Quiz #3 Peripheral Vascular System and Lymphatics Flashcards
Temporal artery location
In front of the ear
Carotid artery location
Between Sternomastoid and trachea
Brachial artery location
in the bicepts-triceps furrow of the upper arm, bifurcaes into the ulnar and radial arteries
Femoral artery
posterior at lower thigh as the popliteal artery
Popliteal artery divides
anterior tibial artery and posterior tibial artery
Peripheral artery disease
involves non-coronary arteries located in the limbs.
Usually caused by atherosclerosis
Veins in the legs
Deep veins—femoral vein; popliteal vein.
Superficial veins—great and small saphenous veins.
Veins keep blood moving by:
contracting skeletal muscles; pressure gradient caused by breathing (thoracic pressure decreases, abdominal pressure increases); intraluminal valves create one-way flow.
Called capacitance vessels due to veins’ ability to stretch.
Venous stasis is due to:
problems with contraction of skeletal muscles, and/or incompetent valves in the veins, and/or a patent lumen.
Risk for venous disease
Hypercoagulable state
Vein wall trauma
Incompetent valves created by dilated and tortuous veins
Lymphatic system function
retrieves excess fluid and plasma proteins from interstitial space—returns it to the circulation.
Conserves fluid and plasma protein
Forms major part of immune system
Absorbs lipids from the small intestine
Lymph vessels drain into the venous system at the
subclavian veins
Right lymphatic duct drains into
right subclavian vein
Thoracic duct
drains most of the body; empties into the left subclavian vein
Lymph nodes
where pathogens are exposed to B and T lymphocytes
Superficial nodes accessible to palpation
Cervical—head and neck
Axillary—breast and upper arm
Epitrochlear—hand and lower arm
Inguinal—lower extremities, external genitalia, anterior abdominal wall
Organs with involvement in the lymph system
spleen, tonsils, thymus gland
Lymph in Infants and Children
lymph nodes larger; superficial nodes may be palpable
Aging Adult Peripheral vascular system
Arteriosclerosis—increased BP
Enlargement of intramuscular calf veins
29% over 70—have PAD
Increased risk for PAD in the aging adult
smoking, DM, dyslipidemia, HTN
Increased risk for DVT in the aging adult
prolonged BR, prolonged immobilization, heart failure
Subjective data for peripheral vascular system and regional lymphatics (6)
- Leg pain or cramps
- Skin changes on arms or legs
- Swelling in arms or legs
- Lymph node enlargement
- Medications
- Smoking history
What to ask about leg pain for subjective assessment
PQRST, symptoms while walking, night pain
Night leg pain
Common in aging adults, may indicate ischemic rest pain of PVD, severe night muscle cramping, or restless leg syndrome
Claudication distance
The number of blocks walked or stairs climbed to produce pain
Arteriosclerosis
Peripheral blood vessels grow more rigid with age.
Athersclerosis
the deposition of fatty plaques on the intima of the arteries
Lymph nodes in older adults
loss of lymph tissue causes a decrease in the number of nodes and a decrease in the size of remaining nodes
Objective data for peripheral vascular system
- profile sign- check for clubbing
- capillary refill
- arm size symmetry
- radial pulses
- epitrochlear lymph notes check
- modified Allen test
- inspect and palpate the legs
Leg exam- inspection (6)
- Skin color and temperature
- Hair distribution
- Venous pattern
- Size (swelling/atrophy)
- Symmetry
- Skin lesions or ulcers
Signs of DVT
Acute, unilateral, painful swelling and asymmetry of calves 1cm or more
Brown discoloration of the legs
Occurs with chronic venous stasis caused by hemosiderin deposits from red blood cell degradation.
Venous ulcers site
medial malleolus, from bacterial invasion of poorly drained tissues
Arterial ulcers site
tips of toes, metatarsal heads, and lateral malleoli
Unilateral cool foot or sudden temperature drop moving down the leg caused by
arterial deficit
Cause of bilateral pitting edema
heart failure, diabetic neuropathy, hepatic cirrhosis. May also occur with excessive standing and pregnany
elevational pallor cause
arterial insufficiency
Tenderness in the calf may indicate
DVT, superficial phlebitis, lumbosacral disorders, muscle injury
Leg objective: palpation
- Temperature
- Compress calf muscle for tenderness
- Palpate inguinal lymph notdes
- Palpate femoral, popliteal, dorsalis pedis, and posterior tibial arteries.
- Check for pretibial edema
Bruit in femoral arteries indicates
Partial occlusion
dependent rubor
deep blue-red color with severe arterial insufficiency
Chronic hypoxia due to arterial insufficiency can produce
Vasomotor tone and sensory loss, pooling of blood in the veins
Unilateral edema occurs with
Occlusion of a deep vein or lymphatic ovstruction
If bilateral pitting edema is present, examine for
Distended neck veins- indicates heart disease or pulmonary hypertension.
Objective peripheral vascular and Lymphatic in aging adult
DP and PT pulses may be more difficult to find
Trophic changes associated with arterial insufficiency- ie thin, shiny skin, ridged nails, loss of hair- also occur with aging
Pulse characterizations
0- absent
1- weak
2- absent
3- increased/bounding
Right lymphatic duct empties into the
right subclavian vein
Right lymphatic duct 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 right upper section of the liver
