peripheral vascular system
Terms
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- three major arteries of the arm
- brachial, radial, and ulnar
- major artery that supplies the arm
- brachial artery
- What artery extends down the thumb side of the arm
- radial artery
- What artery extends down the little finger side of the arm?
- ulnar artery
- What artery is the major supplier of blood to the legs ?
- femoral artery
- Where can the femoral artery be palpated?
- under the inguinal ligament.
- What artery does the femoral artery become once it crosses the back of the thigh?
- popliteal artery
- Where can the popliteal artery be palpated?
- behind the knee
- Where can the dorsalis pedis artery be palpated?
- on the top to the foot, on the great toe side
- Which system is a low pressure system?
- venous system
- What vessels can expand if the blood volume increases?
- veins
- What vessel contains 70% of the body's blood volume?
- the veins
- What is the purpose of the perforator (communicator)?
- connect the superficial veins with the deep veins
- What are three mechanisms that propel blood back to the heart?
-
one way valves
skeletal muscle contractions
pressure gradient - What are four risk factors for venous status?
-
long periods of standing still, sitting or lying down.
lack of muscular activity
varicose veins
damage to the vein wall - What are the primary functions of the lymphatic system?
-
drains excess fluid and plasma proteins from bodily tissues and returns them to the venous system.
prevents edema - What is lymph fluid made of ?
- fluids and proteins absorbed by the lymp. vessels
- What do lymph nodes do?
- trap and destroy microorganisms,foreign materials. dead blood cells, and abnormal cells
-
Lymph nodes are how big?
What shape?
And where are they located? -
circular or oval, 1-2 cm. in diameter, and non-palpatable.
many are located near major joints - The lymphatic system is composed of ?
- lymphatic capillaries, lymphatic vessels, and lymph nodes
- What does the right lymphatic duct drain?
- upper right side of the body.
- What area of the body does the thoracic duct drain?
- all of the body except the right upper side.
- Because of the lymph nodes, the second function of the lymphatic system?
- as a major part of the immune system.
- The third function of the lymphatic system?
- absorbs fats from the small intestine into the blood stream.
- Normally, can the lymph nodes be palpated?
- NO.
- The superficial inguinal nodes drain?
- the legs, external genitalia, and lower abdomen and buttocks.
- What is the capillary bed is important in maintaining?
- equilibrium of interstitial fluid and preventing edema.
- Symptoms of the legs that are associated with arterial insufficiency are?
- cold, pale, clammy skin and thin shiny skin with loss of hair, especially on the lower legs.
- Warm and brown pigmented skin around the ankles is associated with?
- venous insufficiency
- What are symptoms of intermittent claudication?
- pain, tension, and weakness that occurs with activity and is relieved with rest
- Intermittent claudication may indicate?
- arterial insufficiency
- heaviness or aching sensation that is aggravated by standing or sitting for long periods of time and is relieved by rest is associated with ?
- venous disease
- Leg pain that awakens a client from sleep is associated with ?
- chronic arterial occlusive disease
- older clients with arterial disease may not have the classic symptom of intermittent claudication but may experience what other symptoms?
- coldness, color change, numbness, and abnormal sensations.
- What are ropelike, bulging, or contorted veins?
- varicose veins
- Varicose veins develop from ?
- heredity or increased venous pressure and venous pooling
- What can increase the risk for varicosities?
- standing in one place for long times
- Where are arterial ulcers often located ?
- toes, foot, or lateral ankle
- Where are venous ulcers usually located?
- on the medial ankle or lower leg.
- Which ulcers, venous or arterial, are painful?
- arterial ulcers
- An obstruction of the lymphatic flow, or from venous insufficiency or deep vein thrombosis can cause?
- peripheral edema AKA swelling
- Enlarged lymph nodes or swollen glands indicates?
- local or systemic infection
- What disorders cause damage to the blood vessels?
- diabetes, hypertension, coronary heart disease, or elevated cholesterol or triglyceride levels
- What can alter the appearance of the veins or skin?
- heart or blood vessel surgeries or treatments such as coronary artery bypass grafting, repair of an aneurysm, or vein stripping
- Smoking cigarettes increases the risk of?
- chronic arterial insufficiency
- What can help a person decrease his or her risk for peripheral vascular disease?
- regular exercise
- How does exercise decrease a person's risk for peripheral vascular disease?
- It improves peripheral vascular circulation, and decreases stress, pulse and blood pressure
- Female clients who take oral contraceptives are at an increased risk for developing?
- Thrombophlebitis, Raynaud's disease, hypertension, and edema
- How does stress contribute to vascular disease?
- it increases the heart rate and blood pressure.
- How do support stockings reduce varicose veins?
- they reduce venous pooling and increase blood return to the heart.
- prominent venous pattern can indicate ?
- venous obstruction
- Breast surgery can cause?
- Lymphedema
- Is prominent venous pattern a normal or abnormal finding?
- abnormal
- lymphedema causes what ?
- induration and non-pitting edema
- What is Raynaud's disease caused by ?
- vasoconstriction or vasospasm of the fingers or toes.
- What are symptoms of Raynaud's disease?
-
rapid changes in color
swelling
pain
numbness
tingling
burning
throbbing
coldness - Would Raynaud's disease affect both sides of the body?
- yes, it occurs bilaterally; symptoms last minutes to hours
- What disorders can cause clubbing of the fingertips ?
- heart diseases and lung diseases
- Normal capillary refill time?
- less than two seconds
- Capillary refill time that exceeds 2 seconds could indicate?
- vasoconstriction, decreased cardiac output, shock, arterial occlusion, or hypothermia.
- What is a radial pulse that is 2+ considered ?
- normal
- What does an increased radial pulse indicate?
- hyperkinetic state
- Diminished or absent pulses could indicate ?
- partial or complete arterial occlusion.
- An obliteration of the pulse may result from ???
- compression by external sources
- To palpate a difficult to palpate pulse the nurse should?
- apply more pressure on the most distal palpating finger or use a Doppler ultrasound device
- After palpating the radial pulse, if you suspect arterial insufficiency you would then palpate what artery?
- ulnar pulse, then the brachial pulse
- enlarged epitrochlear lymph nodes indicates?
- an infection in the hand or forearm, generalized lymphadenopathy, or because of a lesion in the area
- What does the nurse do if lymph nodes are enlarged on in one arm?
- evaluate the size, tenderness, consistency, and repeat palpation on the opposite arm
- How does a nurse palpate the epitrochlear lymph nodes.
- take the clients right hand into your left hand, as if shaking hands. Flex the elbow at a 90 degree angle. use your left hand to palpate behind the elbow in the groove between the biceps and triceps muscle
- Why is the Allen test preformed?
- to evaluate the patency of the radial or ulnar arteries
- Why is the Allen test done?
- when the patency is questionable or before procedures as a radial artery puncture
- Which artery does the Allen test begin with?
- the ulnar artery
- What is a normal Allen test result?
-
pink coloration returns to the palm within 3 to 5 seconds if the ulnar artery is patent.
Pink coloration returns to the palm within 3 to 5 seconds if the radial artery is patent - What is an ABNORMAL Allen test result?
- with both arterial or venous insufficiency pallor persists
- What can cause a false positive Allen test result?
- an exaggerated extension of the hand when opening after making a fist.
- Pallor when elevated and rubor when dependent suggests?
- arterial insufficiency
- Legs that are cyanotic when dependent suggest?
- venous insufficiency
- Is hair loss on the lower extremities of the elderly client an absolute sign of arterial insufficiency ?
- NO...hair loss could be a result of the aging process.
- Ulcers with smooth even margins, that occur at pressure points (toes, foot, lateral side of the ankle) are the result of ?
- Arterial insufficiency
- Ulcers with irregular edges, bleeding, and possible bacterial infection, and occur on the medial ankle are the result of ?
- venous insufficiency
- Bilateral edema indicates ?
-
systemic problems such as chronic heart failure.
local problems such as lymphedema or prolonged standing or sitting - orthostatic edema is caused by ?
- prolonged standing or sitting.
- Muscular atrophy can be the result of?
- disuse due to stroke or from a limb being in a cast for an extended period of time.
- What are the characteristics of unilateral edema?
- 1 cm. difference in measurement at the ankles or a 2 cm. difference at the calf, and a swollen extremity.
- What causes unilateral edema ?
- usually it is caused venous stasis due to insufficiency or an obstruction
- If the legs appear asymmetic where would you take measurements ?
-
circumference at mid-thigh.
largest circumference of the calf
smallest circumference of the ankle
and across the forefoot - Pitting that is 1+ is ?
- slight pitting
- Pitting that is 2+ is considered?
- deeper than 1+
- Pitting that is 3+ is ?
- noticeably deep pit; extremity looks larger
- 4+ pitting is considered?
- very deep pit; gross edema in the extremity
- If edema is noted during inspection of the legs what should the nurse do first?
- palpate the area to determine if it is pitting or non pitting
- How should a nurse test for pitting?
- press the edematous area with the tips of your fingers, hold for a few seconds, and then release. If skin remains indented on release, pitting edema is present.
- What does generalized coolness in one leg or a change in temperature from warm to cool as you move down suggest?
- arterial insufficiency
- increased warmth in the leg may be caused by?
- superficial thrombophlebitis from a secondary inflammation in the tissure around a vein
- five common vascular disorders
-
aortic aneurysms
cerebrovascular disease
deep vein thrombosis
pulmonary embolism
peripheral arterial occlusive disease - What does PVD refer to ?
- disorders of the veins and arteries of the lower limbs.
-
venous disease and venous insufficiency have a higher _________
and ___________ incidence than __________. -
higher prevelence
higher incidence
arterial disease - What race has a higher incidence of varicose veins?
- Caucasians
- Who has the highest incidence of Peripherial Arterial Occulsive Disease (PAOD)?
- elderly Italians
- Eight risk Factors for Arterial Disease.
-
Age- > older adults
diabetes mellitus
tobacco smoking
hypertension
elevated blood lipid levels
coronary or cerebral vascular disease
male
family history - 11 Risk factors for venous disease?
-
pregnancy
job w/ prolonged sitting or standing
limited physical activity
congenital or acquired vein wall or valve weakness
female sex
increasing age
genetics-non-African Americans
obesity
family history
lack of fiber
use of constrictive clothing - Lymphedema results from__________, may be caused by_________ and usually effects what side of the body?
-
blocked lymphatic ducts
breast surgery
one side of the body - Buerger's disease or scleroderma can cause a _________ in the radial pulse?
- decrease
- A popiteal pulse that is difficult or impossible to detect would be considered a ____________ finding.
- normal. the popliteal pulse is not easily palpated further circulatory assessment would be needed.
- What postition would the client be in if the nurse is to palpate the femoral pulse?
-
supine
bend the knee and move it out and to the side - Where would the nurse feel the femoral pulse?
- below and medial to the inguinal ligament
- What should the nurse do if he/she suspect an arterial occlusion over the femoral artery?
- position stethoscope over femoral artery and listen for bruits
- Bruits over one or both femoral arteries indicated?
- partial obstruction of the vessel and diminished blood flow to the lower extremities
- If you cannot palpate a popliteal pulse what would you do next?
- ask the client to lay in the prone position and the nurse would then try again
- What percent of the population will have congenitally absent dorsalis pedis?
- 10-15 percent.
- common sites for varicose veins.
- anterior lower thigh and lower leg, the posterior lateral calf, or anus (hemorrhoids)
- superficial vein thrombophlebitis is marked by?
- redness, thickening, and tenderness along the vein.
- Positive Homan's sign.
- aching or cramping that occurs with walking or dorsiflexion of the foot.
- To elicit a Homan's sign. A pain felt when doing this would be a positive Homan's sign.
-
client supine
flex knee about 5 degrees
nurse squeezes the calf muscle against the tibia
then passive dorsiflexion of the foot. - hydrostatic pressure
- pushing....allows interstital fluid to enter tissue space
- osmotic pressure
- pulling....returns fluid to the capillaires
-
persistent rubor of toes and feet w. legs dependent
persistent pallor w. legs elevated
return of pink that takes >10-15 sec
indicated? - arterial insufficiency
- manual compression test assesses for
- assesses the competence of the veins valves.
- performing the manual compression test
-
compress the lower portion of varicose
place the other hand 6 -8 inches below
feel for pulsation in the upper hand
repeat in other leg if varicose is present. - ABNORMAL manual compression finding
- if the valves are incompetent you will feel a pulsation with your upper fingers
- Use of Doppler
-
apply lukewarm gel
at 45-60 degree angle
whoosing=artery rushing=vein - trendelenburg test
-
to determine the competency of the saphenous vein valves.
normal vein fills from below < 30 sec.
abnormal vein fills from above >30 sec - ABI= ankle-brachial index
- is the ratio of the ankle systolic blood pressure to the arm (brachial) systolic pressure.
- Normal ABI
-
ankle pressure the same or slightly higher than the brachial pressure
reading of 1 or no arterial insufficiency -
ABI
ABNORMAL -
an ABI of 0.5 to 0.95 indicates moderate arterial insufficiency
an ABI of 0.25 or lower indicates severe arterial insufficiency - What test should be done by the nurses if pulses in the legs are weak?
- positions change test
- If superficial thrombophlebitis is noted the nurse should ?
- note redness or discoloration on the skin surface over the vein