1. Cervical Node 2. Axillary Node 3. Epitrochlear Node 4. Inguinal Node

Peripheral Vascular Assessment Flashcards by kaiya champagne

Arteries

Pump oxygenated blood to the body tissues
- the pumping of the heart
makes the arteries a high
pressure system
- elastic recoil of stretched
arteries propel blood
forward, creates pressure
waves (the pulse)

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Composition of Artery Walls (2)

a. Elastic Fibres - allow the walls of the arteries to stretch with systole and recoil with diastole

b. Muscle Fibres - (vascular smooth muscle) change vessel diameter to control the amount of blood delivered to the tissues and control the rate of blood flow

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Palpable Arteries in the Arm (3)

a. brachial artery
b. ulnar artery
c. radial artery

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Palpable Arteries in the Leg (4)

a. femoral artery
b. popliteal artery
c. dorsalis pedis artery
d. posterior tibial artery

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Veins

Veins return deoxygenated blood and its waste products to the heart → to be returned to the lungs for gas exchange
- low pressure system
- body has more veins (to
facilitate venous return)
and they are closer to the
skin

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Composition of Vein Walls

thinner, larger in diameter, more distensible = CAPACITANCE VESSELS
- can expand to hold more
blood when blood volume
increases
- compensatory mechanism
to reduce stress on the
heart

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Mechanisms for Forward Blood Flow Through Veins (3)

Contraction of skeletal
muscles - milk blood
through veins
pressure gradient created by
breathing
intraluminal valves

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Veins in the Arms (2)

superficial veins
deep veins

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Veins in the Legs (3)

deep veins
superficial veins
perforators

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Risks for Venous Disease

prolonged standing, sitting or bed rest
hypercoagulable states
vein wall trauma

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Lymphatic System

Lymphatics function to remove excess fluid from tissue spaces, filter it, and return it to the bloods
- returns fluid that leaks from
veins
- prevents edema

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Ducts of the Lymphatic System (2)

Right Lymphatic Duct
Thoracic Duct

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Right Lymphatic Duct

Empties into the right subclavian vein

Drains:
- right side of the head, neck,
and head
- the right arm, lung and
pleura
- the right upper section of
the liver

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Thoracic Duct

Empties into the left subclavian vein

Drains:
- the rest of the body

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Functions of the Lymphatic System

Conserve fluid and plasma proteins that leak out of the capillaries
Form a major part of the immune system
Absorbs lipids from the intestinal tract

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Important Nodes (4)

Cervical Node
Axillary Node
Epitrochlear Node
Inguinal Node

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Cervical Node

drains the head and neck

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Axillary Node

drains the breast and uper arm

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Epitrochlear Node

drains the lower arm and hand

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Inguinal Node

drains the lower extremities, external genitalia, and anterior abdominal wall

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Related Organs

Lymphatic System

Spleen
Tonsils
Thymus Gland
Bone Marrow

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Spleen

located in the LUQ

4 functions
(a) destroy old RBCs
(b) create antibodies
(c) store RBCs
(d) filter microorganisms from
blood

Tonsils

located in the entrance of the respiratory and GI tracts
- functions to respond to local
inflammation

Thymus Gland

located at the superior mediastinum, dorsal to the sternum and anterior to the aorta (between the sternum and aorta)
- important function in
children, no function in
adults

Bone Marrow

located in the center of bones - functions to create T and B lymphocytes in the mature adult

Past Medical History | Peripheral Vascular System

Subjective Data | Peripheral Vascular System

Physical Exam Techniques (2) | Peripheral Vascular System

1. Inspection 2. Palpation

Physical Exam Points | Peripheral Vascular System

a. circulation b. motor c. sensation d. symmetry e. dermatology

Physical Exam - Circulation

- colour - temperature - capillary refill - lymph nodes - pulse (rate, rhythm, force)

Physical Exam - Motor

- presence of pain with movement - strength tests (legs)

Physical Exam - Sensation

- presence of paresthesia - presence of anesthesia

Paresthesia

Numbness, pins and needles

Anesthesia

Complete lack of sensation

Physical Exam - Symmetry

presence or absence of edema - degree (1+ to 4+) - location - atrophy

Edema

the accumulation of excess fluid in tissue space Causes: - increased pressure in the capillaries - decreased venous return - heart failure - medications - kidney disease - surgery

Lymphedema

usually only present on one side, only swells Measurement: using non-stretch tape measure, measure the widest point and compare to the same spot on the other limb

Pitting Edema

graded on a scale of 1-4 due to the presence of pitting Measurement: push on the skin for 5 seconds using 2-3 fingers, and release

Grade 1+ Pitting Edema

Mild pitting, slight indentation, no perceptible swelling of the leg

Grade 2+ Pitting Edema

Moderate pitting, indentation subsides rapidly

Grade 3+ Pitting Edema

Deep pitting, indentation remains for a short time (<5 mins), leg looks swollen

Grade 4+ Pitting Edema

Very deep pitting, indentation lasts a ong time (>5 mins), leg is very swollen and distorted - “Distorted” because the pressure of the excess fluid physically moves muscles to create more space, resulting is a changed leg appearance

Physical Exam - Dermatology

- texture - turgor - scars - nail bed - lesions - hair distribution - venous patterns

Physical Exam - nail bed

should be 160 degrees - an angle less than 160 could indicate clubbing (low perfusion)

Physical Exam - hair distribution

hair will not grow in regions of low perfusion

Physical Exam - turgor

elasticity of the skin

Deep Venous Thrombophlebitis

an inflammatory process causing blood clot formation in multiple veins, usually affecting the legs - increased blood flow + pooling in one area

Arterial Occlusions

Arterial Aneurysms

Older Adult Considerations

1. Arteriosclerosis 2. Peripheral Artery Disease (PAD) 3. Deep Vein Thrombosis (DVT) 4. Lymphatic System

Arteriosclerosis | Older Adult Considerations

a condition in which peripheral vessels become hard, rigid, and thick - produces a rise in systolic blood pressure via increased resistance

Peripheral Artery Disease (PAD) | Older Adult Considerations

a condition caused by atherosclerosis - the deposition of fatty plaque in the arteries (narrowing of the arteries) - silent = underdiagnosed and undertreated - major risk factor for lower extremity amputation (low perfusion, necrosis)

Deep Vein Thrombosis (DVT) | Older Adult Considerations

blood clot formation in a deep vein, usually in the lower extremities - can lead to a pulmonary embolism if left untreated Risk Factors: - progressive enlargement of intramuscular calf veins - increased bed rest (sedentary behaviour) - decreased physical activity - heart failure

Lymphatic System | Older Adult Considerations

as adults age, they lose lymphatic tissue - results in a decreased quantity of lymph nodes and a decreased size of the remaining nodes - decreased ability to respond to pathogens - increased risk of edema