peripheral vascular system Flashcards
3 layers of arteries
intima, media, adventitia
4 jobs of tunica intima
- Regulators of thrombosis
- Prothrombotic molecules
- Modulates bloodflow with vasoconstrictors and vasodilators
- Regulates immune and inflammatory reactions
what does tunica media do?
Smooth muscle cells that dilate and constrict to accommodate blood pressure and flow
what does tunica adventitia do?
Connective tissue containing the nerve fibers and blood vessels to the blood vessels
where are the arterial pulses in the arm?
Arterial pulses in arm
Brachial artery
Radial artery
Ulnar artery
Arterial arches: Redundant blood flow to the hand
where are the arterial pulses in the leg?
Femoral artery
Popliteal artery
Dorsalis pedis artery
Posterior tibial artery: An interconnecting arch between the two chief arterial branches protects circulation to the foot
how do arteries vary in size and function ? 5 types
- Large -highly elastic (Aorta, carotids)
- Medium sized -muscular artery ( Coronary and renal arteries)
- Small arteries (Less than 2 mm in diameter)
- Arterioles (Diameter 20-100 micrometers)
- Capillaries (Diameter of one red blood cell- 7-8 microns
Endothelial lining but no media
how are veins different from arteries? -in terms of capacity for blood…
Thin walled and highly distensible
Capacity to hold 2/3rd of the circulating blood flow
what layers do veins have?
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
superior vs inferior vena cava - where does the blood come from ?
Superior vena cava
Veins from the arms, trunk head and neck
Inferior vena cava
Veins from the legs and lower trunk drain upward
what veins ? Carry ~90% of the venous return to the heart
Well supported by surrounding tissue
deep veins
what veins? Subcutaneous with relatively poor support
superficial veins
what do the lymphs do?
Cells within the lymph nodes engulf cellular debris and bacteria and produce antibodies
Drains lymph fluid and returns it to the venous system
how does the arm drain?
Axillary lymph nodes drain most of the arm
Ulnar surface first drain into the epitrochlear nodes then into axillary lymph nodes
lymph system: horizontal vs vertical group of the leg
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)
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
outward flow , inward flow
lymph system , left-over proteins
peripheral artery disease
Stenotic, occlusive and aneurysmal disease of the aorta, its visceral arterial branches and the arteries of the lower extremities.
Coronary arteries are NOT included
S&S (7) to ask about pertaining to peripheral artery disease
- 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
claudication
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
allen test
Allen test: squeezing wrist on medial and lateral side, looking for blanching and refilling- checking both arteries are patent
if these risk factors are present, check ABI (ankle-brachial index)
50 years or older +
Smoking, diabetes, HTN, High cholesterol, African-American ethnicity , or Coronary artery disease.
inspecting arms bilaterally you are documenting … (4)
Documents: ____Size, Symmetry, Swelling ____Venous pattern or enlargement
____Skin and Nail color
____Skin texture
palpating the epitrochlear lymphs, you are documenting…(4)
Documents: ____Size ____Consistency ____Discreteness ____Tenderness
palpating the radial artery bilaterally, you are documenting…
____Amplitude of pulses (0 - 3+)
____Capillary refill of fingers
examining the lower extremities, you are documenting… (6)
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
checking the lymph system in the legs includes…
___Palpates superficial inguinal lymph nodes (horizontal and vertical)
Documents: ____Size ____Consistency ____Discreteness ____Tenderness
what 4 peripheral arteries are you palpating in the lower extremity?
____Femoral ____Popliteal ____Posterior tibialis ____Dorsalis pedis
(check temp and amplitude of pulses 0-3+)
how do you check for edema in the legs? what do you document and where do you palpate?
Documents: ____Relative size ____Prominence of veins, tendons and bones
Palpates for pitting edema:
____Over dorsum ____Behind medial malleolus ____Over shins
if edema were present… (5)
___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
what are your two tests to check for DVT?
Homan’s Sign: dorsiflex foot and see if calf hurts
Calf squeeze
how do you check for chronic arterial insufficiency? (technique and what to document)
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
what can erectile dysfunction be a sign of ?
PAD
what is “dependent rubor” ?
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
“mapping” variscoe veins
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
pitting edema vs lymphedema vs chronic venous insufficiency
- 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)
chronic venous insufficiency vs arterial insufficiency: pulse, color, temp, edema, skin, ulcer, gangrene
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
what is ABI?
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)
how would you calculate left ABI?
highest left average ankle pressure (dorsal pedis or posterior tibial) / highest avg. arm pressure (right or left)
(>0.9 is normal)
ABI for mild, moderate and severe PAD?
0.89-0.6 is mild
0.6-0.4 is moderate
<0.4 is severe
neuropathic ulcer
- 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
