peripheral vascular system

Question 1

3 layers of arteries

Answer 1

intima, media, adventitia

Question 2

4 jobs of tunica intima

Answer 2

• Regulators of thrombosis
• Prothrombotic molecules
• Modulates bloodflow with vasoconstrictors and vasodilators
• Regulates immune and inflammatory reactions

Question 3

what does tunica media do?

Answer 3

Smooth muscle cells that dilate and constrict to accommodate blood pressure and flow

Question 4

what does tunica adventitia do?

Answer 4

Connective tissue containing the nerve fibers and blood vessels to the blood vessels

Question 5

where are the arterial pulses in the arm?

Answer 5

Arterial pulses in arm
Brachial artery
Radial artery
Ulnar artery

Arterial arches: Redundant blood flow to the hand

Question 6

where are the arterial pulses in the leg?

Answer 6

Femoral artery
Popliteal artery
Dorsalis pedis artery
Posterior tibial artery: An interconnecting arch between the two chief arterial branches protects circulation to the foot

Question 7

how do arteries vary in size and function ? 5 types

Answer 7

1. Large -highly elastic (Aorta, carotids)
2. Medium sized -muscular artery ( Coronary and renal arteries)
3. Small arteries (Less than 2 mm in diameter)
4. Arterioles (Diameter 20-100 micrometers)
5. Capillaries (Diameter of one red blood cell- 7-8 microns
   Endothelial lining but no media

Question 8

how are veins different from arteries? -in terms of capacity for blood…

Answer 8

Thin walled and highly distensible

Capacity to hold 2/3rd of the circulating blood flow

Question 9

what layers do veins have?

Answer 9

Intima: Non-thrombogenic endothelium. Valves that keep blow flowing in one direction
Media: Circumferential rings of elastic tissue and smooth muscle that change vein caliber in response to even minor changes in venous pressure

Question 10

superior vs inferior vena cava - where does the blood come from ?

Answer 10

Superior vena cava
Veins from the arms, trunk head and neck
Inferior vena cava
Veins from the legs and lower trunk drain upward

Question 11

what veins ? Carry ~90% of the venous return to the heart

Well supported by surrounding tissue

Answer 11

deep veins

Question 12

what veins? Subcutaneous with relatively poor support

Answer 12

superficial veins

Question 13

what do the lymphs do?

Answer 13

Cells within the lymph nodes engulf cellular debris and bacteria and produce antibodies
Drains lymph fluid and returns it to the venous system

Question 14

how does the arm drain?

Answer 14

Axillary lymph nodes drain most of the arm

Ulnar surface first drain into the epitrochlear nodes then into axillary lymph nodes

Question 15

lymph system: horizontal vs vertical group of the leg

Answer 15

Follow superficial and deep veins
Horizontal group
Drains the superficial portions of the lower abdomen and buttock, the external genitalia (not testes), and the anal canal and the lower vagina
Vertical group
Upper part of the saphenous vein drains upper leg
Lower leg, small saphenous vein area, don’t drain into the inguinal lymph nodes (heel and outer aspect of the foot)

Question 16

As blood travels through the capillary bed the forces favor ______ as it enters and _______ as it gets to the venous side.
The ______ picks up the extra fluid and the ________ *** important

Answer 16

outward flow , inward flow

lymph system , left-over proteins

Question 17

peripheral artery disease

Answer 17

Stenotic, occlusive and aneurysmal disease of the aorta, its visceral arterial branches and the arteries of the lower extremities.
Coronary arteries are NOT included

Question 18

S&S (7) to ask about pertaining to peripheral artery disease

Answer 18

• Abdominal, flank or back pain
• Pain in arm or leg
• Intermittent claudication
• Cold, numbness, pallor in the legs, hair loss
• Swelling in calves, legs or feet
• Color change in fingertips or toes in cold weather
• Swelling with redness or tenderness

Question 19

claudication

Answer 19

at some point muscles are in need of more O2 than you can supply (claudication)- similar to angina
blood is going and its not enough = pain

Question 20

allen test

Answer 20

Allen test: squeezing wrist on medial and lateral side, looking for blanching and refilling- checking both arteries are patent

Question 21

if these risk factors are present, check ABI (ankle-brachial index)

Answer 21

50 years or older +

Smoking, diabetes, HTN, High cholesterol, African-American ethnicity , or Coronary artery disease.

Question 22

inspecting arms bilaterally you are documenting … (4)

Answer 22

Documents: ____Size, Symmetry, Swelling ____Venous pattern or enlargement
____Skin and Nail color
____Skin texture

Question 23

palpating the epitrochlear lymphs, you are documenting…(4)

Answer 23

Documents: ____Size ____Consistency ____Discreteness ____Tenderness

Question 24

palpating the radial artery bilaterally, you are documenting…

Answer 24

____Amplitude of pulses (0 - 3+)

____Capillary refill of fingers

Question 25

examining the lower extremities, you are documenting… (6)

Answer 25

Documents: ____Size, Symmetry, Swelling
____Skin and Nail color
____Skin texture
____Venous pattern or enlargement
____Pigmentation, rashes, scars or ulcers ____Hair distribution on lower legs, feet and toes

Question 26

checking the lymph system in the legs includes…

Answer 26

___Palpates superficial inguinal lymph nodes (horizontal and vertical)
Documents: ____Size ____Consistency ____Discreteness ____Tenderness

Question 27

what 4 peripheral arteries are you palpating in the lower extremity?

Answer 27

____Femoral ____Popliteal ____Posterior tibialis ____Dorsalis pedis
(check temp and amplitude of pulses 0-3+)

Question 28

how do you check for edema in the legs? what do you document and where do you palpate?

Answer 28

Documents: ____Relative size ____Prominence of veins, tendons and bones
Palpates for pitting edema:
____Over dorsum ____Behind medial malleolus ____Over shins

Question 29

if edema were present… (5)

Answer 29

___note the extent of swelling, how far up leg/legs does it go
____demonstrate how to measure legs
____Checks for DVT (tenderness or cords): Homan’s sign & Calf squeeze
____tenderness of the femoral vein
____With patient standing, checks lower legs for varicosities bilaterally

Question 30

what are your two tests to check for DVT?

Answer 30

Homan’s Sign: dorsiflex foot and see if calf hurts

Calf squeeze

Question 31

how do you check for chronic arterial insufficiency? (technique and what to document)

Answer 31

Chronic Arterial Insufficiency
____Color changes with legs elevated 60 degrees
____Changes with patient sitting with legs dangling
Documents: ____Time for pinkness to return (10 seconds)
____Time for veins to fill (15 seconds)
____Dependent rubor to replace pallor

Question 32

what can erectile dysfunction be a sign of ?

Answer 32

PAD

Question 33

what is “dependent rubor” ?

Answer 33

When a person with PAD (peripheral arterial disease) has redness of the foot when it is down on the floor (“dependent” meaning it is down below the level of the heart and “rubor” meaning red)
-occurs when dermal arterioles and capillaries no longer constrict in the presence of increased hydrostatic pressure

Question 34

“mapping” variscoe veins

Answer 34

mapping course and connections: pt standing, palpating fingers on vein and sharply compressing with your other hand some distance below it
-feel for a pressure wave transmitted to the palpating fingers: signals the two veins are connected

Question 35

pitting edema vs lymphedema vs chronic venous insufficiency

Answer 35

• pitting edema: low in protein conc. (pitting, stays soft)
• lymphedema: extra lymph fluid b/c not draining (thickening, soft then hardens over time)
• chronic venous insufficiency: hardened and stretch- thick skin, incompetent bounce: venous pressure sitting in the legs (hard, brown, ulcers)

Question 36

chronic venous insufficiency vs arterial insufficiency: pulse, color, temp, edema, skin, ulcer, gangrene

Answer 36

arterial: pulse: dec. or absent, color- pale then dusky red, temp- cool, edema- absent, skin- thin, hair loss, ulcer- points of trauma, gangrene- yes
venous: pulse- normal, color- normal then red/brown, temp-normal, edema- present, skin- thick, ulcer- ankle, gangrene- no

Question 37

what is ABI?

Answer 37

ankle-brachial index (ABI) : ratio of the blood pressure at the ankle to the blood pressure in the upper arm (brachium). Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD)

Question 38

how would you calculate left ABI?

Answer 38

highest left average ankle pressure (dorsal pedis or posterior tibial) / highest avg. arm pressure (right or left)
(>0.9 is normal)

Question 39

ABI for mild, moderate and severe PAD?

Answer 39

0.89-0.6 is mild
0.6-0.4 is moderate
<0.4 is severe

Question 40

neuropathic ulcer

Answer 40

• at pressure points w/ diminished sensation
• surrounding skin calloused
• will likely never heal b/c no blood supply, amputate until they can heal the wound they’ve made