Vascular System & Hematology Flashcards
Vascular system:
network of arteries, veins, and capillaries
Hematologic system:
living blood cells
and plasma within the blood vessels.
Lymphatic system:
assists the vascular
system by draining unabsorbed plasma
from tissue spaces and returning this fluid
(lymph) to the heart via the thoracic duct ,
which empties into the left jugular vein
Functions of Blood
Oxygen & carbon dioxide transport
Nutrient & metabolite transport
Hormone transport
Transport of waste products to kidneys & liver
Transport cells & substances involved in immune reactions
Clotting at breaks in blood vessels
Maintenance of fluid balance
Body temperature regulation
Maintenance of acid
base balance
Vascular Examination
History
Inspection
Palpation
Auscultation
Vascular Tests
Diagnostic Studies
Vascular Examination (History)
• Relevant medical history (DM, HTN, hyperlipidemia, syncope or
vertigo, & nonhealing ulcers).
• Relevant social history (exercise, dietary habits, & use of tobacco or
alcohol).
• Pain in arms & legs (visceral pain & arthritis pain may radiate to the
extremities).
• Presence of intermittent claudication . If so, the speed , distance ,
and the site of the pain, should be noted.
• Presence of nocturnal pain (can develop as the vascular occlusion
worsens). Caused by leg elevation & reduced cardiac output.
• History of acute or chronic peripheral edema .
• Precautions (weight bearing or BP parameters after vascular surgery).
Vascular Examination (Inspection)
• Skin color: (discoloration of the distal extremities/nail bed).
• Hair distribution: patchy hair loss on the lower leg may indicate arterial insufficiency
• Venous pattern: dilated veins, particularly in the calf.
• Edema or atrophy:
– Peripheral edema from right sided CHF : bilaterally in dependent
– Edema from trauma, lymphatic obstruction, or chronic venous insufficiency: generally unilateral.
• Presence of cellulitis.
• Presence of petechiae: small, purplish, hemorrhagic spots on the skin.
• Skin lesions: ulcers, blisters, or scars.
• Digital clubbing: poor arterial oxygenation or circulation.
Vascular Examination (Palpation)
- Pain & tenderness
- Strength & rate of peripheral pulses
- BP
- Skin temperature
- Limb girth (if edematous)
Vascular Examination
(Vascular Tests)
Capillary refill time
Elevation pallor
Manual compression test
Allen’s test
Homans’ sign
Ankle
brachial index (ABI)
Capillary refill time
is defined as the time taken for a distal capillary bed to regain its color after pressure has been applied to cause blanching
Manual compression test
if varicose v are seen then occlude the proximal and palpate the distal. If a pulse is felt, then it is a positive test.
Homans’ sign
for people you expect has DVT. Bring pt foot into DF and squeeze at the calf make sure knee is flexed to take away potential of tight hamstrings. Pos if pt feels pain and discomfort.
Allen’s test
used to assess collateral blood flow to the hands, generally in preparation for a procedure that has the potential to disrupt blood flow in either the radial or the ulnar artery.
Modified wells Criteria:
Criteria for predicting the probability of a DVT
If you have more than 2 than you are at risk for DVT
Vascular Examination (Diagnostic Studies)
Noninvasive Lab studies
• Doppler ultrasound
• Plethysmography
• Exercise testing
• CT
• MRI
• Magnetic resonance angiography
(MRA)
Vascular Examination (Diagnostic Studies) Invasive Vascular Studies
Arteriography (Most common)
• Postangiogram care:
– Bed rest for 4 to 8 hours.
– Pressure dressings to the injection site with assessment for hematoma formation.
– Intravenous fluid administration to help with dye excretion.
– Frequent vital sign monitoring with pulse assessments.
Hematologic Examination (History)
• What are the presenting symptoms?
• Was the onset of symptoms gradual , rapid , or associated with trauma or other
disease?
• Is the pt unable to complete daily activities secondary to fatigue
• Hx of anemia or other blood disorders, cancer, hemorrhage, or systemic
infection?
• Hx of blood transfusion
• Hx of chemotherapy , radiation therapy, or other drug
• Night sweats, chills, or fever?
• Easily bruised ? Is wound healing delayed?
Hematologic Examination (Inspection)
• General appearance ( lethargy , malaise , or apathy
• Degree of pallor or flushing of the skin, mucous
membranes, nail beds, and palmar creases.
• Presence of petechiae ecchymosis (bruising).
• RR.
Laboratory Studies
(CBC)
- Decreased Hgb levels can reduce oxygen transport capacity -> reduce O2 supply -> ↓endurance level.
- Be aware of S&S of hypoxia to major organs : brain, heart, & kidneys
• Hct may be falsely high w/ dehydration & falsely low w/ fluid overload
• Low Hct -> weakness, dyspnea, chills, ↓activity tolerance, or exacerbate
angina.
Pancytopenia
Significant ↓in RBCs, all types of WBCs, & platelets
Neutropenia
An abnormal decrease in WBCs, particularly neutrophils.
Leukocytosis
High level of WBC
Thrombocytopenia
A significant decrease in platelets.
Thrombocytosis
An abnormal increase in platelets.
Laboratory Studies (ESR)
• A measurement of how fast RBCs fall in a sample of
blood.
• Normal values:
– Males: up to 15 mm/hour
– Females: up to 20 mm/hour
• ESR may be elevated in systemic infection , collagen
vascular disease, and HIV.
– Disease worsens -> ↑ESR
– Disease improves -> ↓ESR
Laboratory Studies (Coagulation Profile)
• Coagulation tests assess the blood’s ability to clot.
– Prothrombin time (PT) (11 12.5 seconds)
– International normalized ratio (INR) (0.8 1.1)
– Partial thromboplastin time (PTT) (60 70 seconds)
• Activated PTT ( aPTT ) (30 40 seconds)
• Used in clinical conditions in which an increased risk
of thrombosis is present ( DVT)
Laboratory Studies (D-Dimer)
• Provides measurement of the amount of fibrin
degradation fragment.
• Accurately identifies pts w/ DVT (high negative
predictive value):
– Negative -> patient has a very low likelihood of having DVT.
– Positive -> less helpful (multiple conditions).
Arterial Disorders
Atherosclerosis, Aneurysm, Aortic Dissection, Hypertension, Raynaud’s Disease, Chronic Regional Pain Syndrome, Compartment Syndrome.
Venous Disorders
• Varicose Veins, Venous Thrombosis, Pulmonary Embolism, Chronic Venous Insufficiency.
Combined Arterial & Venous Disorders
Arteriovenous Malformations
Hematologic Disorders
• Anemia, Polycythemia, Thrombocytic Disorders.
Lymphatic Disorders
Lymphedema
Atherosclerosis
- Deposition of plaques of fatty material on their inner walls ↓blood perfusion past the area.
- A 50% to 60% reduction in blood flow is necessary for pts to present w/ symptoms (e.g., pain).
- The underlying cause of ~ 90% of all MI and a large proportion of strokes.
Atherosclerosis Risk Factors
– Reversible: HTN, DM, HLD, cigarette smoking, obesity.
– Irreversible: male gender, family history, genetic.
Atherosclerosis S & S
Reduced to absent peripheral pulses
Coolness & pallor skin, more w/ elevation
Ulcerations, atrophic nails, & hair loss
Increased BP
Burning pain in LE, more w/ elevation
Pain at rest?
Severe (80% 90%) occlusion
Calf cramp
↑by walking & ↓by rest
Artherosclerosis Ambulation
• The distance a person can walk before the
onset of pain indicates the degree of
circulatory inadequacy:
- ≥2 blocks: mild
- 1 block: moderate
- ≤½ block: severe
Aneurysm
• Localized dilatation or outpouching of the vessel.
• Common places:
– Abdominal aorta or iliac arteries, popliteal, femoral, & carotid.
• ~ 80% of the aneurysms are identified incidentally.
Aortic Dissection
• Caused by an intimal tear, which allows creation of
a false lumen between the media and adventitia.
• Twice as frequently in men than in women.
Aortic Dissection S&S
– Sudden pain in upper back migrates to the neck,
abdomen, or groin.
– Cardiogenic or hypovolemic shock.
– Syncope.
– Hypertension.
– Reduced or absent pulses.
– Pleural effusions
– Neurological manifestations (CVA).
Aortic Dissection Clinical Tip
– pain can mimic that of myocardial ischemia
Hypertension
- Elevated arterial blood pressure, both systolic & diastolic, that is abnormally sustained at rest.
- Frequently asymptomatic.
- Causes: genetic predisposition, smoking, type A personality, obesity, DM, atherosclerosis.
- Hypertensive crisis is a medical emergency.
Hypertention (Brain)
• Cerebrovascular accident
Hypertension (Eyes)
• Blurred or impaired vision
Hypertension (Heart)
- Myocardial infarction
- Congestive heart failure
- Myocardial hypertrophy
- Dysrhythmias
Hypertension (Kidneys)
- Renal insufficiency
- Renal failure
Hypertension
(PT Considerations)
- HTN is a risk factor for heart attack, stroke, & kidney failure
- Women typically have lower BP than men until after menopause
- Physical exertion increases BP acutely & decreases resting BP over time
- Knowledge of medication schedule may facilitate activity tolerance
- Review & clarify strict BP parameters by physician
- BP is high? check cuff size, take in the opposite side, then notify the team
- If contraindicated in the UEs, take it in the LE
