise feet
53
For patients with lymphatic disorders such as lymphedema what are nursing interventions that they can implement during daily life to prevent exasterbations  3 things)
#1 treat chronic lymphedema early 2. Avoid sitting/standing for long periods 3.  execute Dorsiplantar flexion
54
With patients who have excessive lymphedema what is vital to remember when it comes to their apperance
excessive lymphedema is considered to be a disfigurement Those with chronic lymphedema have body image issues
55
What are common symptoms of peripheral vascular and lymphatic assessments
Pain, numbness/tingling, cramps, Adema, decreased functional ability
56
And you’re older adults what are common signs and symptoms related to the peripheral vascular and lymphatic assessments
1. Edema 2. Fatigue 3. Cramping 4. Aching legs
57
What culture population is most likely to have PAD and by how much
African-Americans are 3x more likely to have PAD v Caucasians
58
If you cannot palpate a pulse what is your next step
If you cannot palpate a pulse use the Doppler
59
When inspecting the arms and legs what are you looking for
``` Color size symmetry hair distribution ulcers edema muscle hypertrophy/atrophy Varicose veins ```
60
When you’re pulpating the arms and legs what are you palpating for and what are you palpating for over your arterials
During arms and legs palpate for: - edema - Pulsus - capillary refill Over arterials you’re palpating for any thrills 
61
What is the ABI index and how do you perform this technique What are normal findings What are abnormal findings 2 types
ABI= ankle brachial index Technique: - take brachial SBP with doopler bilat • use highest brachial SBP as denominator -Put cuff on ankle, take dorsalis or tibial SBP with Doppler • ankle SBP higer or equal to brachial SBP divide ankle SBP by highest brachial SPBP ``` Norm: 1-1.40 Abnorm: -below 0.9: material insufficiency -above 1.4 non-compressible  ```
62
What does the color change technique assess for How do you perform the color change technique Normal findings Abnormal findings
Color change technique assess for arterial insufficiency Technique: -Patient supine elevate legs 12 inches above heart -patient pump feet to drain blood -sit up an dangle feet Norm: Color returns in 10 seconds Abnorm: rubor (flush) greater than 10 seconds = arterial insufficiency
63
What does the manual compression test evaluate  Who do you perform the manual compression test on
Manual compression test evaluates the competence of valves Done inpatients with varicose veins
64
What is the Trendelenburg test evaluate
The Trendelenburg test evaluate saphenous vein valves for varicose veins
65
If you cannot palpate a pulse and you use the Doppler what is the Doppler used to confirm How do you use a Doppler
Doppler confirms adequate blood flow Technique: Apply Gel 90° angle transducer hear swoosh
66
What pulse palpation site must you have a very light touch for
When palpating the dorsalis pedis you must have a very light touch
67
If you cannot help heal pulse what are signs to look for that indicate adequate perfusion
Color, temperature, capillary refil
68
What is a main characteristic of PVD
Decreased blood flow
69
What are lifespan considerations for older adults in regards to peripheral vascular and lymphatic assessments ``` Disease Physical exam integration SBP Decreased activity increasing what DVT Oint what pain ehy ```
Arterial disease is common and frequently under diagnosed Ankle brachial index integrated into physical exams Systolic hypertension increases with age Decreased activity increases venous stasis (inflamm) DVT development Decreased joint mobility decreasing blood flow to legs causing pain with walking 
70
What is an arterial diagnostic/laboratory test done
Arteriogram
71
What are common Venus diagnostic/laboratory tests done
D dimer, venous ultrasonography (Doppler), anticoagulant
72
When getting a patient cholesterol and triglyceride levels what must a patient do What are normals What is normal DM glucose What is normal DM hemoglobin A1c
When getting cholesterol or triglyceride levels patient must fast Cholesterol: below 200 Triglycerides: below 150 DM glucose between 120 to 130 and below DM hemoglobin A1c: pillow six. Five
73
What are two Diagnostic tests done to diagnose lymphedema
MRI and CT used to diagnose lymphedema
74
Give nursing outcomes related to PVD
Peripheral pulses strong, symmetrical Cap refill less than three seconds Decrease peripheral edema
75
Give nursing interventions related to PVD
Monitor peripheral pulses, edema as ordered Evaluate pain on 10 point scale
76
Give nursing diagnosis related to PVD
Altered tissue perfusion Risk for peripheral Neurovascularfunction Activity intolerance
77
When your assessing pulsus especially of the lower legs what else you want to assess for
When assessing pulses especially of the lower legs access for edema grade, location, and degree
78
How is hair growth an important indicator about peripheral vascular function
Hair growth shoes oxygenation to tissues and adequate perfusion