objective 15 Flashcards
consists of the vessels of the body which transport fluid such as the blood or lymph
vascular system
heart pumps freshly oxygenated blood through the ____ to all body tissues
arteries
what do arteries contain?
elastic fibers
muscle fibers
allow the walls to stretch with systole and recoiled with diastole
elastic fibers
control the amount of blood delivered to the tissues
muscle fibers
created by each heartbeat which makes the arteries expand and then recoil
pressure wave
projects the blood through like a wave
recoil
what are the arteries that are accessible to examin?
temporal
carotid
arm: brachial, ulnar, radial
leg: femoral, popliteal, dorsalis pedis, posterior tibial, plantar
lead to death of the distal tissue
complete blockages
causes insufficient supply and may only be noted during exercise, when oxygen needs increase
partial blockage
what are the deep veins?
femoral and popliteal
what are the superficial veins?
great and small saphenous veins
drain deoxygenated blood and waste products from the tissues and return it to the heart
are a low pressure system
have a mechanism to keep blood moving
veins
how do veins keep the blood moving?
contracting the skeletal muscles that milk the blood back to the heart
a pressure gradient caused by breathing
intraluminal valves which ensure unidirectional flow
mechanism in the legs in which during walking the calf muscles alternately contract and relax. due to the intraluminal valves, the blood can only go in one direction which is toward the heart
calf pump or peripheral heart
how do veins and arteries differ?
veins are thinner than arteries
veins have larger diameter
veins can expand and hold more blood when blood volume increased
forms a completely separate vessel system, which retrieves excess fluid from the tissue spaces and returns it to the bloodstream.
lymphatic system
what are the functions of the lymphatic system?
- Conserve fluids and plasma proteins that leak out of the
capillaries - Form a part of the immune system
- Absorb lipids from the intestinal tract
converge and drain into 2 main trunks
lymph vessels
what are the 2 main trunks of the lymph vessels?
right lymphatic duct
thoracic duct
drains the right side of the head and neck, right arm, right side of the thorax, right lung and pleura, right side of the heart, upper right section of the liver
right lymphatic duct
drains the rest of the body
thoracic duct
what are lymph nodes?
- Small oval clumps of lymphatic tissue
- Located in intervals along the vessels
- Mostly arranged in groups in the body
- Superficial and deep
what are lymph nodes able to do?
filter the fluid before it returns to the bloodstream; filter out
microorganisms that could be harmful to the body
what are the superficial nodes that are accessible for inspection and palpation?
cervical
axillary
epitrochlear
inguinal
drain head and neck
cervical node
drain the breast and upper arm
axillary node
drain the hand and lower arm
epitrochlear node
drain most of the lymph of the lower
extremity, the external genitalia, and the anterior
abdominal wall
inguinal node
what are the cultural and developmental considerations during pregnancy?
- Hormonal changes cause vasodilation – blood pressure
drops in first and second trimesters - Venous pressure increases because the growing uterus
obstructs drainage of the iliac veins and inferior vena
cava - Can causes dependent edema, varicosities in the legs
and vulva, and hemorrhoids
what are the cultural and developmental considerations of older adults?
- Peripheral blood vessels get more rigid with age – this
results in arteriosclerosis (causes rise in systolic blood
pressure) - Intramuscular calf veins enlarge
- Fewer number of lymph nodes and lymph nodes size
decreases - Dorsalis pedis and posterior tibial pulses may become
more difficult to find - Trophic changes associated with arterial insufficiency
also occur normally with aging
how do we prep for examination of peripheral vascular and lymphatic system?
- Examination includes: peripheral vascular characteristics, skin (ch.13),
musculoskeletal findings (ch.24), and neurological findings (ch.25) - Room temperature should be warm, but not hot (avoid vasoconstriction
and vasodilation) - Compare findings bilaterally
what is the equipment we need?
- Stethoscope
- Paper tape measure
- Tourniquet or blood pressure cuff
- Doppler
how do we inspect the hands?
- Note: Colour of the skin and nail beds, temperature,
texture, and turgor of the skin - Note: Presence of lesions, edema, clubbing (profile sign)
- Check capillary refill
how do we inspect the arm?
Note: whether the arms are symmetrical in size (normal
finding)
* Asymmetry can occur with edema from obstructed lymphatic
drainage (i.e. after breast surgery)
* Note: presence of scars
what pulses do we palpate?
radial and brachial
how do we inspect and palpate the epitrochlear lymph node?
- Location: depression above and behind the medial condyle of
the humerus - Assessment:
- “shake hands” with the client
- Reach the other hand under the client’s elbow to the groove between
the biceps and triceps muscles, above the medial epicondyle
what are the normal and abnormal findings of epitrochlear lymph node?
- Normal: node is not palpable
- Abnormal: enlarged (infection in hand or arm; conditions of
generalized lymphadenopathy)
how do we inspect the legs?
- skin colour, hair distribution, venous pattern, skin lesions,
ulcers - skin discolouration, skin ulcers, gangrene
- size (swelling and atrophy) and symmetry in size
what are the abnormal findings of the legs?
- Diffuse bilateral edema – systemic illnesses
- Acute unilateral, painful swelling and asymmetry of calves 1 cm
or more (refer client to determine is DVT is present) - Asymmetry - lymphedema (mild, moderate, severe)
- Mild (1-3 cm), moderate (3-5 cm), severe (>5 cm)
- If asymmetry noted or if DVT suspected, measure the calf
circumference with a non-stretchable tape measure - Measure at the widest point at the exact same place for both legs
(measure the number of cm down from the patellar) - If lymphedema is suspected, measure at the ankle, distal calf, knee, and
thigh
how do we palpate the legs?
- Palpate for temperature
- Palpate the inguinal lymph nodes
- It is not unusual to palpate small nodes (1 cm or less) that are moveable
and non-tender - Abnormal: nodes that are enlarged, tender, or fixed
- Pulses:
- Palpate the pulses in both legs
- Grade the pulses on the four point scale
- Femoral, popliteal (more diffuse pulse, can be difficult to localize – can
use 2 approaches), posterior tibial, dorsalis pedis
how do we assess the venous system?
- Ask client to stand and note any visible, dilated, and tortuous veins
- Assess for arterial deficit (colour change test):
- Raise client legs approx. 30 cm off the table and ask client to wag
the feet for approximately 30 seconds - Then, ask the client to sit up with the legs over the side of the
examination table - Compare the colour of both feet – note the time it takes for the
colour to return (normal: 10 seconds or less), note when the
superficial veins fill (normally about 15 seconds) - Test the lower legs for strength (ch.24)
- Test the lower leg for sensation (ch.25)
what is the doppler ultrasonic stethoscope used for?
- Detect a weak peripheral pulse
- Monitor blood pressure in infants and children
- Measure a low blood pressure
- Measure blood pressure in a lower extremity
what is the procedure for using the ultrasonic stethoscope?
- Position the client
- Place coupling gel on the end of the transducer
- Place the transducer over the pulse site at a 45 degree angle
- Apply very light pressure
- The pulse is located when the swishing, whooshing sound is
heard
