Ch 21 PVS and lymphatics Flashcards
Efficient venous return is dependent on:
- ______ skeletal muscles
- ______ in veins
- ______ lumen
contracting skeletal muscles
competent valves
patent lumen
problems with any 3 factors –> venous stasis
Right lymphatic duct empties into _________
It drains __________
R subclavian vein
Drains R side of head/neck R arm R thorax R lung and pleura R heart R upper section of liver
_______ lymphatic duct empties into left _______
It drains ________
Thoracic duct –> L subclavian vein
Drains rest of body
Name 3 functions of the lymphatic system
- conserve fluid and plasma proteins that leaked out of capillaries
- major part of immune system
- absorb lipids from intestinal tract
Cervical lymph nodes drain _______
Axillary lymph nodes drain _______
Epitrochlear lymph nodes drain ______
Inguinal lymph nodes drain ________
Cervical: head and heck
Axillary: breast and upper arm
Epitrochlear: hand and lower arm
Inguinal: lower extremities, external genitalia, anterior abdomen wall
Name 4 functions of the spleen
- to destroy old RBC
- to produce antibodies
- to store RBC
- to filter microorganisms from blood
Define claudication distance
number of blocks walked or stairs climbed that produce pain
Name 3 conditions where radial pulse can be full and bounding
- hyperkinetic states (exercise, anxiety, fever)
- anemia
- hyperthyroidism
Calf asymmetry of >_____ cm measured at _____ is abnormal
Suspect _____ if accompanied by acute, unilateral painful swelling
Wells Score: calf swelling > ____cm measured at ____ cm below tibial tuberosity
Measured at widest point
>1 cm –> assess for DVT
Wells Score: calf swelling >3 cm measured 10 cm below tibial tuberosity
Venous stasis: discolouration appears ______ due to _______ deposits from ______
brown discoloration due to hemosiderin deposits from RBC degradation
Increase in weight of >_____ kg over single day needs immediate evaluation with head to toe assessment
- 5 kg
* daily weights are best indicator of fluid status than in/out
Describe how to check arterial deficit for arterial insufficiency
Severe arterial insufficiency will show:
supine position: raise legs 30 cm, wag feet for 30 sec
then sit up and dangle legs over side of table
note time for colour to return to feet (normal <10 sec)
note time for veins in feet to fill
In severe arterial insufficiency:
- marked elevational pallor
- dependent rubor
- delayed venous filling
Lower limb motor loss and sensory loss will occur with ____ deficit eg in _______
arterial deficit
eg diabetes
Pulsus paradoxus:
pulse is ____ with inspiration, ____ with expiration
common finding in _____ and ______
pulse is weaker with inspiration, stronger with expiration
common with cardiac tamponade and severe bronchospasms with acute asthma
Pulsus alterans
pulse varies in _____, alternating beats of large and small _______
common finding in _________
varies in force, alternates in amplitude
common with severe L ventricular failure
-from ischemic heart disease, valvular heart disease, chronic HTN, cardiomyopathy
Raynauds
Tricolour changes
- white from ______
- blue from _____ (symptoms: _______)
- red from ______ (symptoms: _______)
white from arteriospasm (deficit in blood supply)
blue from slight relaxation of spasm (small amt of blood trickles through) –> cold/numb/pain
red from return of blood into dilated capillary bed/hypermeia –> burning/throbbing/swelling
Lymphedema
occurs from build up of _____ which increases _______ pressure
Subjective symptoms:
Objective symptoms:
-pitting or not?
-induration or not?
build up of protein-rich lymph in interstitial space (increase colloid oncotic pressure)
Subjective: tired, heavy arms, tight jewellry, swelling, tingling
Objective: unilateral swelling, nonpitting brawny edema with induration
Chronic arterial symptoms
- location:
- character:
- worse with: ______ and _______
- pain at _____ indicates severe involvement
- relieved with: ______ and ______
- skin feels: ______
location: deep muscle pain (usually calf, can be lower leg)
character: intermittent claudication, feels like cramp/numb/tingling/feels cold
worse with: activity (claudication distance), elevation
*pain at rest = severe involvement
relieved with: rest, dangling
skin feels: cool and pale
Chronic venous symptoms
- location:
- character:
- worse with: ______ and _______
- relieved with: ______ and ______
- skin has: ______, _____ and ______
location: calf, lower leg
character: aching, tired, full
worse with: sitting, standing (worse at end of day)
relieved with: elevation, lying, walking
skin: edema, varicosities, weeping ulcers
Arterial ischemic ulcers
-pain with _____
If severe, will have pain with _____
Skin feels: (temp, colour)
Skin looks:
Location of ulcers:
Appearance of ulcers:
Bleeding?
pain with walking (claudication)
pain at rest = worsening/severe
skin feels cool, pale with elevational pallor and dependent rubor
skin looks: malnourished (thin, shiny, no hair, thick ridged nails), xanthoma, gangrene
Location of ulcers: toes, metatarsal heads, heels, lateral ankle
pale ischemic base with well defined edges
no bleeding
Venous stasis ulcers
-pain with ______
Skin looks: _____ from ________
Location of ulcers:
Appearance of ulcers:
Bleeding?
pain with prolonged sitting/standing
worse at end of day
Skin looks brown and thick from hemosiderin deposits
-pruritic weepy stasis dermatitis
Location of ulcers: medial malleolus
uneven edges
bleeding
Aneurysm
- is a _____ in ______ wall
- most common site: ______
- most common cause: ______
- most common in (gender)______
aneurysm is a dilation in artery wall
most common is aorta
most common cause is artherosclerosis
most common in men (4-5x overall occurrence)
men 55+, women 70+
