Lecture 7.1 - Peripheral Vascular and Lymphatics

Question 1

How do the elastic fibers in arteries help maintain blood pressure?

Answer 1

They stretch to accommodate systolic pressure so that the heart does not have to increase its workload.
Their elastic recoil also helps to propel blood foward.

Question 2

The brachial artery branches to form the ____ and ___ arteries.

Answer 2

Radial and ulnar arteries.

Question 3

What are the best four arteries to assess for pulse?

Answer 3

Femoral, popliteal, dorsalis pedis, and posterior tibial.

Question 4

How does the structure of veins differ from arteries?

Answer 4

Veins have thinner, more distensible walls with a a larger diameter.
This allows them to serve as blood reservoirs and reduce stress on the heart.

Question 5

What are three ways blood pressure is maintained in the venous system?

Answer 5

1. Contraction of skeletal muscles
2. Pressure gradient created by breathing (Decrease thoracic, increase abdominal)
3. Intraluminar semilunar valves

Question 6

What is the “peripheral heart”?

Answer 6

A pattern of contractility and relaxation of the calf muscles while walking that propels blood forwards

Question 7

What are the three roles of the lymphatic system?

Answer 7

1. To conserve fluid and plasma proteins
2. To form a major part of the immune system
3. To absorb lipids from the intestinal tract

Question 8

Describe the two main lymphatic trunks:
Where do they empty?
What do they drain?

Answer 8

Right Duct
–> Empties into right subclavian vein
–> Drains right side of head, neck and heart; right arm, lung and pleura; and right upper section of the liver

Thoracic Duct
–> Empties into left subclavian vein
–> Drains rest of body

Question 9

Which lymph node drains the head and neck?

Answer 9

The cervical nodes

Question 10

Which lymph node drains the breasts and upper arm?

Answer 10

The axillary

Question 11

Which lymph node drains the hands and lower arm?

Answer 11

The epitrochlear

Question 12

Which lymph node drains the lower extremities, external genitalia, and anterior abdominal wall?

Answer 12

The inguinal

Question 13

The spleen is an accessory organ of the lymphatic system. Where is it located and what are its four functions?

Answer 13

Located in the LUQ
1. Destroys old RBCs
2. Creates antibodies
3. Store RBCs
4. Filter microorgansims from blood

Question 14

What are the four related organs to the lymphatic system?

Answer 14

The spleen, tonsils, thymus, and bone marrow

Question 15

The tonsils are an accessory organ of the lymphatic system. Where is it located and what is its function?

Answer 15

Three places: palatine, pharyngeal, and lingual
–> Responds to local inflammation

Question 16

The thymus gland is an accessory structure of the lymphatic system. Where is it located and what is its function?

Answer 16

Located in the superior mediastinum, dorsal to sternum and anterior to aorta.
No function in adults, but produces T-lymphocytes in children before bone marrow is mature.

Question 17

The bone marrow is an accessory organ of the lymphatic system. What role does bone marrow have in relation to lymphatics?

Answer 17

Creation of T and B lymphocytes

Question 18

What are the four considerations for the peripheral vascular system of older adults?

Answer 18

–>Arteriosclerosis
–> Peripheral Vascular Disease
–> Deep Vein Thrombosis
–> Loss of Lymphatic tissue

Question 19

Older adults are at risk of developing arteriosclerosis. What is this and how does it affect their health?

Answer 19

When peripheral vessels become rigid and thick –> Causes rise in SBP due to loss of elasticity + Heart has to work harder

Question 20

Older adults are at risk of developing peripheral arterial disease. What is this and how does it affect their health?

Answer 20

Atherosclerosis - deposit of fatty plaques in arteries
–> Large cause of morbidity and mortality due to it often being underdiagnosed, misdiagnosed, and undertreated
–> Major risk factor for lower extremity amputation

Question 21

Older adults are at risk of developing deep vein thrombosis (DVT). What is this and how does it impact their health?

Answer 21

A blood clot formation in a deep vein, frequently in calf.
–> Can lead to pulmonary embolism + edema

Question 22

What are some risk factors for developing a DVT?

Answer 22

–> Progressive enlargement of intramuscular calf veins
–> Increased bed rest
–> heart failure

Question 23

Older adults are at risk of loss of lymphatic tissue. What does this mean?

Answer 23

Less lymph nodes and decreased size of those that remain

Question 24

What medications are especially important to ask about when performing a vascular assessment?

Answer 24

HRT + Oral contraceptives –> Increase risk of blood clots, especially in those who are genetically predisposed or smoke.

Question 25

What chronic conditions should you ask about when performing a vasculature assessment?

Answer 25

Obesity, DM, CVD

Question 26

What lifestyle factors are important to ask about when performing a vasculature assessment?

Answer 26

--> Prolonged standing for work --> Trauma --> Pregnancy --> Smoking --> Bed rest

Question 27

What is lymphadenopathy?

Answer 27

Swelling due to issues with lymphatic drainage - often differs from peripheral edema in that it will not pitt, and the skin of swollen tissue will be taught.

Question 28

How long should capillary refill take?

Answer 28

Less than 2 seconds

Question 29

What should be noted when inspecting and palpating circulation during a vasculature assessment?

Answer 29

--> Colour --> Temperature --> Capp refill --> Pulse strength --> Lymph nodes

Question 30

What motor functions should be assessed when performing a vasculature assessment?

Answer 30

--> Presence of pain with movement --> Leg strength

Question 31

How can edema be noticed?

Answer 31

By examining for symmetry - often unilateral

Question 32

What can abnormalities in the nail bed tell you about circulation?

Answer 32

Clubbing of fingers indicates hypoxemia

Question 33

What might absence of body hair in areas/strange patterns of hair growth indicate?

Answer 33

Poor perfusion

Question 34

What might skin turger indicate?

Answer 34

Dehydration

Question 35

Which lymph nodes should be should be palpated for?

Answer 35

Epitrochlear, inguinal on arm. *Note that they should not be palpable unless there is an infection or localized inflammation

Question 36

What is edema?

Answer 36

Accumulation of excess fluid in tissue.

Question 37

What might cause edema?

Answer 37

--> Increased pressure in capillaries --> Decreased venous return --> Heart failure --> Medications --> Kidney disease --> Surgery

Question 38

How is lymphedema described/assessed?

Answer 38

By using a non-stretchable tape measure to measure the widest point and comparing it to the same place on the other limb

Question 39

How is pitting edema graded?

Answer 39

1+ - Mild pitting, slight indentation, no perceptible swelling 2+ - Moderate pitting, indentation subsides rapidly 3+ - Deep pitting, indentation remains for a short time, leg looks swollen 4+ - Very deep pitting, indentation lasts a long time, leg very swollen and distorted

Question 40

Which perceptual changes might a person with edema complain of?

Answer 40

Parasthesia

Question 41

What is deep venous thrombophlebitis? What objective data can be collected?

Answer 41

Occlusion of deep vein by thrombus. --> Swelling (inflammation/edema), cyanosis, redness, possible varicose veins, reduced venous return, clot/blockage might be palpable, warmer than rest of body,

Question 42

What are some risk factors for DVT?

Answer 42

Stasis of blood - bed rest Endothelial dysfunction Cancer Infection Hypercoagulability History of varicose veins

Question 43

What subjective data is characteristic of DVT?

Answer 43

Sudden onset calf pain Sharp pain on dorsiflexion

Question 44

What are the risk factors for arterial occlusion?

Answer 44

Obesity, smoking, HNT, sedentary lifestyle, family Hx, dyslipidemia

Question 45

What are some subjective complains related to arterial occlusion?

Answer 45

--> Pain, paresthesia --> Localized coldness

Question 46

What objective data indicates arterial occlusion?

Answer 46

Pallor and Loss of Pulse

Question 47

A new hoarseness of voice, subclavian pain, and SOB can be indicative of what?

Answer 47

Thoracic Aneurism

Question 48

What is claudication Distance?

Answer 48

The number of blocks walked or stairs climbed that produces muscle pain in an individual with peripheral circulatory issues.

Question 49

Unilateral edema occurs with ____

Answer 49

Occlusion of a deep vein.

Question 50

Motor and sensory loss occur with ____

Answer 50

Arterial deficit