Ch 18: Peripheral vascular and lymphatic assessment Flashcards
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
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
Give Alton pulse sites and group them to corresponding body structures (broad)
Temporal carotid -head/neck apical brachial radial ulnar-arm femoral popliteal dorsalis pedis posterior tibial-feet and legs
Give the three layers of an arterial/ arterioles walls
Tunica INtima
tunica MEDia
tunica EXTERNa
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
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
What does smooth epithelial cells line and prevent from inside
What happens if there’s injury to the smooth epithelial cells
Smooth epithelial cells line blood vessels, prevent platelet adhesion and thrombus formation
Injury to sells creates arteriosclerosis
What are the elastic fibers in the heart allow
Allow arteries to constrict and recoil
What is an important fact about veins that are farther from the hear and why
The more distal the vein from the heart the greater number of valves it has because of gravity‘s pull beibg stronger
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
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
What do Veins rely on to combat the pull of gravity and what do they promote
Veins rely on muscle pump to combat the pull of gravity and promote venous return
What do calf and leg muscle contractions promote and to where
Give an example of when calf and leg muscles promote this
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

What is a hospital application (2) that imitate walking to prevent DVT and in who
hospitals people use
SCD(sequential compression devices)
Tedhole socks
that pulsate the calf to imitate walking in those were bedbound to prevent DVT‘s
What is the pressure gradient
Why do veins have valves
Pressure gradient = The force pushing blood through the blood vessels
valves to prevent the pull of gravity so they have uni directional flow
What do you develop if you have an interruption in the pressure gradient
What are risk factors for this development
Mainly: women’s standing for long periods
-pregnant
- Women +50
- sitting or standing for too long
- Being overweight
What is the direction the lymphatic system runs 
What is The lymphatic system function
The lymphatic system runs parallel to arteries and veins
The lymphatic system maintains fluid and protein balance AND Works with immune system V inf
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

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 
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 
Inguinal nodes= horizontal
If a patient has superficial notes accessible assess if cancerous
Give the location of the epitrochlear note
Epi-trochlear node found 1 inch above the elbow on medial (inner side)
Where are the thoracic ducts located And where do they return lymph fluid to
Thoracic docks located between the subclavian and internal jugular veins
Thoracic veins return lymph to the circulation
What is the definition of arterial sclerotic disease
(give the one medical term and explain it)
Arterial sclerotic disease is claudication
=narrow blocked arteries causing very little blood flow to pass through
Give the definition of arteriosclerosis
Why does systolic blood pressure increase in your older population
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 
What are the two main factors in peripheral artery disease (PAD)
Peripheral artery disease = arteriosclerosis + arteriosclerotic disease
In a patient who has arteriosclerotic disease what is going to be their main complaint and why does this happen
The main complaint of someone with arteriosclerotic diseas
complain about Bilat pain while walking short distances
due to claudication
Who is peripheral artery disease (PAD) dramatically seen in
Give gender statistic
PAD dramatically seen in 70-80 year-olds
= in men and woman
What cultural populations has the highest risk for hypertension and peripheral arterial disease
African-American and Mexican women have the highest risk for hypertension and peripheral arterial disease
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 
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

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
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
- Start anticoags
- Get D dimer
- Heparin stat (5-10k units)
- Heparin drip (1-1.5k units)
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)
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
1 diagnostic test for PE = D dimer
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 
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
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
Give abnormal ARTERIAL findings
-PAD
- acute atrial occlusion
- AAA
- raynauds disease
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
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
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
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
What were the patient who has DVT complain of
3 things
- pain/aches
- Erythema
- warmth
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
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
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
Name the seven Ps for assessing PVD or any peripheral assessment
- Pain
- Pallor
3.Poikilothermia: And ability to regulate core body temperature 
(A colder or hotter extremity v other)
- Paresthesia: numbness /tingling
- Pulselessness : pulse?
- Paralysis : cant move
- Perfusion: cap refill
 Give personal risk factors for the peripheral vascular in lymphatic assessment
smoking
High cholesterol/fat/hypertension
Sedintary lifestyle
Obesity
Give relevant family history as subjective data for The peripheral and lymphaticassessments
PAD AAA CAD arteriosclerotic disease chronic venous disease Lymphedema
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 
 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
What are risk factors in relation to risk reduction and health promotion for the peripheral vascular and lymphatic system
Nonmodifiable
Age, gender, family history
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
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

In a patient with venous disease what are prophylactic ways to aid the patient
LMWH
- the use of Novalox (LMWH)
- as it last long and is easy to manage - The use of SCD & Ted hose stockings
- assess all pulses the patient has eternal stocking around
- Antiembolism
What are risk factors for DVT
Bed rest
surgery of hip/knee with anesthesia
Contraceptive/pregnancy
*Patients with respiratory issues (intubated/coma)
Suffered MI 
What are nursing interventions done to prevent DVT that you can teach the patient
- Elevate legs
 - Complete Dorsi plantar flexion
-exercise feet
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
- Avoid sitting/standing for long periods
-  execute Dorsiplantar flexion
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
What are common symptoms of peripheral vascular and lymphatic assessments
Pain, numbness/tingling, cramps, Adema, decreased functional ability
And you’re older adults what are common signs and symptoms related to the peripheral vascular and lymphatic assessments
- Edema
- Fatigue
- Cramping
- Aching legs
What culture population is most likely to have PAD and by how much
African-Americans are 3x more likely to have PAD v Caucasians
If you cannot palpate a pulse what is your next step
If you cannot palpate a pulse use the Doppler
When inspecting the arms and legs what are you looking for
Color size symmetry hair distribution ulcers edema muscle hypertrophy/atrophy Varicose veins
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

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 
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
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
What is the Trendelenburg test evaluate
The Trendelenburg test evaluate saphenous vein valves for varicose veins
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
What pulse palpation site must you have a very light touch for
When palpating the dorsalis pedis you must have a very light touch
If you cannot help heal pulse what are signs to look for that indicate adequate perfusion
Color, temperature, capillary refil
What is a main characteristic of PVD
Decreased blood flow
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

What is an arterial diagnostic/laboratory test done
Arteriogram
What are common Venus diagnostic/laboratory tests done
D dimer, venous ultrasonography (Doppler), anticoagulant
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
What are two Diagnostic tests done to diagnose lymphedema
MRI and CT used to diagnose lymphedema
Give nursing outcomes related to PVD
Peripheral pulses strong, symmetrical
Cap refill less than three seconds
Decrease peripheral edema
Give nursing interventions related to PVD
Monitor peripheral pulses, edema as ordered
Evaluate pain on 10 point scale
Give nursing diagnosis related to PVD
Altered tissue perfusion
Risk for peripheral Neurovascularfunction
Activity intolerance
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
How is hair growth an important indicator about peripheral vascular function
Hair growth shoes oxygenation to tissues and adequate perfusion
