CH20 Peripheral Vascular System Flashcards
Deep veins on leg
femoral vein; popliteal vein.`
Superficial veins on leg
great and small saphenous veins.
Veins keep blood moving by
contracting skeletal muscles; pressure gradient caused by breathing (thoracic pressure decreases, abdominal pressure increases); intraluminal valves create one-way flow.
Called capacitance vessels due to veins’ ability to stretch.
Venous stasis is due to problems with
contraction of skeletal muscles, and/or competent valves in the veins, and/or a patent lumen.
Other risk for venous disease
Hypercoagulable state
Vein wall trauma
Incompetent valves created by dilated and tortuous veins
Lymphatic system function
retrieves excess fluid and plasma proteins from interstitial space—returns it to the circulation.
Conserves fluid and plasma protein
Forms major part of immune system
Absorbs lipids from the small intestine
Lymph vessels drain into the venous system at the
subclavian veins.
Right Lymphatic dict
into right subclavian vein
thoracic duct
drain most of the body; empties into the left subclavian vein
Superficial nodes accessible to palpation
Cervical—head and neck
Axillary—breast and upper arm
Epitrochlear—hand and lower arm
Inguinal—lower extremities, external genitalia, anterior abdominal wall
Organs with involvement in the lymph system
spleen, tonsils, thymus gland
Infants and Children
lymph nodes larger; superficial nodes may be palpable
Aging Adult
peripheral blood vessels become rigid
Arteriosclerosis—increased BP
Enlargement of intramuscular calf veins
29% over 70—have PAD
Increased risk for PAD: smoking, DM, dyslipidemia, HTN
Increased risk for DVT: prolonged BR, prolonged immobilization, heart failure
SD: Pain
PQRST
Symptoms while walking
Night leg pain: ischemic rest pain of PVD or severe night muscle cramping or restless leg symptoms
SD: List all but pain
Skin changes; sores or lesions Edema Enlarged lymph nodes Medications Smoking history
OD:
Cap refill
check OD: Leg Exam
Skin color, temperature Hair distribution Venous pattern Size (swelling or atrophy) Symmetry Skin lesions or ulcers
the epitrochlear node is in the
antercubital fossa and drains the hand and lower arms
Brown discoloration—venous stasis—why?
red blood cells dying and venous insufficiency hemosiderin resurfacing
Elevational pallor could mean
arterial insufficiency
Dependent rubor
deep blue-red color—severe arterial insufficiency
arterial insufficiency causes
chronic hypoxia—loss of vasomotor tone—pooling of blood in vessels
DC: aging adult
Pulses may be more difficult to find Trophic (skin) changes associated with arterial insufficiency—also occur with normal aging! Thin, shiny skin Thick-ridged nails Loss of hair on lower legs
Enlarged tonsils are a familiar sign of
respiratory infection
excessive lymphoid response also may account for children symptoms of
abdominal pain with seeming unrealted problems such as URI
DC: agining adults; arteriosclerosis
pbv growing more rigid with agin
DC: agining adults; atherosclerosis
deposition of fatting plaques on the intima of the arteries
the ethnic group with pad who also have the highest risk of theses pad factors are
non-hispanic blacks
with PAD, blood flow cannot match muscle demand during
exercise; therefore people feel muscle fatigue or pain when walking (claudication). But only 10% of those with PAD have these classic symptoms 40% do not have leg pain and 50% have varying leg symptoms
Leg pain in aging adult
is common, may indicate the ischemic rest pain of PVD, sever night miscle cramping, or rls
aortoiliac occlusion is associated with
ED
coolness occurs with
PAD
Full bounding pulse (3+) occurs with
hyperkinetic states (exercise anxiety, fever) anemia, and hyperthyroidism
Weak thready pulse (1+) occurs with
shock and PAD
Edema of the upper extremities occurs when
lymphatic drainage is obstructed after breast surgery or radiation.
and enlarged epitrochlear node occurs with
infection of the hand or forearm and is a condition of generalized lymphadenopty
modified allen test is
used to evaluate the adequacy of collateral circulation before cannulating to the radial artery
how to admin modified allen test
1) firmly occlude both ulnar and radial arteries of one hand
2) have person make a first several times
3) ask the person to open the hand without hyperextending.
4) normal circulation/color should return at 2-5 seconds
malnutrition,, pallor, coolness, ulcers, gangrene all occur with
arterial insufficiency
Diffused B/L edema occurs with
systemic illnesses
acute/ unilateral painful swelling and asymmetry of calves of ___ or more is abnormal; refer to person to detemine if DVT is present
1cm
Asymmetry of __ to ___ in calfs occurs with mild lympedema
Asymmetry of __ to ___ in calfs occurs with sever lympedema
1-3cm
3-5cm
B/L pitting edema clls for
examination of the neck vessels.
If the neck veins are abnormally distended, the peripheral edema may be r/t to heart disease or pulmonary hypertension.
If neck veins are normal,s omething else may be the cause such as leiver disease, nephrosis, chronic venous insufficiency, antihypertensive or hormonal meds.
motor and sensory loss occurs with
arterial insufficiency
Aging Adult
DP and TP pulses may become more difficult to find. Trophic changes occur with arterial insufficeincy (thin, shiny skin; thick ridged nails; loss of hear in lower legs) also occurs with normal aging
