Exam 4 - Peripheral Vascular System Flashcards
What is the purpose of the vascular system?
Transport fluid such as blood or lymph
Delivers oxygen and nutrients
Eliminates carbon dioxide and waste products
Function of the arteries
Pump O2 rich blood to all body tissues
What is a pressure wave?
Pulse.
Created by each heartbeat
Which makes the arteries expand and then recoil
The recoil propels blood through, like a wave
Accessible pulse locations:
Temporal Carotid Brachial Femoral Popliteal Dorsal is pedis Posterior tibial
Major artery to the leg
Femoral artery
Artery behind knee
Popliteal
Artery on dorsum of foot (spelling)
Dorsalis pedis
Artery behind medial malleolus and forms plantar arteries in the foot (spelling)
Posterior tibial
Function of veins
Absorb CO2 and waste products from periphery and carry them back to the heart
What is ischemia?
What is it caused by?
Deficient blood supply of oxygenated arterial blood to a tissue.
Caused by obstruction of blood vessel
What does a complete arterial blockage cause?
Death of distal tissue
What does a partial arterial blockage cause? And when does this become apparent?
Insufficient blood supply, and the ischemia may be apparent only at exercise when oxygen needs increase
Which arteries are affected with peripheral artery disease (PAD)?
Affects no coronary arteries and usually refers to arteries supplying the limbs
What usually causes PAD?
Atherosclerosis
Sometimes an embolism, hypercoagulable states, or arterial dissection
Veins accessible to examination
Jugular veins
Veins in the arm
Veins in the legs
What is intermittent claudication?
Cramping/pain in legs that comes and goes
What should you ask your patient about intermittent claudication?
“Does it get worse with walking and better after sitting (for 2 mins)?”
What is intermittent claudication a symptom of?
PAD (peripheral arterial disease)
What is claudication distance?
The distance pt can walk before having pain
Examples of skin changes we look for on arms or legs
Arteries not good at pumping to peripheries = cool, pale, cyanotic skin
Varicose veins: during pregnancy, obesity, or due to genetics
Main thing to note if pt has swelling
Unilateral or bilateral?
What can unilateral swelling be due to?
Injury
What can bilateral swelling be due to?
Cardiac related
Lymphedema
Blood clot
Infection
Which medications are we most concerned with regarding the peripheral vascular system?
Hormone replacement therapy
Birth control pills
(Can cause blood clots)
Function of the lymphatic system:
1- Conserve fluid and plasma proteins that leak out of the capillaries
2- Form a major part of the immune system that defends the body against disease
3- Absorb lipids from the small intestine
What can lymph node enlargement tell us?
If swollen, body may be fighting something above it (inguinal would mean something is going on with legs)
When should you examine pt’s arms and what position should they be in?
With vital signs while person is sitting
What position should pt be in while examining legs?
Examine while pt is still supine
Then stand person up to evaluate leg veins
What should the room temperature be during physical examination and why?
22C or 71F and free of drafts
To prevent vasodilation or vasoconstriction
What do we look at while inspecting skin on extremities?
Color
Capillary refill
Normal capillary refill
< 1-2 seconds
Abnormal capillary refill
> 2 seconds
What does capillary refill tell us?
An index of peripheral perfusion and cardiac output
What is profile sign?
Viewing the finger from the side to detect clubbing
Measurement of a normal nail bed
160 degrees
If a patient has clubbing, what could it mean?
Congenital cyanotic heart disease
Lung cancer
Pulmonary diseases (chronic lung inflammation)
What should you do if pt’s capillary refill is greater than 2 seconds?
If pt has 2+ pulse, don’t panic, just need to investigate further
What do we do during palpation?
Palpate pulses
Note rhythm
Elasticity of vessel wall
Check for equal force
Upper extremity pulses to palpate
Brachial
Radial
Ulnar
Which upper pulse do we use to note the rate of pulse?
Radial
What should you do if you can’t find ulnar pulse?
Hard to find, so test capillary refill. If that’s ok, have someone else come try to find pulse
How to grade force on a 3 point scale
3+ increased, full, bounding
2+ normal
1+ weak
0 absent
What could cause a 3+ pulse force?
Hyperthyroidism
Anxiety
Just finished exercise
When would a 1+ pulse force be considered normal?
Elderly
Go to pulse to measure on babies
Brachial
Test used for checking collateral blood flow
Modified Allen test
What is the modified Allen test used for?
ABG (arterial blood gas) collection
Evaluate the adequacy of collateral circulation before cannulating the radial artery
Steps to perform the modified Allen test
1) Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times (this causes the hand to blanch)
2) Ask the person to open the hand without hyperextending it, then release pressure on the ulnar artery while maintaining pressure on the radial artery (adequate circulation is suggested by a palmar blush)
What is a palmar blush?
Return to the normal color of the hand in less than 7 seconds
What do we look at for inspection of lower extremities?
Skin Hair distribution Venous pattern Size (any swelling or atrophy) Skin discoloration, ulcers, or gangrene