Chapter 20: Peripheral Vascular System and Associated Lymph

Question 1

femoral artery

Answer 1

under the inguinal ligament

Question 2

posterior tibial artery

Answer 2

behind the medial malleolus of the foot

Question 3

Peripheral Vascular System and Associated Lymph History (Subjective Data)

Answer 3

A. Leg pain or cramps
B. Skin changes on extremities (arms and legs), color, temperature or sores
C. Swelling in the extremities
D. Smoking hx
E. Medications
F. (Lymph node enlargement/swollen glands)

Question 4

Peripheral Vascular System and Associated Lymph Physical Exam/Assessment (Objective Data)

Answer 4

1. Inspect and Palpate Arms

2. Inspect and Palpate Legs

Question 5

Inspecting Arms

Answer 5

note symmetry, color of skin, nail beds, temperature, texture, turgor, presence of edema, lesions or clubbing

Question 6

Palpating Arms

Answer 6

1. Check capillary refill
2. Palpate radial pulse bilaterally.
3. Palpate brachial pulses
4. Modified allen test

Question 7

Palpate radial pulse bilaterally for

Answer 7

note rate and equal force; grade force.

Question 8

Grade force for radial pulse

Answer 8

4+ bounding
3+ increased
2+ normal 
1+ weak
0 absent

Question 9

Palpate brachial pulses for

Answer 9

note any nodes (epitrochlear- usually not palpable)

Question 10

Modified Allen Test

Answer 10

not routine; compress both radial and ulnar arteries with your thumbs while client forms a fist, continue to compress the arteries then have client open their hand, release pressure on ulnar artery, the palm should turn pink promptly (~2-5 seconds) (crude test and subject to error)

Question 11

Inspect legs for

Answer 11

• skin color
• symmetry (if asymmetrical consider DVT)
• hair distribution
• venous pattern
• swelling or atrophy
• skin lesions/ulcers
• edema

Question 12

Palpate legs for

Answer 12

• the femoral artery

- popliteal pulse, posterior tibial and dorsalis pedis pulse

Question 13

Palpate the femoral artery for

Answer 13

grade the force, for inguinal lymph nodes

Question 14

If pitting edema, present grade on the scale

Answer 14

1+ mild pitting, slight indentation, no perceptible swelling of the leg
2+ moderate pitting, induration subsides rapidly
3+ deep pitting, indentation remains for a short time, leg looks swollen
4+ very deep pitting, indentation lasts a long time, leg is very swollen

Question 15

Common PVR and Lymph Abnormalities

Answer 15

A. Raynaud’s Syndrome
B.	Lymphedema
C.	Arteriosclerosis/Ischemic Ulcer
D.	Venous Stasis/Ulcer
E.	Varicose Veins
F.	Deep Vein Thrombophlebitis
G.	Aneurysm

Question 16

Raynaud’s Syndrome

Answer 16

-abrupt episodes of decreased circulation in the hands and sometimes the feet

Question 17

Raynaud’s Syndrome results in

Answer 17

• Results in color change (pallor to cyanotic) from exposure to cold (most common), vibration, or stress.
• Pain and numbness evident with decreased circulation stages, may feel burning and throbbing with increased blood supply to dilated capillaries.

Question 18

Lymphedema

Answer 18

abnormal drainage of lymph causes protein rich lymph to build up in the interstitial spaces which further raises local colloid oncotic pressure and promotes more fluid leakage

Question 19

Arteriosclerosis/Ischemic Ulcer

Answer 19

build up of fatty plaques on intima (atherosclerosis) plus hardening and calcification of arterial wall (arteriosclerosis)

Question 20

Venous Stasis/Ulcer

Answer 20

following acute deep vein thrombosis or following chronic incompetent valves in deep veins

Question 21

Varicose Veins

Answer 21

incompetent valves permit reflux of blood, producing dilated, tortuous veins

Question 22

Deep Vein Thrombophlebitis

Answer 22

a deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis and edema

Question 23

Aneurysm

Answer 23

a sac formed by dilation in the artery wall

Question 24

Claudication distance

Answer 24

the number of blocks walked or stairs climbed to produce pain.

Question 25

PAD

Answer 25

blood flow cannot match muscle demand during exercise therefore people feel muscle fatigue or pain when walking.

Question 26

Risk factors for PVD

Answer 26

diabetes and smoking

Question 27

PVD

Answer 27

coolness occurs, varicose veins

Question 28

Edema is bilateral when

Answer 28

the cause is generalized (heart failure)

Question 29

Edema is unilateral when

Answer 29

it is the result of a local obstruction or inflammation

Question 30

Indicators for malnutrition

Answer 30

thin, shiny, atrophic skin; thick-ridged nails; loss of hair; ulcers; gangrene