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Health Assessment > peripheral vascular > Flashcards

peripheral vascular Flashcards

1
Q

what causes a pressure wave?

arteries or veins

A

arteries

“all arteries have this pressure wave, or pulse”

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2
Q

major arteries

what is the major artery supplying the arm?

what artery?

A

brachial artery

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3
Q

what is the major artery to the leg?

this passes under the inguinal ligament

A

femoral artery

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4
Q

what are the arteries in the legs?

4 total

A
  1. femoral
  2. popliteal
  3. dorsalis pedis
  4. posterior tibial
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5
Q

when would a partial blockage (ischema) be apparent?

A

during exercise when oxygen needs increase

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6
Q
  1. PAD affects what?
  2. what is PAD usually affected by?
A
  1. noncoronary arteries and usually refers to arteries supplying the limbs.
  2. atherosclerosis, embolism

hypercoaguable states, arterial dissection also affect PAD

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7
Q

a complete blockage leads to what

A

death of the distal tissue

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8
Q

which veins are responsible for most of the venous return in the ARMS?

HINT: superficial or deep

pg 502

A

superficial veins in the SQ tissue

pg 502

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9
Q

which veins are responsible for most of the venous return in the LEGS?

HINT: deep or superficial AND which ones?

pg 502

A

deep femoral and popliteal veins

pg 502

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10
Q

what are perforators?

pg 503

A

“connecting veins that join the two sets (A / Vs). They have one-way valves that route blood from superficial into the deep veins and prevent reflux to the superficial veins.”

pg 503

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11
Q

how do veins keep blood moving? 3 ways

veins are a LOW-PRESSURE system & they do not have a pump like arteries

A
  1. skeletal muscle contraction that milk blood proximally back toward the <3
  2. the pressure gradient caused by breathing, where inspiration makes the thoracic pressure ↓ and the abdominal pressure ↑
  3. the intraluminar valves, which ensure unidirectional flow.
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12
Q
  1. what is the calf pump/peripheral heart
  2. what does this mean

pg 503

A
  1. in the legs, this is how veins push blood back to the <3 w/o it returning
  2. when walking, the calf muscles alternately contract (systole) and relax (diastole). In contraction, gastrocnemius and soleus muscles squeeze veins & direct BF proximally
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13
Q

list the ways venous structure differs from arterial structure

3-4 differences

A
  1. venous pressure is lower
  2. walls of veins are thinner
  3. veins have a larger diameter and more distensible (can expand/hold more blood when BV ↑)
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14
Q
  1. the ability of veins to stretch is a _________ _______ ?
  2. what is this called?
A
  1. the ability of veins to stretch is a _________ _______ ?
  2. what is this called?
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15
Q

what is ‘capacitance vessels’?

A

the ability of veins to stretch

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16
Q
  1. efficient venous return depends on what 3 things?
  2. problems w/ any of these 3 elements leads to what?
A
  1. 1) contracting skeletal muscles
    2) competent valves in the veins
    3) patent lumen
  2. venous stasis
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17
Q

who is at risk for venous disease?

A

people who undergo prolonged standing, sitting, or bed rest

they do not benefit from the milking action that walking accomplishes

pg 504

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18
Q

dilated and tortuous (varicose) veins create ?

A

incompetent valves - the lumen is so wide that the valve cusps cannot approximate.

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19
Q

incompetent valves

what does this condition do to venous pressure?

A

increases venous pressure, further dilating the vein

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20
Q

venous pooling occurs in what type of people?

HINT: 2 types of people

A

obese and women following multiple pregnancies

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20
Q

venous pooling occurs in what type of people?

HINT: 2 types of people

A

obese and women following multiple pregnancies

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21
Q

lymphatics

hydrostatic pressure is caused by what

A

the pumping action of the <3 & pushes more fluid out of capillaries than the venules can absorb

22
Q
  1. lymphatics do what?
  2. fluid moves according to
A
  1. retrieve excess fluid & plasma proteins from the IS space & return them to the bloodstream.
  2. a pressure gradient
23
Q

without lymphatic drainage…?

A

fluid would build up in the IS spaces & produce edema

24
Q

the vessels converge and drain into what two trunks and where do these trunks empty into?

A
  1. right lymphatic duct - empties into the right subclavian vein
  2. thoracic duct - drains the rest of the body and empties into the left subclavian vein
25
Q

lymphatics

what functions does the lymphatic system have

A
  1. conserve fluid & plasma proteins that leak out of caps.
  2. form a major part of the immune system that defends the body from disease
  3. absorb lipids from the small intestine
26
Q

these nodes drain what?

  1. cervical nodes
  2. axillary nodes
  3. epitrochlear node
  4. inguinial nodes
A
  1. head and neck
  2. breast/upper arm
  3. hand/lower arm
  4. most of the lymph of the lower extremity, external genitalia, anterior abdominal wall
27
Q

definition

arteriosclerosis

A

when peripheral blood vessels grow more rigid due to aging

28
Q

definition

atherosclerosis

A

deposition of fatty plaques on the intima of the arteries

29
Q

definition

intermittent claudication

A

pain in a specific muscle group that is brought on by walking and is relieved with rest

30
Q

definition

claudication distance

A

number of blocks walked/stairs climbed to produce pain

31
Q
  1. pitting edema that is bilateral dependent is indicative of what?
  2. pitting edema that is unilateral dependent is indicative of what?

pitting = squishy

A
  1. HF, diabetic neuropathy, hepatic cirrhosis
  2. occlusion of a deep vein
31
Q
  1. edema that is bilateral is indicative of what?
  2. edema that is unilateral is indicative of what?
A
  1. HF
  2. local obstruction or inflammation
32
Q

risk factors for PVD

A

diabetes, smoking

smoking is the strongest factor for PAD

33
Q

nursing review question

you have a pt with PAD, you should educate them that what will further impede blood flow?

A

compression stockings

DO NOT PUT COMPRESSION STOCKINGS ON A PAD PT.

34
Q

nursing review question

a pt presents with a 3+ pulse, as the nurse you know this occurs with…?

A
  1. hyperkinetic states: exercise, anxiety, fever
  2. anemia & hyperthyroidism
35
Q

nursing review question

a pt presents with a 1+ pulse, as the nurse you know this occurs with…?

A

shock, PAD

36
Q

nursing review question

when inspecting/palpating arms on a pt, which radial pulse should you palpate?

HINT: trick question

A

BOTH

37
Q

nursing review question

you cannot palpate the ulnar pulse on your pt, as the nurse you know this is…?

A

normal and can occur in healthy individuals

38
Q

nursing review question

if you suspect arterial insufficiency, where should you palpate?

A

brachial pulses

their force should equal bilaterally

39
Q

nursing review question

how do you perform the modified allen test?
what is the normal findings for the MAT?

A
  1. firmly occlude both UA & RA of 1 hand while pt makes a fist several times, causing the hand to blanch
  2. ask pt to open hand w/o hyperextending; then release pressure on UA while maintaining pressure on RA
    normal findings: adequate circulation suggested by palmar blush - return of color in <7 seconds

UA - ulnar artery
RA - radial artery

40
Q

you perform the MAT and the pt’s palmar blsuh returns within 12 seconds, as the nurse, you know this suggests

MAT - modified allen test

A

occlusion of the collateral arterial flow

result range: 8-14 seconds

pg 510

41
Q

in a healthy pt, you know that a venous pattern is normally

A

flat and barely visible

42
Q

you have a pt with acute, unilateral painful swelling in their calves. their calves are asymmetrical by 2 cm, as the nurse you know this could be caused by?

A

DVT

Deep Vein Thrombosis

43
Q

DVT is presented by what?

A

acute, unilateral, painful swelling and asymmetry of calves of >2 cm, warmth/redness from inflammation and superficial venous dilation

greater than OR EQUAL TO 2 cm

44
Q
  1. asymmetry of the legs/calves 1-3 cm occurs with?
  2. 3-5 cm?
  3. more than 5 cm?

what cm for DVT?

A
  1. mild lymphedema
  2. moderate lymphedema
  3. severe lymphedema

2 or greater asymmetrical cm

45
Q

a pt presents with brown discoloration in their legs, as the nurse you know this occurs with?

A

chronic venous stasis

caused by hemosiderin deposits from RBC degradation

pg 512

46
Q

a bruit indicates

NOT definition

A

partial occlusion

definition: turbulent blood flow, whooshing sounds heard

47
Q

unilateral/bilateral nonpitting edema occurs with..?

nonpitting = hard to touch

A

lymphatic obstruction

48
Q

you raise a pt’s legs 12 inches off the table and have the pt wag their feet for 30 seconds, their legs appear pallor, as a nurse you know this is indicative of

A

arterial insufficiency

49
Q

dependent rubor occurs with …?

dependent rubor (deep blue-red color)

A

severe arterial insufficiency

50
Q

what are the 6 p’s of acute arterial

A
  1. pain
  2. pallor
  3. pulselessness
  4. paresthesia
  5. poikiolthermia (coldness)
  6. paralysis (severe indication)
51
Q

chronic arterial symptoms

PAD S/S’s of O2 deficit

A
  1. deep muslce pain
  2. IC- feels like “cramp” “numbness/tingling”
  3. chronic pain, onset gradual after exertion
  4. activity, “claudication distance”

Health Assessment (2 decks)

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