Ch 20 Vascular & Lymphatic System Flashcards
We never want to stick an artery for arterial blood gas unless we know there is adequate circulation on the other side so we don’t possible destroy the only circulation leading to the hand .. so we do this which determines the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery
Allen test
Defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defects
Aneurysm
Variation from the heart’s normal rhythm
Arrhythmia
Thickening and loss of elasticity of the arterial walls
Arteriosclerosis
Plaques of fatty deposits formed in the inner layer (intima) of the arteries
Atherosclerosis
Slow heart rate <50 beats per min in the adult
Bradycardia
Blowing, swooshing sound heard through a stethoscope when an artery is partially occluded
Bruit
Dusky blue mottling of the skin and mucous membranes due to excessive amount of reduced hemoglobin in the blood
Cyanosis
The hearts filling phase
Diastole
Calf pain that occurs when the foot is sharply dorsiflexed (pushed up, toward the knee) may occur with deep vein thrombosis, phlebitis, achilles tendinitis, or muscle injury
Nurses will do this to make sure pt does not have a blood clot in their leg
Homan’s sign
Deficiency of arterial blood to a body part due to constriction or obstruction of a blood vessel
Deficient in oxygen and need more
Ischemia
Swelling of extremities due to obstructed lymph channel, lypmh system isnt working, lymph nodes might have been removed, extra fluid cant be returned because there is no lymphatic network, nonpitting
Lymphedema
Small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels
Usually in groups, some are deep and some are superficial
Typically filter fluid and microorganisms and engulf pathogens
Lymph nodes
Indentation left after examiner depresses the skin over swollen edematous tissue
Pitting edema
Viewing the finger from the side to detect early clubbing
Profile sign
Pressure wave created by each heartbeat, palpable at body sites where the artery lies close to the skin and over a bone
Pulse
Regular rhythm, but force of pulse varies with alternating beats of large and small amplitude
Pulsus alternations
Irregular rhythm, every other beat is premature, premature beats have weakened amplitude
Pulsus bigeminus
Pulse is weaker with inspiration and stronger with expirations
Pulsus paradoxus
The hearts pumping phase
Systole
Rapid heart rate >90 beats per minute in an adult
Tachycardia
Inflammation of the vein associated with thrombus formation
Thrombophlebitis
Open skin lesion extending into dermis with sloughing of necrotic inflammatory tissue
Ulcer
Dilated tortuous (twisting) veins with incompetent valves Easily seen on surface of the skin
Varicose vein
Carries oxygenated blood and nutrients
Arteries
Carries deoxygenated blood and waste products from tissues, pulls it from the tissues and brings it back to the heart
Veins
Filters microorganisms and helps with immune functions
Eliminates foreign pathogens to keep us healthy
Lymphatic system
What happens when there is a complete artery block..
It leads to death of the tissue and any clots need to be opened in order to let blood through
What happens when there is a partial artery block..
It causes pain or discomfort with exercise or movement
The major artery in the arm that is more difficult to palpate
Brachial
The artery in the wrist that is easy to palpate and used to check a pulse
Radial
The artery in the arm that can be used to assess for circulation
Ulnar
The major artery in the leg located in the groin area
Femoral
The artery behind the knee
Popliteal
The artery in the back of the ankle
Posterior tibial
The artery in the top of the foot
Dorsalis pedis
Deep veins typically run along the side of an..
Artery
How does venous flow keep blood moving
Skeletal muscles in the legs contract and this brings the blood proximally or back towards the heart
This causes thoracic and abdominal pressure to decrease causing differences in pressure gradients
Inspiration
Brings smaller and larger veins together
Perforators
How does the venous flow of a calf pump work
As you walk, your calf contracts and rests just like systole and diastole, and returns blood to the heart and the rest of the body
Is arterial or venous pressure lower?
Venous pressure is lower than arterial
Who is at risk for venous stasis
Pregnant women because they have an increased blood flow Genetics People who sit or stand a long time Best rest patients Obese patients People who clot too fast People who have vein wall trauma People who have varicose veins People who have poor valves allowing blood to seep backwards
Retrieves excess fluid from the tissue space and helps to return it back to the blood stream
Helps conserve the fluid and the plasma proteins that leak out of the capillaries and help return that to the circulatory system
Lymphatic system
The fluid leaves the capillaries faster than the veins can absorb so if there isnt adequate lymphatic drainage you can develop…
Edema
Why do you see edema a lot after masectomies
They remove the breast but also the lymph nodes as well, then they are put on arm precautions so no BP, needles, etc.
There is also a lymphatic system in the abdomen that helps to absorb
Lipids form the intestines
These drain the head and the neck
Cervical nodes
These drain the breasts and upper arms
Axillary nodes
These are in the arm and the antecubital fossa and drain the hand the lower arm
Depression above and behind medial condyle of humerus, in the antecubital area
Assessing for enlargement of that lymph node and if there is do a good inspection of the hand figure out if there is infection causing that
Epitrochlear nodes
Located in the groin and drain the lymph of lower extremities, external genitalia, and anterior abdominal wall
Inguinal nodes
Stores red blood cells
Destroys red blood cells that are no longer functional
Makes antibodies to fight off infection
FIlters microorganisms from blood
Spleen
Helps respond to local information
Become swollen when pathogens get in the throat and try to keep it from going from going into the respiratory tract or the rest of the body
Become inflamed easily
Tonsils
Flat, pink, grey gland located in superior mediastinum in the chest behind the sternum
More important for developing t-lymphocytes in children
More in younger children
Atrophies occur after the pt has reached puberty
Thymus
What happens to the peripheral vascular system in older adults
Arteries become less efficient: arterial insufficiency
(thin, shiny skin; thick nails; hair loss on legs which normally occurs with aging as well)
Peripheral vessels become more rigid (thick and lose elasticity) called arteriosclerosis
Develop atherosclerosis
Bigger calf veins
Valves become incompetent with age
More varicose veins
DVT and PEs increase due to bed rest
What happens to the lymphatic system in older adults
Less lymph tissue because we lose lymph nodes creating an increased risk for infections
What is it best for older adults to do as they age
Like to get them walking
Walking prevents heart attacks
Take a low dose of anticoagulants or blood thinners to prevent clots and PEs
What subjective data do we want to know regarding peripheral vascular system
Leg pain or cramps possibly indicating DVT
Skin changes on arms or legs possibly indicating arterial or venous disease
Any swelling
Any lymph node enlargements
Medication list for possible increase for clots
–birth control?
–hormone replacement?
How should you prepare for an examination of the peripheral vascular and lymphatic system
Full set of vitals B/P Comfy room temperature --cold can cause vasoconstriction --hot can cause vasodilation Inspect and palpate bilaterally --temp, skin, symmetry, color, cap refill, edema
What equipment might you need for an examination of the peripheral vascular and lymphatic system
Tape measure for calf size in DVT patients
Tourniquet and B/P cuff
Stethoscope
Doppler if unable to palpate pulses
What are you looking for when you inspect and palpate the arms
Look at the hands
Inspect color, nail beds, cap refill, temp, texture, turgor, lesions, edema, clubbing
Cigarettes, anemia, edema can all cause cold skin
What do you want to look at when taking the radial pulse
Rate (beats/min)
Rhythm is regular or irregular
Elasticity and force
How do you grade the force of a pulse
3+ increased, full, bounding (usually with exercise or hyperthyroidism)
2+ normal
1+ weak, thready pulse
0 absent
What are you looking for when you inspect and palpate the legs
Compare legs
–color, hair distribution, vein size, lesions, ulcers
*Hairy toes = good circulation
Flex knee
Check for tenderness of calf
If asymmetrical legs need to measure calf size for DVT
If lymphedema measure ankle, calf, knee, and thigh
Palpate inguinal lymph nodes
Palpate and grade the 4 arteries in the legs
To check for edema press for how many seconds
5 seconds
How do you grade pitting
1+ mild pitting, slight indentation, no swelling
2+ moderate pitting, indentation subsides rapidly
3+ deep pitting, indentation remains, legs look swollen
4+ very deep pitting, indentation lasts a long time, legs very swollen
Edema that is non pitting
Brawny edema
Detects weak pulses Check B/P Magnifies sounds of that artery Need to use gel Swivel under you hear a pulse Document that you used it
Doppler-ultrasonic stethoscope
How do you find the ankle brachial index (ABI)
Divide ankle or foot systolic pressure by arm systolic pressure
Leg pressure is usually higher than the arm pressure
Normal ABI is 1-1.2
Less than 0.9 indicates peripheral artery disease
Less reliable with diabetes patients
What happens to pulses in older adults
Distal pulses (dorsalis pedis and posterior tibial pulse) hard to palpate
Disease where you get vasospasms in response to stress or cold
Raynauds phenomenon
What are the color orders in Raynauds phenomenon
White/pallor: vasospasms in fingers
Cyanosis: arteries relax
Redness: blood returns and cap beds are dilated again
Brown discoloration over lower extremities, usually on shin area
Chronic venous stasis
Pale skin occurs, cool to touch, pulses diminished, wont be much bleeding because there isnt good blood supply
Aterial ischemic ulcer
Brownish skin on shin and lower legs, blood pools, gets achy and gets worse after standing, pulses will be normal because its not affecting the arterial system, edema and probably thicker skin around the area
Venous ulcer
