Chapter 20: Peripheral Vascular System and Lymphatic System Flashcards
What is atherosclerosis? What is arteriosclerosis?
Atherosclerosis: Build up of plaque on arterial walls, Arteriosclerosis: Thickening and hardening of arterial walls.
What is the end point of circulation?
Capillaries
What is hydrostatic pressure?
Pressure exerted by fluid at equilibrium at a given point within fluid due to gravity.
Where are the following arteries located: temporal, carotid, brachial, femoral, popliteal.
Temporal: in front of ear, carotid: between sternomastoid and trachea, Brachial: bifurcates into radial and ulnar arteries, Femoral: begins in inguinal region, posterior at lower thigh as the popliteal artery, Popliteal: divides anterior tibial and posterior tibial arteries.
What are two deep veins in the legs? What are two superficial veins?
deep: femoral and popliteal veins
superficial: great and small saphenous veins
How do veins keep blood moving?
Veins move blood by: contracting skeletal muscles, pressure gradient caused by breathing (thoracic pressure decreases, abdominal pressure increases), intraluminal valves create one-way flow.
What causes PAD and what arteries does this involve?
Involves non-coronary arteries located in the limbs, usually caused by atherosclerosis.
Why are veins called capacitance vessels?
Veins are called capacitance vessels due to their ability to stretch.
What is venous stasis, its cause?
Venous stasis: blood pooling. It is caused by incompetent valves, problems with muscle contraction, or patent lumen in veins. Lifestyle causes: muscle weakness, injury, standing for long periods of time.
What does prolonged sitting, standing, or bed rest effect?
Venous return.
What are other risk factors for developing venous disease?
Hypercoagulable state, vein wall trauma, and incompetent valves caused by dilated and tortuous veins.
What are some diagnostic tests for PAD?
ABI, Ultrasound, and MRI
What are the main purposes of the Lymphatic system?
- conserve fluid and plasma proteins that leak out of capillaries
- form a major part of the immune system that defends the body against disease.
- absorbs lipids from the small intestine.
What are the two main trunks of the lymphatic system? what parts of the body do they drain?
- Right lymphatic duct: empties into subclavian vein. It drains the right side of the head and neck, right arm, right side of thorax, right lung and pleura, right side of the heart, and right upper section of the liver.
- Thoracic duct: drains the rest of the body; empties into left subclavian vein.
What are lymph nodes?
small, oval clumps of lymphatic tissue located at intervals along the vessels.
What lymphocytes are pathogens exposed to?
B and T lymphocytes
what happens to lymph nodes during an infection?
the nodes become swollen and tender
Which superficial nodes are accessible to palpitation and what structures do they drain?
Cervical: drains head and neck
Axillary: drains breast and upper arm
Epitrochlear: drains hand and lower arm
Inguinal: drains lower extremities, external genitalia, and anterior abdominal wall.
Which organs have an involvement with the lymph system?
tonsils, spleen, and thymus gland
What are the functions of the spleen?
- destroy old RBCs, 2. produce antibodies, 3. store RBCs, and 4. filter microorganisms in the blood.
What are the three types of tonsils and what do they do?
Tonsils: Pharyngeal, palatine, and lingual. Tonsils respond to local inflammation
Where is the thymus located and what does it do?
Thymus is located in superior mediastinum behind the sternum and in front of the aorta. Lg in the fetus and the young child. It atrophies after puberty. It is important in the development of the T-Lymphocytes and stores B-Lymphocytes that have been produced in bone marrow.
at what age is the lymphoid tissue adult size? what is different about palpation of lymph nodes in children?
by the age of 6. Lymph nodes are larger and superficial ones are more readily palpated.
What percentage of adults have PAD
29% of adults over age 70 and adults between 50-59yoa with a history of smoking or diabetes.
What is claudication distance?
The number of blocks walked or stairs climbed to produce pain?
PAD has the same risk factors as what disease?
Coronary Artery Disease.
what are some changes that occur with veins in the aging population? What increases risk for developing a DVT?
progressive enlargement of the intramuscular calf veins. Prolonged bed rest, immobility, and heart failure increase risk for DVT. Other common conditions are malignancies and MI.
What increases risk for PAD?
Smoking, DM, dyslipidemia, HTN
What causes bilateral edema/ unilateral edema?
Bilateral edema: generalized cause (heart failure) Unilateral: local obstruction or inflammation
What subjective information would you ask when completing a CV assessment?
Pain: PQRST, claudication, night leg pain, other symptoms.
What types of leg pain occurring at night would you ask the patient if they have?
Restless leg symptoms, ischemic rest pain of PVD, or severe night muscle cramping.
What skin changes would you look for?
sores, lesions, arterial/venous ulcers.
What signs would you look for and assess for peripheral or arterial disease?
Ulcers, edema, enlarged lymph nodes, Capillary refill, brown speckling, rubor, pallor, thinning of hair on legs.
What is the normal time for capillary refill?
< 1-2 seconds
What is the cause of brown speckling on the legs?
iron deposits from RBCs that settle in the veins. Seen in venous stasis.
What is rubor? What causes this?
Reddish/blue dependent color that occurs with severe arterial insufficiency. This is caused by chronic hypoxia, loss of vasomotor tone, and pooling of blood in vessels.
What does elevational pallor indicate
arterial insufficiency
what does edema on one arm indicate?
may be obstructed lymphatic drainage
How are pulses characterized?
0-3 0=absent, 1=weak, 2=normal, 3=full/bounding,
What are some causes of a full/bounding pulse?
hyperkinetic states, anemia, and hyperthyroidism
What objective data would you collect by inspecting the legs?
skin color, temperature, hair distribution, venous pattern, size (swelling or atrophy), symmetry, lesions, or ulcers.
What conditions might be indicated by the presence of bilateral dependent pitting edema?
heart failure, diabetic neuropathy, and hepatic cirrhosis
With arterial deficit, what neurological loss may occur?
motor or sensory loss
What are some trophic changes associated with arterial insufficiency (may also occur with normal aging)
thin, shiny skin, thick-ridged nails, loss of hair on lower legs. Pulses may be more difficult to find
What is the Modified Allen test and what does it test?
A test used to evaluate the adequacy of collateral circulation before cannulating the radial artery.
What is the ABI
Ankle-Brachial Index: Highest right ankle pressure/highest arm pressure
0.91-1=borderline risk for PAD
0.90-0.71=mild PAD
0.70-0.41=moderate PAD
0.40-0.30=Severe PAD, usually w/rest pain except in presence of diabetic neuropathy.
<0.30-ischemia, with impending loss of tissue.
