Chapter 21- PVS and Lymphatic System Flashcards
The major artery supplying the arm is the __, which runs in the biceps-triceps furrow of the upper arm and surfaces at the antecubital fossa in the elbow medial to the biceps tendon.
brachial artery
The brachial artery bifurcated into the __ and __ .
ulnar and radial
Peripheral artery disease affects ___ vessels and refers to arteries supplying the limbs.
noncoronary
The major artery to the leg is the ___, which passes under the inguin ligament.
femoral artery
At the lower thigh, the femoral artery courses posteriorly which then it is called the ___.
popliteal artery
The anterior tibial artery travels down the front of the leg on the dorian of the foot, where it becomes the ____.
dorsalis pedis.
The the back of the leg, the ___ artery travels down behind the medial malleolus and forms the plantar arteries in the foot.
Posterior tibial
The function of the arteries is to ___.
supply oxygen and essential nutrients to the cells.
a deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessels.
Ischemia
The course of veins is ___ to the course of arteries.
Parallel
Body has more ___, and they lay ___ to the skin.
veins
closer
Function: to drain deoxygenated blood and it’s waste products from tissue and return it to the heart.
veins
veins are called capacitance vessels because ___
of their ability to stretch.
Deep veins in the leg:
the femoral and popliteal veins
Superficial veins in the leg:
the great and small saphenous
Perforator veins:
connecting veins that join the deep and superficial veins.
The veins do not have a pump to generate their blood flow so they need a _____
mechanism to keep blood moving
The mechanism is accomplished by:
contracting skeletal muscles, pressure gradient caused by breathing, and intraluminal valves.
In the legs, the mechanism for venous flow is called ____
calf pump or peripheral heart.
Dilated and tortuous (varicose) veins create ____ valves leading to increased venous pressure, which further dilated the vein.
incompetent
Lymphatic system retrieves what and from/to where?
excess fluid and plasma proteins from the interstitial spaces and returns them to the bloodstream.
Caused by the pumping action of the heart and pushed somewhat more fluid out of the capillaries than the venules can absorb.
Hydrostatic pressure
pulls interstitial fluid back into the venules
colloid osmotic pressure
The right lymphatic duct empties into the ____.
subclavian vein. It drains the Right side of the head, neck, right arm, right side of the thorax, right lung, and pleura, right sid rod the heart, and right upper section of the liver.
The thoracic duct drains the ____ and empties it into the ___.
Rest of the body, and empties into the left subclavian vein.
Lymphatic system functions:
Conserve fluid and plasma proteins that leak out of capillaries
Form a major part of immune system that defends body against disease
absorbs lipids from intestinal tract
small oval clumps of lymphatic tissue located at intervals along vessels
lymph nodes
the ___ groups of nodes are accessible to inspection and palpation and give clues to the status of the lymphatic system.
superficial
located in the left upper quadrant of the abdomen
spleen
spleen’s four functions:
destroy old red blood cells
produce antibodies
store red blood cells
filter microorganisms from the blood
located at the entrance to the respiratory and gastrointestinal tracts and respond to local inflammation
tonsils
the flat, pink-gray gland located in the superior mediastinum behind the sternum and in front of the aorta
thymus
lymph nodes are relatively ___ in children and the superficial ones are palpable even when the child is healthy.
large
Hormonal changes in pregnant women cause ___ and the resulting drop in ___.
vasodilation
blood pressure
the growing uterus obstructs drainage of the ___ and the ___.
iliac veins
inferior vena cava
the pregnant women has a ___ chest cage and ___ estrogen.
wider
increased
Peripheral blood vessels grow more rigid with age, termed ____.
arteriosclerosis
The deposition of fatty plaques on the intima of arteries
Atherosclerosis
What is intermittent claudication (IC) ?
cramping in arms or legs
Aging produces a progressive ___ of the intramuscular calf veins.
enlargement
Loss of ___ leads to fewer numbers of lymph nodes in older people and to a decrease in the size of remaining nodes.
Loss of lymphatic tissue
Environmental risk factors for PAD patients:
smoking, diabetes, and hypertension.
also elevated levels of cholestrol and obesity.
__ have twice the burden of PAD than do Caucasians.
African Americans
the ___ is the first-line noninvasive test (screening tool) for PAD.
ankle-brachial index (ABI)
___ are most at risk for PAD.
Non-hispanic blacks
Increased DVT and subsequent pulmonary embolism is a result of :
prolonged bed rest, immobilization, and heart failure.
AHA considers PAD a CAD risk equivalent, thus ___ are essential.
screening and treatment
For Peripheral Vascular System: take vitals and examine ___ in the beginning while person is still sitting.
arms
Inspecting and palpating the arms: lift the person’s both hands in your hands. Then:
inspect, then turn the persons hands over, noting color of skin and nail beds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing.
how do you detect early clubbing?
profile sign (viewing finger from side to side)
Radial pulses numbers and what they mean:
3+ increased, full bounding
2+ normal
1+ weak
0 absent
What test can provide information about adequacy of collateral circulation?
Modified Allen Test
Insepecting and Palpating the legs:
palpate for temperature along legs down to feet using bilateral comparison.
palpate lied extremity pulses using bilateral comparison
use of monofilament to assess neurovascular status.
How to locate femoral artery:
Locate them just below inguinal ligament halfway between pubis and anterior superior iliac spines
How to locate popliteal pulse:
With leg extended but relaxed. anchor your thumbs on knee, and curl your fingers around into popliteal fossa
How to locate posterior tibial pulse:
curve your fingers around medial malleolus and feel the tapping right behind it in groove between malleolus and Achilles tendon
How to locate Dorsalis pedis:
normally it is just lateral to and parallel with extensor tendon of big toe
How do you check for a pretibial edema?
firmly depress skin over tibia or medial malleolus for five seconds and release
Scale for grading a pitting edema:
1+ : mild pitting/ slight indentation, no perceptible swelling
2+ : moderate pitting, indentation subsides rapidly
3+ : Deep pitting, indentation remains, leg looks swollen
4+ : Very deep pitting, indentation lasts long time, leg grossly swollen and distorted
If you suspect an arterial deficit, raise the legs ___ off the table and ask the person to wag the feet for about __ to drain off venous blood. The skin color now reflects only the contribution of arterial blood.
30 cm
30 seconds
Use this device to detect a weak peripheral pulse, to measure low blood pressure or blood pressure in lower extremity.
Doppler Ultrasonic Probe
Wells Score for Deep Vein Thrombosis facts:
Higher the score, greater the risk. 0-3.
0 low probabaility
1-2 moderate probability
3+ high probability
Combination of assessment findings categorized into low, moderate, or high probability of DVT.
Vaccinations can produce local ____,
lymphadenopathy
In pregnant women, expect ___ pitting edema in the lower extremities especially at the end of the day.
Bilateral
Pregnant women: third trimester common findings
peripheral pitting edema
varicose veins
Finding in older adults:
__ and ___ pulses may become more difficult to find.
DP and PT
Strophic changes associated with arterial insufficiency may be seen:
(occur normally)
think, shiny skin
thick, ridged nails
loss of hair on lower legs
Water-Hammer (Corrigan) Pulse 3+ :
Greater than normal force, then collapsed suddenly.
Difference between:
- Pulses Bugeminus
- Pulses Alternans
- Pulses Paradoxes
- Pulses Bisferiens
- rhythm coupled, every other best comes early or normal beat is followed by a premature beat
- Rhythm regular, but force varies
- beats have weaker amplitude with inspiration, stronger with expiration
- each pulse has two strong systolic peaks with a dip in between
Caused by the chronic gradual buildup of (in order) fatty streaks, fibroid plaque, calcification of the vessel wall, and thrombus formation.
Occlusion
a sac formed by dilation in the artery wall
Aneurysms
Arterial disease causes symptoms of ___.
Oxygen Deficit
Venous disease causes symptoms of ____.
metabolic waste build up
