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Health Assessment > PV > Flashcards

PV Flashcards

1
Q

Injury to vascular endothelial cells provokes…

A

thrombus formation, atheromas (fatty layers), and vascular lesions of HTN

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2
Q

atheroma, pathogenesis

A
  • begins in intima (inner layer of vessels) as lipid-filled foam cells and then becomes fatty streaks.
  • Complex atheromas are thickened asymmetric plaques that narrow the lumen, reducing blood flow, and weaken underlying media
    • They have soft lipid core and fibrous cap of smooth muscle cells and collagen-riich matrix
  • Plaque rupture may precede thrombosis
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3
Q

location of brachial artery

A

bend of elbow just medial to biceps tendon

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4
Q

location of radial artery

A

lateral flexor surface of forearm

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5
Q

location ulnar artery

A

medial flexor surface of forearm

overlying tissues may obscure ulnar artery

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6
Q

location femoral artery

A

just below inguinal ligament, midway between ASIS and symphysis pubis

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7
Q

location popliteal artery

A

extension of femoral artery that passes medially behind femur, palpable just behind knee

DIvides into dorsalis pedis and posterior tibial

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8
Q

location dorsalis pedis artery

A

dorsum of foot just lateral to extensor tendon of big toe

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9
Q

ocation posterior tibial artery

A

behind medial malleolus of ankle.

An interconnecting arch between its two chief arterial branches protects circulation to the foot

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10
Q

layers of arteries

A

3 concentric: intima, media, adventitia

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11
Q

Where do the veins of the arms, upper trunk, head and neck drain?

A

SVC, which empties into the right atrium

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12
Q

where do veins of legs and lower trunk drain?

A

upward into IVC

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13
Q

Important characteristic of leg veins

A

weaker wall structure, susceptible to irregular dilation, compression, ulceration, invasion by tumors = warrant special attn

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14
Q

intermittent claudication

A

symptomatic limb ischemia w/exertion

Present in atherosclerotic PAD

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15
Q

neurogenic claudication

A

pain w/walking or prolonged standing, radiating from spinal area into buttocks, thighs, lower legs, or feet

increases likelihood of spinal stenosis if pain is relieved by sitting or bending forward or if bilateral buttock or leg pain is present

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16
Q

PAD symptom location and site of arterial ischemia: buttock, hip

A

aortoiliac

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17
Q

PAD symptom location and site of arterial ischemia: erectile dysfunction

A

iliac-pudendal

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18
Q

PAD symptom location and site of arterial ischemia: thigh

A

common femoral or aortoiliac

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19
Q

PAD symptom location and site of arterial ischemia: upper calf

A

superficial femoral

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20
Q

PAD symptom location and site of arterial ischemia: lower calf

A

popliteal

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21
Q

PAD symptom location and site of arterial ischemia: foot

A

tibial or peroneal

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22
Q

abdominal pain, “food fear”, and weight loss suggest …

A

intestinal ischemia of the celiac or superior or inferior mesenteric arteries

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23
Q

ABI

A

ankle divided by brachial BP

  • >0.9 = normal
  • <0.89 - > 0.60 = mild PAD
  • <0.59 to >0.40 = moderate PAD
  • <0.39 = severe PAD
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24
Q

Key components of Peripheral Arterial Exam

A
  • BP in both arms
  • Carotids: palpate, auscultate
  • Auscultate aortic, renal, femoral
  • Palpate aorta & determine diameter
  • Palpate brachila, radial, ulnar, femoral, popliteal, dorsalis pedis, posterior tibial arteries
  • Inspect ankles & feet for color, temperature, skin integrity; not ulcerations, hair loss, trophic skin changes, hyper trophic nails
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25
Q

Prominent veins and edematous arm suggest…

A

venous obstruction

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26
Q

Grading of pulses

A
  • 3+ bounding
  • 2+ brisk, expected (normal)
  • 1+ diminished, weaker than expected
  • 0 absent, unable to palpate
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27
Q

warmth and redness over calf signal

A

cellulitis

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28
Q

atherosclerosis most commonly obstructs arterial circulation to…

A

the thigh. Normal femoral w/diminished to absent popliteal

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29
Q

Calf asymmetry, Differential Dx

A
  • DVT
  • muscle tear or trauma
  • Baker’s cyst (posterior knee)
  • muscular atrophy
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30
Q

Characteristic of venous cause to edema

A

venous distention - bilateral present in heart failure, cirrhosis, nephrotic syndrome

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31
Q

ulcer location: arterial, venous

A

arterial: often anterior tibiae, dry or brown-black from gangrene
venous: brownish discoloration or ulcers just above malleolus

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32
Q

dependent rubor

A

suggests arterial insufficiency, but not reliable if veins are incompetent

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33
Q

Mapping varicose veins

A

patient standing. placepalpating fingers gently on vein. compress w/bottom hand - feel for wave in upper hand

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34
Q

Evaluating competency of venous valves

A

Retrograde filling (trendelenburg) test

  • pt supine.
  • elevate one leg to about 90 degrees to empty it of venous blood.
  • occlude great saphenous vein in upper thigh by manual compression, using enough pressure to occlude this vein but not deeper vessels.
  • Ask pt to stand while you keep vein occluded.
  • Watch for refilling of leg. Should refill from below, takes about 35 seconds
  • After 20 seconds of standing, release compression and look for sudden additional venous filling - normally there is none - competent saphenous valves should obstruct retrograde flow
  • both steps normal? negative-negative

difficult w/older - may want doppler study instead​

35
Q

lymphedema

A

soft in early stages, then indurated, nonpitting.

skin markedly thickened, ulceration rare, no pigmentation

d/t lymph channels blocked by tumor, fibrosis, inflammation

36
Q

Allen Test

A
  • Ask pt to make tight fist w/one hand, then compress both radial and ulnar arteries firmly between your thumbs and fingers
  • Ask pt to open the hand into a relaxed, slightly flexed position. Palm is pale
  • Release pressure over ulnar artery, if patent, palm flushes w/in 3-5 seconds

important b/c collateral arches must be patent

37
Q

Cap Refill

A
  • Blanch the beds and release
  • Normal capillary refill time is within 3 second
  • >5 seconds indicates arterial vascular insufficiency
38
Q

VTE

A

venous thromboembolism

an umbrella term classifying PEs (1/3) and DVTs (2/3)

39
Q

Vascular Arches

A

-connect the radial and ulnar arteries protecting the distal circulation in the hand from arterial occlusion

40
Q

Veins in the Legs

A
41
Q

Rubor indicative of

A

arterial disease - ruddy color

42
Q

Great saphenous vein

A

originates on the dorsum of the foot passing anterior to the medial malleolusèup the medial aspect of the leg joining the femoral vein of the deep venous system below the inguinal ligament

43
Q

Small Saphenous Vein

A

begins at side of footètravels upward along the posterior calf joining the deep venous system in the popliteal fossa

44
Q

What does the loss of a femoral pulse represent?
adult/gero vs pedi

A
  • adult/gero: is it acute or chronic? may be increase in insufficiency, look for intermittent claudication, trophic changes in skin, postural color changes.
  • Pedi: coarctation of the aorta, congenital abnormalities in arterial blood flow, diastolic HTN
45
Q

Coarctation of the Aorta

A
  • congenital narrowing of aorta, causes severe obstruction. Most often picked up in first days, but can be later in life. Branches must be perfused by collateral blood flow
  • common in Turner syndrome, some birth defects, may also have VSD
  • Clinically: femoral pulse is weak or absent. BP is weaker in legs than arms, possibly w/HTN
46
Q

Arterial vs venous insufficiency

A
47
Q

warmth over vein may be…

A

thrombophlebitis

may have read streak, may have low-grade fever…

48
Q

Dependent rubor and cyanosis of the 1st digit are characteristic of

A

arterial insufficiency

49
Q

5 Ps of arterial occlusion

A
  • Pain
  • Pallor
  • Poikilothermia (coolness)
  • Pulselessness
  • Paresthesia
  • Paralysis

Pain often involves the foot
Sudden onset

50
Q

Raynaud’s Phenomenon

A
  • Episodic spasm of the small arterioles
  • Effects one or more fingers/toes
  • Numbness and tingling +
  • Pain may be present
  • Trigger-emotions, exposure to cold
  • Color changes to distal fingers, blanching –> cyanosis –> redness (as fills up again)
  • Warm climate (will move b/c so bad); Ca+ blockers (can help if very bad)
  • Suggest: hands under warm water*
51
Q

pregnancy and thrombosis

A

hormones, etc., can predispose

52
Q

Venous Stasis vs venous insufficiency

A

Stasis:

  • Pigmentation
  • Dermatitis
  • Ulceration
  • Thrombus formation
  • Cellulitis

Insufficiency: obstruction in forward movement - can cause clots, varicose veins. Dusky brown, ulcerations

53
Q

Superficial Thrombophlebitis

A

-acute episode of clot with local redness, tenderness and swelling with a palpable cord of superficial vein, most often sapehnous; may be febrile

54
Q

Deep Venous Thrombosis

A

-clot in a deep vein; unilateral; tense muscle; may NOT have pain; aggravated by walking; relieved with elevation; may have swelling of calf and foot; previous hx of DVT-high risk factor

55
Q

Chronic Venous Insufficiency

A

-chronic venous engorgement secondary to venous occlusion or incompetent venous valves; aching along let; chronic, worsening as day wears on; aggravating by prolonged standing; relieved with elevation; chronic edema, pigmentation, may have ulcers

56
Q

Concerns associated with the PV System

A
  • Arteries, veins, or lymphatics
    • Occlusion
    • Atherosclerosis
    • Aneurysm
    • Valvular insufficiency
    • Infection
    • Malignancy
57
Q

Meds common to those w/PVD

A
  • Insulin
  • Antiglycemics
  • Diuretics
  • Antihypertensives
  • Lipid Therapy
  • Oral Contraceptive Pills (OCP)/HRT
  • Anticoagulation
  • NSAIDs
  • Complementary/Alternative Therapy
58
Q

The Lymphatic System: components

A
  • Lymph nodes
  • Tonsils and adenoids
  • Thymus gland
  • Spleen
  • Intestines known as Peyer’s patches

Lymph tissue

  • Bone marrow
  • Stomach mucosa
  • Appendix
  • Lungs
59
Q

Most common cause of chronic arterial occlusive dz of lower extremities

A
  • chronic arterial insufficiency. Caused by arterial narrowing or obstruction, reducing blood flow. Leads to intermittent claudication, usually in calf.
  • ABI usually <0.9
  • Treat w/aspirin, w/exercise therapy. More severe - angioplasty, stenting, surgical grafts…
60
Q

Lymphatic movement

A

Peripherally-lymphatic capillaries –> centrally, thin vascular channels –> collecting ducts –> major neck veins

61
Q

Role of lymph nodes

A

Aid in maturation of lymphocytes and monocytes, using phagocytosis and filtration

62
Q

varicosities on back of calves/lower legs

A

if on feet a lot, age

PVD

63
Q

Lymphocytes

A
  • Found in bone marrow, lymph nodes, spleen, tonsils, adenoids
  • B-lymphocytes: bone marrow
  • T-lymphocytes: thymus
64
Q

Lymph nodes of lower extremities

A

Heel and outer aspect of the foot drain into the lesser saphenous vein to the deep popliteal space

65
Q

Pitting Edema

A
  • Press firmly x at least 2 seconds
  • Check dorsum
  • Check medial malleolus
  • Shins
  • Grade (1-4+pitting)-slight to very marked
  • Unilateral or bilateral?
  • Measure circumference; note extension
  • Prominent veins?
  • Color/ulcers/thickness?
66
Q

preauricular nodes

A

Eye, middle ear and parotids

67
Q

postauricular nodes

A

Both inner & outer ear

68
Q

occipital nodes

A

scalp, outer ear

69
Q

Tonsillar nodes

A

Tonsillar and posterior pharyngeal regions. Also includes the mouth, larynx, thyroid, & trachea

70
Q

submandibular nodes

A

mouth-mucosa, floor of mouth, face, nose, maxillary sinus

71
Q

Submental nodes

A

Anterior portion of the mouth and lower lip, and teeth

72
Q

Anterior cervical nodes

A

Internal structures of the throat, posterior pharynx, tonsils. Also the mouth, tongue, thyroid, trachea

73
Q

posterior cervical nodes

A

Mono/ other viral illness or respiratory infections

74
Q

Infraclavicular nodes

A

Upper limb

75
Q

Supraclavicular nodes

A
  • (Think malignancy)
  • Right: Esophagus, Mediastinum, lungs, GI
  • Left: Virchow’s node – Thorax, abdomen, lymphoma, thoracic or retroperitoneal cancer, bacterial/fungal infection
76
Q

axillary nodes

A

central, subscapular/posterior, anterior/pectoral, brachial/lateral

Infection of the upper extremity, chest wall, breast tissue of affected side, intrathoracic lesions, neck

77
Q

epitrochlear nodes

A

Malignancy (non-hodgkin’s lymphoma), infection of 3, 4,& 5 digits

78
Q

Superior superficial inguinal nodes (horizontal)

A

rectum, anus, genitals, buttocks, and abd wall below umbilicus.

79
Q

Inferior superficial inguinal

A

(vertical-drains Leg)

80
Q

visual for documenting pulses

A
81
Q

What if you can’t palpate the dorsalis pedis?

A

ask them to flex their big toe toward ceiling - shows extensor tendon & you can palpate lateral to extensor tendon

82
Q

characteristics of lymph nodes

A

soft, nontender, mobile

83
Q

Shotty nodes

A

spray of lymph nodes in one area - d/t viral illness, etc. Should go away, if not, concerning

84
Q

2 areas w/no lymphatic system

A

placenta & brain

Health Assessment (14 decks)

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