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Health Assessment > Peripheral Vascular/Lymphatic Systems (Exam 2) > Flashcards

Peripheral Vascular/Lymphatic Systems (Exam 2) Flashcards

1
Q

What are the 8 palpable arteries and where are they located?

A

temporal (ear)
carotid (neck)
brachial (arm)
ulnar and radial (arm and wrist)
femoral (upper leg)
popliteal (behind knee)
posterior tibial (back of ankle)
dorsalis pedis (top of foot)

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2
Q

What is the function of the veins?

A

absorb CO2 and waste and carries back to heart; lies closer to skin surface

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3
Q

What are the accessible veins?

A

jugular
arm veins (SUPERFICIAL AND DEEP)
leg veins (SUPERFICIAL, DEEP, AND PERFORATORS)

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4
Q

What’s the function of lymph nodes?

A

retrieve excess fluid and plasma proteins from interstitial spaces and puts them back in bloodstream

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5
Q

What’s the function of the cervical nodes?

A

drains the head and neck

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6
Q

What’s the function of the axillary nodes?

A

drains the breast and upper arm

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7
Q

What’s the function of the inguinal nodes?

A

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

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8
Q

Subjective Data for Peripheral Vascular Disease (PVD): Leg Pain/Cramps

A

• if present, where?
• OLDCARTS
• aggravated by activity or walking?
• claudication

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9
Q

What is claudication?

A

muscle pain or fatigue with walking or activity (PAD)

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10
Q

Subjective Data PVD: History

A

• vascular problems
• heart problems or HTN
• smoking (PVD)
• diabetes (PVD)

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11
Q

Subjective Data PVD: Skin changes on arms or legs

A

• if present, what color?
• temperature- hot or cold? (coolness common in PAD)
• bulging or crocked veins (varicose)?
• leg sores or ulcers (common in chronic PVD)

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12
Q

Subjective Data PVD: Swelling in arms or legs?

A

• OLDCARTS
• Swelling in one or both legs?
• when did swelling start
• what time is swelling it’s worst
• does the swelling come and go?

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13
Q

Edema is bilateral when…. and unilateral when….

A

the cause is generalized like heart failure; it is the result of a local obstruction or inflammation

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14
Q

Subjective Data PVD: Lymph Node enlargement

A

• any swollen glands (lumps or bumps under skin)
• recent changes?
• hard or soft?
• pain or local infection

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15
Q

Subjective Data PVD: Medications

A

• taking any meds like oral contraceptives or hormone replacement? (may cause hypercoagulative state)

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16
Q

Subjective Data: Smoking

A

• how many PPD, what start age?
• any attempt to quit?

STRONGEST RISK FACTOR FOR PAD, STARTING SMOKER YOUNGER THAN 16 MORE THAN DOUBLES RISK

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17
Q

Objective Data: Inspecting Hands and Arms

A

• skin color
• nail beds
• temperature
• texture
• turgor
• lesions
• edema
• clubbing (profiles sign)
• symmetry
• scars

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18
Q

You should palpate the brachial pulses if…

A

you suspect arterial insufficiency, forces should be equal bilaterally

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19
Q

You should palpate BOTH radial pulses for…

A

rate
rhythm
elasticity
force

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20
Q

What are some abnormal findings regarding hair distribution for arterial insufficiency?

A

malnutrition, pallor, and coolness

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21
Q

Where should you check for venous ulcers?

A

medial malleolus

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22
Q

Where should you check for arterial deficit ulcers?

A

tips of toes, lateral malleolus, matatarsal heads

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23
Q

What should you infer if you see unilateral asymmetry?

A

suspect DVT (measure calf circumference) OR lymphedema (measure calf, ankle, knee and thigh)

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24
Q

What is common when there is unilateral cool foot or leg, or sudden drop in temp as you move leg?

A

arterial ischemia

25
Q

What should you infer if there is calf tenderness during assessment?

A

possible DVT or phlebitis

26
Q

How should you palpate the femoral pulse?

A

if weak or diminished, auscultate for bruit

27
Q

The popliteal pulse is…

A

difficult to palpate

28
Q

How should you palpate the dorsalis pedis pulse?

A

curve fingers around medial malleolus

29
Q

The posterior tibialis pulse is…

A

easy to locate

30
Q

Objective Data: Palpating for pretibial edema

A
  1. Firmly depress skin over tibia or medial malleolus for 5 seconds and release
  2. should not leave indentation
  3. if present grade using scale
31
Q

What are the 4 grades on the pretibial edema scale and what do they mean?

A

+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, leg looks swollen
+4 VERY DEEP PITTING: indentation lasts a long time, leg is grossly swollen and distorted

32
Q

Objective Data: Suspected Arterial Deficit

A
  1. raise legs 12 in. off the table and ask person to wag their feet for 30 sec. to drain venous blood (skin color now reflects arterial blood)
  2. have patient sit up with legs over side of table, compare color bilaterally and note time for color to return to feet (10 sec. or less)
  3. note time it takes for superficial veins around feet to fill (15 sec.)
33
Q

What is the Doppler ultrasonic probe used to detect?

A

weak peripheral pulses
monitor BP in infants and children
measure a low BP or BP in a lower extremity

MAGNIFIES PULSATILE SOUNDS

34
Q

How do you use the Doppler Ultrasonic Probe?

A
  1. apply gel to transducer
  2. place transducer over a pulse site
  3. apply very light pressure and tilt probe around till you locate swishing, whooshing sound of the pulse
35
Q

What does the ankle-brachial index determine?

A

the extent of PAD (peripheral artery disease)

36
Q

How do you prepare a patient for the ankle-brachial index?

A
  1. Patient lying flat for 5-10 mins.
  2. No smoking 2 hours before
  3. Choose correct cuff size for measurements
  4. Position the ankle cuff just above malleoli
37
Q

What are the steps for the ankle-brachial index?

A
  1. Locate pulse with Doppler
  2. Inflate the cuff 20 mmHg above disappearance of flow signal
  3. Deflate slowly to detect reappearance of flow signal
  4. Measure right arm, right posterior tibial (PT), right dorsalis pedis (DP), left PT, left DP, left arm
  5. calculate ABI using formula
38
Q

What is the Wells score for?

A

probability of DVT (low, moderate, or high)

39
Q

Developmental Competence: Infants and Children

A

transient acrocyanosis and skin mottling at birth
pulse forces should be normal and symmetrical
palpable lymph nodes common

40
Q

Developmental Competence: Pregnancy

A

expect diffuse bilateral pitting edema in lower extremities
varicose veins common in 3rd trimester
remain alert for generalized edema plus hypertension (preeclampsia)

41
Q

Developmental Competence: Aging Adult

A

DP and PT pulses may be harder to find
trophic changes associated with arterial insufficiency (thin, shiny skin, thick ridged nails, loss of leg hair) occur normally

42
Q

What are some examples of effective health promotion?

A

CHECK FEET OFTEN (look for skin changes, wash frequently, keep toenails trimmed)
KEEP BLOOD FLOWING (walk or rotate ankles, keep legs uncrossed while sitting)
WEAR SHOES THAT FIT
KEEP SKIN SOFT AND SMOOTH (avoid oils and bubble bath too slippery!)

43
Q

Subjective Data: ARTERIAL (ischemic) ULCER

A

• deep muscle pain in calf or foot
• claudication
• pain worse with leg elevation
• pain at rest indicates worsening

44
Q

Subjective Data: VENOUS (stasis) ULCER

A

aching pain in calf or lower leg
pain worse at end of day and with prolonged standing or sitting
pain lessens with leg elevation

45
Q

Objective Data: ARTERIAL ULCER

A

• coolness in one foot or leg
• elevational pallor
• diminished pulses
• systolic bruits
• distal gangrene

46
Q

Objective Data: VENOUS ULCER

A

• firm, brawny lower leg edema
• coarse, thickened skin
• pulses normal
• brown pigment discoloration
• petechiae; dermatitis

47
Q

Common Locations: ARTERIAL ULCER

A

toes
metatarsal heads
heels
lateral ankles

48
Q

COMMON LOCATIONS: VENOUS ULCERS

A

medial malleolus and tibia

49
Q

Characteristics: ARTERIAL ULCER

A

• pale ischemic base
• well-defined edges
• no bleeding
• appear dry and punched out
• may have eschar, necrosis

50
Q

Characteristics: VENOUS ULCER

A

• bleeding
• uneven edges
• weepy, pruritic statis dermatitis may be present

51
Q

What is the cause of neuropathic ulcers?

A

REPETITIVE STRESS; can become infected and chronic

75% OF LOWER EXTREMITY AMPUTATIONS OCCUR WITH DIABETES

52
Q

Name 5 symptoms of neuropathic ulcers

A
  1. numbness and tingling
  2. pain
  3. weakness
  4. loss of balance
  5. falling
53
Q

Name 4 signs of neuropathic ulcers (7 total)

A
  1. decreased reflexes
  2. loss of proprioception
  3. loss of vibration sensation
  4. small muscle wasting
  5. loss of warm and cold sensation and pinprick
  6. poor blood flow
  7. cold feet
54
Q

What are superficial varicose veins?

A

dilated leg veins from chronic increased venous pressure (obesity, multiple pregnancies, prolonged standing)

MORE COMMON IN WOMEN

new varicosities sit on surface of muscle or bone; older ones are deep and feel spongy

55
Q

What is deep vein thrombophlebitis (DVT)?

A

vein occluded by a thrombus, causing inflammation, blocked venous return, cyanosis and edema

sudden onset of sharp, intense and deep muscle pain, requires emergency referral due to pulmonary embolism risk

WELLS CRITERIA

56
Q

What are occlusions?

A

calcification of the vessel wall and thrombus formation caused by atherosclerosis

RISK FACTORS: obesity, smoking, hypertension, diabetes mellitus, elevated serum cholesterol, sedentary lifestyle, family history of hyperlipidemia

57
Q

What are aneurysms?

A

sac formed by dilation in the artery wall which causes wall to weaken and pressure creates a balloon

MOST COMMON SITE IS AORTA, CAUSED BY ATHEROSCLEROSIS IN MEN

58
Q

8 STEP SUMMARY CHECKLIST FOR PERIPHERAL VASCULAR EXAMINATION

A
  1. Inspect arms for color, size, lesions
  2. Palpate pulses: radial, brachial
  3. Check epitrochlear node
  4. Inspect legs for color, size, lesions, trophic skin changes
  5. Palpate temp of feet and legs
  6. Palpate inguinal nodes
  7. Palpate pulses: femoral, popliteal, posterior tibial, dorsalis pedis
  8. Check for and grade pretibial edema

Health Assessment (14 decks)

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