Peripheral Vascular Assessment Flashcards
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)
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
Palpable Arteries in the Arm (3)
a. brachial artery
b. ulnar artery
c. radial artery
Palpable Arteries in the Leg (4)
a. femoral artery
b. popliteal artery
c. dorsalis pedis artery
d. posterior tibial artery
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
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
Mechanisms for Forward Blood Flow Through Veins (3)
- Contraction of skeletal
muscles - milk blood
through veins - pressure gradient created by
breathing - intraluminal valves
Veins in the Arms (2)
- superficial veins
- deep veins
Veins in the Legs (3)
- deep veins
- superficial veins
- perforators
Risks for Venous Disease
- prolonged standing, sitting or bed rest
- hypercoagulable states
- vein wall trauma
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
Ducts of the Lymphatic System (2)
- Right Lymphatic Duct
- Thoracic Duct
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
Thoracic Duct
Empties into the left subclavian vein
Drains:
- the rest of the body
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
Important Nodes (4)
- Cervical Node
- Axillary Node
- Epitrochlear Node
- Inguinal Node
Cervical Node
drains the head and neck
Axillary Node
drains the breast and uper arm
Epitrochlear Node
drains the lower arm and hand
Inguinal Node
drains the lower extremities, external genitalia, and anterior abdominal wall
Related Organs
Lymphatic System
- Spleen
- Tonsils
- Thymus Gland
- Bone Marrow
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
- Inspection
- 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
- Arteriosclerosis
- Peripheral Artery Disease (PAD)
- Deep Vein Thrombosis (DVT)
- 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
