Peripheral Vascular and Lymph Flashcards
Pulse Sites
Carotid, Brachial, Radial, Ulnar, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis
Homan’s Sign
Flex the person’s knee, then gently compress the calf (gastrocnemius) muscle anteriorly against the tibia; no tenderness should be present
Subjective Data
Leg pain or cramps, skin changes on arms or legs, swelling in arms or legs, lymph node enlargement, medications
Capillary Refill
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)
Allen’s test
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.
Aneurysm
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
Arrhythmia
irregular heart beat
Arteriosclerosis
peripheral blood vessels grow more rigid with age. This condition produces the rise in systolic blood pressure
Atherosclerosis
deposition of fatty plaques on the intima of the arteries
Bradycardia
slow heart beat, less than 10 bpm
Bruit
unusual sound the blood makes when it rushes past an obstruction, called turbulent flow
Ischemia
deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel
Lymphedema
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
Pitting Edema
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.
Tachycardia
rapid heart beat; >100 bpm
Thrombophlebitis
swelling or inflammation of a vein caused by a blood clot
Lymph nodes
small, oval clumps of lymphatic tissue located at intervals along the vessels. Enalrged lymph nodes occur with infection, malignancies, and immunologic disease
Varicose veins
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
Arterial - Ishcemic Ulcer
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
Deep Vein Thrombophlebitis (DVT)
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.
Venous (Stasis) Ulcer
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.
Mechanisms for venous blood return
- contracting skeletal muscles
- competent valves in veins
- patent lumen
Palpation of pulses
note the force +2 is normal
Legs
note skin color, hair distribution, venous pattern, size (swelling or atrophy), any skin lesions or ulcers.
Calf measurement
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.
Risk factors for Venous Stasis
prolonged standing or sitting; obesity; pregnancy; prolonged bedrest; hx of heart failure, variscosities, or thrombophlebitis; veins crushed by trauma or surgery
Pitting Edema Scale
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.
