Chapter 20: Peripheral Vascular System and Associated Lymph Flashcards
femoral artery
under the inguinal ligament
posterior tibial artery
behind the medial malleolus of the foot
Peripheral Vascular System and Associated Lymph History (Subjective Data)
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)
Peripheral Vascular System and Associated Lymph Physical Exam/Assessment (Objective Data)
- Inspect and Palpate Arms
2. Inspect and Palpate Legs
Inspecting Arms
note symmetry, color of skin, nail beds, temperature, texture, turgor, presence of edema, lesions or clubbing
Palpating Arms
- Check capillary refill
- Palpate radial pulse bilaterally.
- Palpate brachial pulses
- Modified allen test
Palpate radial pulse bilaterally for
note rate and equal force; grade force.
Grade force for radial pulse
4+ bounding 3+ increased 2+ normal 1+ weak 0 absent
Palpate brachial pulses for
note any nodes (epitrochlear- usually not palpable)
Modified Allen Test
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)
Inspect legs for
- skin color
- symmetry (if asymmetrical consider DVT)
- hair distribution
- venous pattern
- swelling or atrophy
- skin lesions/ulcers
- edema
Palpate legs for
- the femoral artery
- popliteal pulse, posterior tibial and dorsalis pedis pulse
Palpate the femoral artery for
grade the force, for inguinal lymph nodes
If pitting edema, present grade on the scale
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
Common PVR and Lymph Abnormalities
A. Raynaud’s Syndrome B. Lymphedema C. Arteriosclerosis/Ischemic Ulcer D. Venous Stasis/Ulcer E. Varicose Veins F. Deep Vein Thrombophlebitis G. Aneurysm
Raynaud’s Syndrome
-abrupt episodes of decreased circulation in the hands and sometimes the feet
Raynaud’s Syndrome results in
- 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.
Lymphedema
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
Arteriosclerosis/Ischemic Ulcer
build up of fatty plaques on intima (atherosclerosis) plus hardening and calcification of arterial wall (arteriosclerosis)
Venous Stasis/Ulcer
following acute deep vein thrombosis or following chronic incompetent valves in deep veins
Varicose Veins
incompetent valves permit reflux of blood, producing dilated, tortuous veins
Deep Vein Thrombophlebitis
a deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis and edema
Aneurysm
a sac formed by dilation in the artery wall
Claudication distance
the number of blocks walked or stairs climbed to produce pain.
PAD
blood flow cannot match muscle demand during exercise therefore people feel muscle fatigue or pain when walking.
Risk factors for PVD
diabetes and smoking
PVD
coolness occurs, varicose veins
Edema is bilateral when
the cause is generalized (heart failure)
Edema is unilateral when
it is the result of a local obstruction or inflammation
Indicators for malnutrition
thin, shiny, atrophic skin; thick-ridged nails; loss of hair; ulcers; gangrene
