peripheral vascular Flashcards
function of arteries
supply oxygen and essential nutrients to tissues
which arteries are accessible to examination?
temporal, carotic, brachial, ulanr, radial, femoral, popliteal, anterior tibial, dorsalis pedis, posterior tibial
peripheral arterial disease affects…
noncoronary vessels and refers to arteries afecting the limbs
function of veins
drain deoxygenated blood and its waste products from tissues and return it to heart
structure of veins
ability to stretch, capacitance vessels
which veins are accesible to examination
femoral, popliteal, great and small saphenous, connecting veins that join two sets, jugular veins
venous flow low pressure system
mechanism to keep blood moving by contracting skeletal muscles, pressure gradient caused by breathing and intraluminal valves, in the legs it is the calf pump or peripheral heart
what is varicose vein affect on veins
creates incompetent valves leading to increased venous pressure, further dilating the valve
functions of lymphatic system
conserve fluid and plasma proteins that leak out of capillaries, form major part of immune system that defends the body against disease, absorb lipids from intestinal tract
what are lymph nodes
small oval clumps of lymphatic tissue located at intervals along vessels
spleen
destroys old RBCs and stores RBCs, produces antibodies, filters microorganisms from the blood
tonsils
located at entrance to respiratory and digestive tracts and respond to local inflammation
thymus
behind sternum and in front of aorta
vascular vs. lymphatic
vascular moves blood, lymphatic moves plasma proteins from the tissues to the blood
inguinal lymph nodes
can be palpated, should be small, less than 1 cm, moveable and non-tender
SHOULD NOT BE: enlarged, tender, fixed
epitrochlear lymph nodes
not palpable, SHOULD NOT BE: enlarged, palpable
inspection of the arms
- note color of skin and nail beds, temperature, texture, turgor, presence of lesions or clubbing
- check cap refill
- check radial pulses
inspection of the legs
- measure leg at widest point
- in the presence of ulcers, gangrene, discoloration, note size and exact lcoatino
- palpate lower extremity pulses using bilateral comparison
- palpate for temperature
- use monofilament to asses neurovascular status
what arteries should you palpate in the leg
femoral, popliteal, dorsalis pedis, posterior tibial
assess pretibial edema
firmly deprss skin over tibia, grade 0-4
1+ scale of edema
mild, slight indentatino, no perceptible sweating
2+ scale of edema
moderate pitting, indentation subsides rapidly
3+ scale of edema
deep pitting, indentation remains, leg looks swollen
4+ scale of edema
very deep pitting, indentation lasts a long time, leg grossly swollen and distorted
what should you do if you suspect arterial deficit?
have the patient raise legs about 12 inches off table and have them wag their feet for 30 seconds to drain venous blood, color will now only reflect contribution of arterial blood, color should return in 10 seconds or less
peripheral artery disease risk factors
smoking, diabetes mellitus, dyslipidemia, hypertension
what should you assess during peripheral vascular assessment? (8 things)
cap refill, color changes, edema, hair distribution, lymphatic system, pulses, temperature, ulcers
what are the implications for a prolonged capillary refill?
sign of vasoconstriction, decreased cardiac output, low blood pressure, shock
abnormal findings of temperature assessment
hyper or hypo thermia
what are the implications of localized hyperthermia?
could be trauma, infection, sunburn
what are the implications of localized hypothermia?
peripheral arterial insufficiency and Raynaud’s disease
what should you note during inspection of the legs/arms?
skin color/lesions; hair distribution, venous pattern, size of extremity
abnormal findings of color
pallor, ulcers, thin or shiny skin
should be appropriate for ethnic background
normal venous pattern
veins should be flat and barely visible
abnormal venous pattern
varicose veins
size of extremities findings
should be symmetric in size;
should be no edema unilaterally or bilaterally; or atrophy
health promotion
foot care, good shoes, hydrate feet, exercise
abnormal pulse findins
weak or bounding; water hammer pulse; pulsus bigeminus, alternans, paradoxus, bisferiens
abnormal findings in the arm
raynaud phenomenon; lymphedema
abnormal findings of the legs
arterial, venous, or neuropathic ulcer
abnormal findings of PVD in the legs
superficial varicose veins; deep vein thrombophlebitis
peripheral artery disease abnormal findings
aneurysms, occlusions
arterial disease causes symptoms of…
oxygen deficit
venous disease causes symptoms of…
metabolic waste build up
deep vein thrombus
clot in the leg; unilateral swelling, tenderness, extreme pain and warmth or redness of skin
deep vein thrombosis
can lead to pulmonary embolism, needs to be reported to provider
neurovascular checklist
6 p’s: pain, pulse, pallor, paresthesia, paralysis, pressure
check pain, sensation, skin temperatuer, cap refill, pulses, and movement
allen’s test
helps to see if hand has good blood supply, hand should flush within 15 seconds
red flags for neurovascular status
unilateral lower extremity pain, pulselessness, unilateral temperature change, unilateral edema
