Peripheral vascular system Flashcards
Arteries
- Pump O2 rich blood to all body tissues-
- Pressure wave-“pulse”
Pulse Locations
- Temporal
- Carotid
- Brachial
- Femoral-Groin area
- Popliteal-Behind the knee
- Dorsalis Pedis- top of foot
- Posterior tibial- Medial side of ankle
Veins
-Absorb CO2 and waste products from periphery and carry them back to the heart.
-Low pressure system- does not have pump to generate their blood flow.
-Blood flow happens by muscle contractions, pressure gradient caused by breathing: the thoracis pressure decrease and the abdominal pressure increases, the intraluminal valves.
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Veins in legs
- Deep veins: popliteal and femoral
- Superficial veins: great and small saphenous
- Perforators: join the deep and superficial veins.
Two main trunks of lymph system
- Right lymphatic duct: Empties into the right subclavian vein. It drains the right side of the head and neck, right arm, right side of the thorax, right lung and pleura, right side of the heart, and right upper section of the liver.
- Thoracic duct: drains the rest of the body. It empties into the left subclavian vein.
Functions of lymphatic system
- conserve fluid and plasma proteins that leak out of the capillaries.
- form major part of the immune system that defends the body against disease.
- absorb lipids from the small intestine.
aides to the lymphatic system
- Thymus: T cells are produced here.
- B cells originate in bone marrow.
- Spleen: Destroys old red blood cells, produces antibodies, stores red blood cells, filter microorganisms from the blood.
- Tonsils: respond to local inflammation.
Peripheral artery disease
- Affects noncoronary arteries and usually refers to arteries supplying the limbs.
- Usually caused by atherosclerosis- deposit of fatty plaques on the intima of the arteries.
- Blood flow cannot match muscle demand during exercise; therefore people feel muscle fatigue or pain when walking.
- Coolness in extremities.
Claudication
-Cramping or pain
-Symptom of peripheral artery disease.
-Question to ask: Does it hurt when you walk?
Does it get better when you rest?
Claudication Distance
-Number of blocks walked or stairs climbed to produce pain.
Swelling
- Unilateral: result of a local obstruction or inflammation. (Blood clot)
- Bilateral: cause is generalized ( heart failure)
- Lymphatic obstructions can cause unilateral or bilateral edema
Medications
Hormone replacement and birth control cause a hypercoagulable state.
Risk factors for Peripheral vascular disease
Smoking and diabetes
Objective data: preparation
- Examine arms while doing vitals signs and the person is sitting.
- Examine legs while person is still supine; then stand person up to evaluate leg veins.
- Room temperature should be about 71 F and free of drafts to prevent vasodilation or vasoconstriction.
- Use inspection and palpation
- Compare with opposite extremity
Upper extremities- inspect and palpate
- Note skin color and nail beds
- Note temperature, texture, turgor of skin, presence of any lesions, edema, or clubbing.
Capillary refill
<1-2 seconds
-2 seconds is abnormal.
Profile sign
- viewing the finger to detect clubbing.
- Clubbing is caused by
- Vasoconstriction
- Hypovolemia
- Early congestive heart failure.
Pulses
- Note rhythm, elasticity of vessel wall and equal force.
- Bracial- go to spot of babies
- Radial- note rate- can complete with vital signs
- Ulnar- If you can not feel ulnar pulse and cap refill is greater than 2
Pulses grade scale
-Graded on a three point scale
0, absent- never document and not follow up. Investigate further.
1+ weak, “thready”- shock and PAD
2+ Normal
3+ increased, full, bounding- young athlete, hyperthyroidism
Modified Allen Test
- Used to evaluate the adequacy of collateral circulation before cannulating the radial artery.
- Adequate circulation is suggested by a palmar blush, a return to the normal color of the hand in less than 7 seconds.
- Although simple and useful, this test is crude and subject to error.
Grading edema
1+ Mild pitting edema, slight indentation, no perceptible swelling of the leg
2+ Moderate pitting edema, indentation subsides rapidly
3+ Deep pitting edema, indentation remains for short time, leg looks swollen
4+ Very deep pitting, indentation lasts a long time, leg very swollen
-Scale is subjective
Atherosclerosis vs. Arteriosclerosis
- Atherosclerosis= plaque build up
- Arteriosclerosis= narrowing and hardening
Arterial Insufficiency- color
-Pale, cyanotic, mottled
Arterial Insufficiency- Temperature
-Cool to cold
Arterial Insufficiency- Skin characteristics
-Thin, shiny skin, dependent rubor, elevation pallor of foot.
Arterial Insufficiency- Nails
-Thickened and ridged
Arterial Insufficiency- distribution of hair
-Loss of hair over toes and dorsum of foot
Arterial Insufficiency- Edema
-None to minimal
Arterial Insufficiency- Pulses
-Decreased or absent
Arterial Insufficiency- Pain
-Intermittent claudication (relieved by rest)
Arterial Insufficiency- Ulcers
-Between toes or tips of toes, heels, lateral malleolus. Well-defined edges, deep, circular ulcers base-black or gangrene; non bleeding.
Venous Insufficiency-Color
-May be reddish blue
Venous Insufficiency- Temperature
-Warm
Venous Insufficiency- Skin Characteristics
- Firm, brawny, brownish pigmentation in area between medial and lateral malleolus, skin thickened and tough, cyanosis when dependent.
Venous Insufficiency- Nails
-Not thickened
Venous Insufficiency- Distribution of hair
-hair is present
Venous Insufficiency- Edema
-Moderate to severe; pitting; ankle, foot, lower leg
Venous Insufficiency- Pulses
-Present but may be difficult to palpate through edema.
Venous Insufficiency- Pain
-Aching, cramping, feeling of fullness, relieved by elevation.
Venous Insufficiency- Ulcers
-Medial Malleolus, and lower leg; uneven edges, superficial, ulcer base- granulation tissue- beefy red to yellow; bleeding; may or may not be painful.
