Chapter 20 Peripheral Vascular System and Lymphatic System Flashcards
When a question says peripheral always think-
Legs
Intermittant Claudication
Always think Arteries-
Think smoking, diabetes, athlosclerosis, hypertension as possible causes.
Intermittent claudication- is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.
The nurse is assessing a patient’s risk for developing a deep vein thrombosis (DVT). The patient considered at the highest risk is a 60-year-old patient who:
A. has been on bed rest for 3 days.
B. has been receiving physical therapy for left knee replacement.
C. has calf and thigh measurements that have less than an inch of variation on both legs.
D.was admitted to the hospital with asthma exacerbation.
A. has been on bed rest for 3 days.
Mechanisms that keep blood moving toward the heart
Skeletal muscles
Valves
Pressure gradient created by respirations
PERIPHERAL VASCULARDevelopmental Considerations-Pregnancy
Total blood volume increases 40%
Blood pressure changes
Increased venous pressure and venous pooling causing peripheral edema, varicosities, and hemorrhoids
Lymphatic System Functions:
Production of lymphocytes within the lymph nodes, tonsils, adenoids, spleen and bone marrow
Production of antibodies
Phagocytosis
Maintenance of fluid balance thru movement of lymph fluid
Note: Is also a pathway for spread of malignant diseases.
LYMPH SYSTEM
Developmental Considerations
Infants: lymph nodes are generally not palpable
Children: nodes up to 1cm in the cervical or inguinal areas are usually no concern (Cervical nodes larger than 1 cm are considered abnormal)
Older adults: lymph nodes become more fibrotic
Thrombophlebitis-
Thrombophlebitis is phlebitis (vein inflammation) related to a thrombus (blood clot).
The following symptoms are often (but not always) associated with thrombophlebitis:
pain in the part of the body affected
skin redness or inflammation (not always present)
swelling (edema) of the extremities (ankle and foot)
palpable cord-like veins
PERIPHERAL VASCULAR & LYMPH SYSTEM
Subjective Data-
Leg pain or cramps
Skin changes on arm or legs
Swelling
Lymph node enlargement
Medications
Dizziness?
PERIPHERAL VASCULAR & LYMPH SYSTEM
PMH subjective data-
SB, HTN, DM, AF
Surgery
Recurrent infections
Thrombophlebitis
PERIPHERAL VASCULAR & LYMPH SYSTEM
Family History subjective data-
Malignancy: Hodgkin’s disease, Lymphoma
Tuberculosis
PERSONAL/SOCIAL HISTORY
TOBACCO USE… NUTRITION… EXERCISE… ALCOHOL USE… OTC DRUGS… OCCUPATION
PERIPHERAL VASCULAR
OLDER ADULTS - HISTORY
LEG EDEMA?…
CLAUDICATION?…
CAROTID STENOSIS?…
VARICOSE VEINS…
Peripheral Arteries Accessible to Exam are-
Arteries
Temporal artery
Carotid artery
Arteries in the arm
Brachial
Ulnar
Radial
Arteries in the leg
Femoral
Popliteal
Dorsalis pedis
Posterior tibialPulse Deficit-
is the difference between the apical and radial pulses
Orthostatic Hypotention change should be no more than ______mmHg from lying to standing.
15mmHg
There should not be a change greater than ______mmHg from right to left arm.
10mmHg
Structure and function Temporal artery:
The temporal artery can be palpated in front of the ear
ch 13 pg 267, temporal arteries may look twisted and prominent in some elderly adults
Structure and function Carotid artery:
The carotid artery is palpated in the groove between the sternomastoid muscle and the trachea.
The corotid artery is a central artery (it is close to the heart) so its timing closely coincides with ventricular systole. p463
Structure and function of the Arteries in the arm-
Brachial artery- is the major artery that supplies the arm. It runs in the bicep-triceps furrow of the upper arm and surfaces at the antecubital fossa in the elbow medial to the bicepts tendon.
Immediately below the elbow, the brachial artery bifurcates into the radial and ulnar arteries. These run distally and form the two arches that supply the hand.
Ulnar artery is difficult to feel.
Radial artery pulse lies just medial to the radius on the wrist.
pg 500
Artery blood flow from neck to hands:
common carotid artery -> Subclavian artery -> Axillary artery -> Brachial artery -> (brachial pulse site) -> brachial splits into radial and ulnar arteries at the pulse site and travels to the hands.
Structure and function of the arteries in the leg:
The major artery in the leg is the femoral artery which passes under the inguinal ligament. It travels down the thigh, and when it gets to the lower thigh it courses posteriorly. When this happens it becomes the popliteal artery.
Below the knee, the popliteal artery divides into the anterior and posterior tibial arteries.
The anterior tibial artery runs down the front of the shin onto the dorsum of the foot where it then becomes the dorsal pedis.
The posterior tibial artery travels down the medial malleous (back of the leg, calf area) and in the foot forms the plantar arteries.
Function of arteries:
The function of the arteries is to supply oxygen and essiential nutrients to the tissues.
Ischemia-
is a deficient suppy of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel.
A complete blockage leads to tissue death of the distal tissue.
A partial blockage creates an insufficient supply and the ischemia may be apparent only at exercise when the oxgen needs increase.
Allen test
determining the patency of the radial and ulnar arteries by compressing one artery site and observing the return of skin color as evidence of patency of the other artery.
173 lab manual
Aneurysm
defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect.
173 lab manual
Arrhythmia
variation from the hearts normal rhythm
173 lab manual
Arteriosclerosis
Thickening and loss of elasticity of the arterial walls
173 lab manual
Atherosclerosis
plaques of fatty deposits formed in the inner layer of the arteries
173 lab manual
Diastole-
The hearts filling phase
174 lab manual
Systole-
The hearts pumping phase
174 lab manual
Varicose Vein
dilated tortuous veins with imcompetent valves
174 lab manual
Pulse-
Pressue wave created by each heartbeat, palpable at body sites where an artery lies close to the skin and over a bone
174 lab manual
Lymph nodes
small oval clumps of lymphatic tissue located at grouped intravals along lymphatic vessels.
174 lab manual
Lymphedema
swelling of an extremity due to obstructed lymph channel, nonpitting.
174 lab manual
Bruit
blowing, swooshing sound heard through a stethoscope when an artery is partially occluded.
174 lab manual
Cyanosis
dusky blue mottling of the skin and mucous membranes due to excessive amount of reduced hemoglobin in the blood.
174 lab manual
A function of the venous system is:
a. To hold more blood when blood volume increases.
b. to concerve fluid and plasma proteins that leak out of the capillaries.
c. to form a major part of the immune system than defends the body against disease
d. to absorb lipids from the intestinal tract
a. To hold more blood when blood volume increases
lab manual pg178
The organs that aid the lymphatic system are
a. liver, lymph nodes, and stomach
b. pancreas, small intestine, and thymus
c. spleen, tonsils, and thymus
d. pancreas, spleen, and tonsils
c. spleen, tonsils, and thymus
lab manual pg178
Mrs. T has come for a prenatal visit. She complains of dependent edema, varicosities in the legs, and hemorrhoids. The best response is:
A. if these problems persist we will perform an amniocentesis
B. If these symptoms persist we will discuss having you hospitalized
C. the symptoms are caused by a pressure of the growing uterus on the veins. They are the usual conditions of pregnancy.
D. at this time you symptoms are a minor inconvienenve and you should learn to accept them
C. the symptoms are caused by a pressure of the growing uterus on the veins. They are the usual conditions of pregnancy.
lab manual pg178
A pulse with an amplitude of 3+ would be considered:
A. irregular, with 3 premature beats
B. increased, full
C. Normal
D. Weak
B. increased, full
lab manual pg178
Inspection of a persons right hand reveals a red swollen area. To further assess for infection, you would palpate the:
A. cervical node
B. Axillary node
C. Epitrochlear node
D. inguinal node
C. Epitrochlear node
lab manual pg178
To screen for deep vein thrombosis you would:
A. measure the circumfrence of the ankle
B. check the temperaure with the palm of your hand
C. Compress the dorsalis pedis pulse looking for blood return
D. measure the widest point with a tape measure
D. measure the widest point with a tape measure
lab manual pg178
During the examination of the lower extremities, you are unable to palpate the popliteal pulse. You should:
A. proceed with the examination, it is often impossible to palpate this pulse
B. refer the patient to a vasular surgeon for further examination
C. schedule the patient for a venogram
D. Schedule the patient for an arteriogram
A. proceed with the examination, it is often impossible to palpate this pulse
lab manual pg178
While reviwing a medical record, a notation of 4+ edema of the right leg is noted. The best description of this type of edema is:
A. Mild pitting, no perceptible swelling of the leg
B. Moderate pitting, indentation subsides rapidly
C. Deep pitting, leg looks swollen
D. Very deep pitting, indentation lasts a long time.
D. Very deep pitting, indentation lasts a long time.
lab manual pg178
Atrophic skin changes that occur with peripheral arterial insufficiency include:
thin, shiny skin with loss of hair.
Brawny edema is
non pitting
Raynauds Phenomenon occurs
in hands and feet as a result of exposure to cold, vibration, or stress
Unilateral Edema suspect
DVT
is Local
Bilateral Edema suspect
right sided heart failure
chronic liver disease
is central
Peyers patches
Lymphoid tissue in the intestines (belly area) pg504
Chronic venous symptoms
chronic pain that increases at the end of the day from sitting or standing to long at work. Hurts all the time
Chronic arterial symptoms
deep calf muscle pain, hurts only when exercising, rest relieves it.
Some Lymph System Abnormals
Acute lymphangitis- Lymphangitis is an inflammation or an infection of the lymphatic channels that occurs as a result of infection at a site distal to the channel. The most common cause of lymphangitis in humans is Streptococcus pyogenes (Group A strep),
Lymphomas- supraclavicular nodes enlarge with hodgkins disease
