Peripheral Vascular and Lymph

Question 1

Pulse Sites

Answer 1

Carotid, Brachial, Radial, Ulnar, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis

Question 2

Homan’s Sign

Answer 2

Flex the person’s knee, then gently compress the calf (gastrocnemius) muscle anteriorly against the tibia; no tenderness should be present

Question 3

Subjective Data

Answer 3

Leg pain or cramps, skin changes on arms or legs, swelling in arms or legs, lymph node enlargement, medications

Question 4

Capillary Refill

Answer 4

Depress and blanch the nail beds, then release and note the time for color to return. Refill lasting more then 1 or 2 seconds signifies vasoconstriction or decreased cardiac output (hypovolemia, heart failure, shock)

Question 5

Allen’s test

Answer 5

used to evaluate the adequacy of collateral circulation before cannulating the radial artery. Occlude both the radial and ulnar arteries of one hand while the person makes a fist several time. This causes the hand to blanch. Person releases the hand without hyperextending. Release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation results in palmar blush.

Question 6

Aneurysm

Answer 6

sac formed by dilation in the artery wall. atherosclerosis weakens the middle layer of the vessel wall. this stretches the inner and outer layers and the effect of blood pressure creates the balloon enlargement, most common site is the aorta, most common cause is atherosclerosis

Question 7

Arrhythmia

Answer 7

irregular heart beat

Question 8

Arteriosclerosis

Answer 8

peripheral blood vessels grow more rigid with age. This condition produces the rise in systolic blood pressure

Question 9

Atherosclerosis

Answer 9

deposition of fatty plaques on the intima of the arteries

Question 10

Bradycardia

Answer 10

slow heart beat, less than 10 bpm

Question 11

Bruit

Answer 11

unusual sound the blood makes when it rushes past an obstruction, called turbulent flow

Question 12

Ischemia

Answer 12

deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel

Question 13

Lymphedema

Answer 13

high-protein swelling of the limb most commonly due to breast cancer treatment. surgical removal of lymph nodes or damage to lymph nodes and vessels with radiation therapy impedes drainage of lymph. protein-rich lymph builds up in the interstitial tissues, raising oncotic pressure promoting more fluid build up

Question 14

Pitting Edema

Answer 14

Observable swelling of body tissues due to fluid accumulation that may be demonstrated by applying pressure to the swollen area; graded from +1 to +4. Unilateral edema occurs with occlusion of a deep vein, or with lymphatic obstruction. Bilateral dependent pitting edema occurs with heart failure, diabetic neuropathy, and hepatic cirrhosis.

Question 15

Tachycardia

Answer 15

rapid heart beat; >100 bpm

Question 16

Thrombophlebitis

Answer 16

swelling or inflammation of a vein caused by a blood clot

Question 17

Lymph nodes

Answer 17

small, oval clumps of lymphatic tissue located at intervals along the vessels. Enalrged lymph nodes occur with infection, malignancies, and immunologic disease

Question 18

Varicose veins

Answer 18

incompetent valves permit reflux of blood, producing dilated tortuous veins. unremitting hydrostatic pressure causes distal valves to be incompetent and causing worsening variscosity; S:aching, heaviness in calf, easy fatiguability, night leg or foot cramps; O:dilated tortuous veins

Question 19

Arterial - Ishcemic Ulcer

Answer 19

buildup of fatty plaques on the intima (atherosclerosis) plus hardening and calcification of arterial wall (arteriosclerosis). S: deep muscle pain in calf or foot, claudication (pain with walking), pain at rest indicates worsening of condition; O: coolness, pallor, elevational pallor, dependent rubor, diminished pulses, systolic bruits, distal gangrene

Question 20

Deep Vein Thrombophlebitis (DVT)

Answer 20

deep vein is occluded by a thrombus, causing inflammation, block venous return, cyanosis, and edema causes may be bedrest, hx of varicose veins, trauma, infection, cancer, or the use of oral estrogenic contraceptives (in young women); S: sudden onset of intense, sharp, deep muscle pain possibly increasing with dorseiflexion; O: increased warmth, swelling, redness, dependent cyanosis , tender to palpation, Homan’s sign present in only a few cases.

Question 21

Venous (Stasis) Ulcer

Answer 21

after acute DVT or chronic incompetent valves in deep veins; S: aching pain in calf or lower leg, worse at the end of the day, worse with prolonged standing or sitting; O: firm, brawny edema; coarse, thickened skin; pulses normal, brown pigment discoloration, petechiae, dermatitis.
This causes increased venous pressure, then causing RBCs to leak into skin and break down leaving iron deposits.

Question 22

Mechanisms for venous blood return

Answer 22

1. contracting skeletal muscles
2. competent valves in veins
3. patent lumen

Question 23

Palpation of pulses

Answer 23

note the force +2 is normal

Question 24

Legs

Answer 24

note skin color, hair distribution, venous pattern, size (swelling or atrophy), any skin lesions or ulcers.

Question 25

Calf measurement

Answer 25

Both legs should be symmetrical in size w/o any swelling or atrophy. Diffuse bilateral edema occurs with systemic illnesses. Acute, unilateral, painful swelling and asymmetry of calves by 1 cm or ore is abnormal, possibly DVT or lymphedema.

Question 26

Risk factors for Venous Stasis

Answer 26

prolonged standing or sitting; obesity; pregnancy; prolonged bedrest; hx of heart failure, variscosities, or thrombophlebitis; veins crushed by trauma or surgery

Question 27

Pitting Edema Scale

Answer 27

1+ Mild pitting, slight indentation, no perceptible swelling of the leg; 2+ moderate pitting, indentation subsides rapidly; 3+ deep pitting, indentation remains for a short time, legs look swollen; 4+ very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted.