Lecture 7.1 - Peripheral Vascular and Lymphatics Flashcards
How do the elastic fibers in arteries help maintain blood pressure?
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.
The brachial artery branches to form the ____ and ___ arteries.
Radial and ulnar arteries.
What are the best four arteries to assess for pulse?
Femoral, popliteal, dorsalis pedis, and posterior tibial.
How does the structure of veins differ from arteries?
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.
What are three ways blood pressure is maintained in the venous system?
- Contraction of skeletal muscles
- Pressure gradient created by breathing (Decrease thoracic, increase abdominal)
- Intraluminar semilunar valves
What is the “peripheral heart”?
A pattern of contractility and relaxation of the calf muscles while walking that propels blood forwards
What are the three roles of the lymphatic system?
- To conserve fluid and plasma proteins
- To form a major part of the immune system
- To absorb lipids from the intestinal tract
Describe the two main lymphatic trunks:
Where do they empty?
What do they drain?
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
Which lymph node drains the head and neck?
The cervical nodes
Which lymph node drains the breasts and upper arm?
The axillary
Which lymph node drains the hands and lower arm?
The epitrochlear
Which lymph node drains the lower extremities, external genitalia, and anterior abdominal wall?
The inguinal
The spleen is an accessory organ of the lymphatic system. Where is it located and what are its four functions?
Located in the LUQ
1. Destroys old RBCs
2. Creates antibodies
3. Store RBCs
4. Filter microorgansims from blood
What are the four related organs to the lymphatic system?
The spleen, tonsils, thymus, and bone marrow
The tonsils are an accessory organ of the lymphatic system. Where is it located and what is its function?
Three places: palatine, pharyngeal, and lingual
–> Responds to local inflammation
The thymus gland is an accessory structure of the lymphatic system. Where is it located and what is its function?
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.
The bone marrow is an accessory organ of the lymphatic system. What role does bone marrow have in relation to lymphatics?
Creation of T and B lymphocytes
What are the four considerations for the peripheral vascular system of older adults?
–>Arteriosclerosis
–> Peripheral Vascular Disease
–> Deep Vein Thrombosis
–> Loss of Lymphatic tissue
Older adults are at risk of developing arteriosclerosis. What is this and how does it affect their health?
When peripheral vessels become rigid and thick –> Causes rise in SBP due to loss of elasticity + Heart has to work harder
Older adults are at risk of developing peripheral arterial disease. What is this and how does it affect their health?
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
Older adults are at risk of developing deep vein thrombosis (DVT). What is this and how does it impact their health?
A blood clot formation in a deep vein, frequently in calf.
–> Can lead to pulmonary embolism + edema
What are some risk factors for developing a DVT?
–> Progressive enlargement of intramuscular calf veins
–> Increased bed rest
–> heart failure
Older adults are at risk of loss of lymphatic tissue. What does this mean?
Less lymph nodes and decreased size of those that remain
What medications are especially important to ask about when performing a vascular assessment?
HRT + Oral contraceptives –> Increase risk of blood clots, especially in those who are genetically predisposed or smoke.
What chronic conditions should you ask about when performing a vasculature assessment?
Obesity, DM, CVD
What lifestyle factors are important to ask about when performing a vasculature assessment?
–> Prolonged standing for work
–> Trauma
–> Pregnancy
–> Smoking
–> Bed rest
What is lymphadenopathy?
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.
How long should capillary refill take?
Less than 2 seconds
What should be noted when inspecting and palpating circulation during a vasculature assessment?
–> Colour
–> Temperature
–> Capp refill
–> Pulse strength
–> Lymph nodes
What motor functions should be assessed when performing a vasculature assessment?
–> Presence of pain with movement
–> Leg strength
How can edema be noticed?
By examining for symmetry - often unilateral
What can abnormalities in the nail bed tell you about circulation?
Clubbing of fingers indicates hypoxemia
What might absence of body hair in areas/strange patterns of hair growth indicate?
Poor perfusion
What might skin turger indicate?
Dehydration
Which lymph nodes should be should be palpated for?
Epitrochlear, inguinal on arm.
*Note that they should not be palpable unless there is an infection or localized inflammation
What is edema?
Accumulation of excess fluid in tissue.
What might cause edema?
–> Increased pressure in capillaries
–> Decreased venous return
–> Heart failure
–> Medications
–> Kidney disease
–> Surgery
How is lymphedema described/assessed?
By using a non-stretchable tape measure to measure the widest point and comparing it to the same place on the other limb
How is pitting edema graded?
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
Which perceptual changes might a person with edema complain of?
Parasthesia
What is deep venous thrombophlebitis?
What objective data can be collected?
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,
What are some risk factors for DVT?
Stasis of blood - bed rest
Endothelial dysfunction
Cancer
Infection
Hypercoagulability
History of varicose veins
What subjective data is characteristic of DVT?
Sudden onset calf pain
Sharp pain on dorsiflexion
What are the risk factors for arterial occlusion?
Obesity, smoking, HNT, sedentary lifestyle, family Hx, dyslipidemia
What are some subjective complains related to arterial occlusion?
–> Pain, paresthesia
–> Localized coldness
What objective data indicates arterial occlusion?
Pallor and Loss of Pulse
A new hoarseness of voice, subclavian pain, and SOB can be indicative of what?
Thoracic Aneurism
What is claudication Distance?
The number of blocks walked or stairs climbed that produces muscle pain in an individual with peripheral circulatory issues.
Unilateral edema occurs with ____
Occlusion of a deep vein.
Motor and sensory loss occur with ____
Arterial deficit
