Ch 20 Vascular & Lymphatic System

Question 1

We never want to stick an artery for arterial blood gas unless we know there is adequate circulation on the other side so we don’t possible destroy the only circulation leading to the hand .. so we do this which determines the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery

Answer 1

Allen test

Question 2

Defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defects

Answer 2

Aneurysm

Question 3

Variation from the heart’s normal rhythm

Answer 3

Arrhythmia

Question 4

Thickening and loss of elasticity of the arterial walls

Answer 4

Arteriosclerosis

Question 5

Plaques of fatty deposits formed in the inner layer (intima) of the arteries

Answer 5

Atherosclerosis

Question 6

Slow heart rate <50 beats per min in the adult

Answer 6

Bradycardia

Question 7

Blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

Answer 7

Bruit

Question 8

Dusky blue mottling of the skin and mucous membranes due to excessive amount of reduced hemoglobin in the blood

Answer 8

Cyanosis

Question 9

The hearts filling phase

Answer 9

Diastole

Question 10

Calf pain that occurs when the foot is sharply dorsiflexed (pushed up, toward the knee) may occur with deep vein thrombosis, phlebitis, achilles tendinitis, or muscle injury

Nurses will do this to make sure pt does not have a blood clot in their leg

Answer 10

Homan’s sign

Question 11

Deficiency of arterial blood to a body part due to constriction or obstruction of a blood vessel
Deficient in oxygen and need more

Answer 11

Ischemia

Question 12

Swelling of extremities due to obstructed lymph channel, lypmh system isnt working, lymph nodes might have been removed, extra fluid cant be returned because there is no lymphatic network, nonpitting

Answer 12

Lymphedema

Question 13

Small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels
Usually in groups, some are deep and some are superficial
Typically filter fluid and microorganisms and engulf pathogens

Answer 13

Lymph nodes

Question 14

Indentation left after examiner depresses the skin over swollen edematous tissue

Answer 14

Pitting edema

Question 15

Viewing the finger from the side to detect early clubbing

Answer 15

Profile sign

Question 16

Pressure wave created by each heartbeat, palpable at body sites where the artery lies close to the skin and over a bone

Answer 16

Pulse

Question 17

Regular rhythm, but force of pulse varies with alternating beats of large and small amplitude

Answer 17

Pulsus alternations

Question 18

Irregular rhythm, every other beat is premature, premature beats have weakened amplitude

Answer 18

Pulsus bigeminus

Question 19

Pulse is weaker with inspiration and stronger with expirations

Answer 19

Pulsus paradoxus

Question 20

The hearts pumping phase

Answer 20

Systole

Question 21

Rapid heart rate >90 beats per minute in an adult

Answer 21

Tachycardia

Question 22

Inflammation of the vein associated with thrombus formation

Answer 22

Thrombophlebitis

Question 23

Open skin lesion extending into dermis with sloughing of necrotic inflammatory tissue

Answer 23

Ulcer

Question 24

Dilated tortuous (twisting) veins with incompetent valves
Easily seen on surface of the skin

Answer 24

Varicose vein

Question 25

Carries oxygenated blood and nutrients

Answer 25

Arteries

Question 26

Carries deoxygenated blood and waste products from tissues, pulls it from the tissues and brings it back to the heart

Answer 26

Veins

Question 27

Filters microorganisms and helps with immune functions | Eliminates foreign pathogens to keep us healthy

Answer 27

Lymphatic system

Question 28

What happens when there is a complete artery block..

Answer 28

It leads to death of the tissue and any clots need to be opened in order to let blood through

Question 29

What happens when there is a partial artery block..

Answer 29

It causes pain or discomfort with exercise or movement

Question 30

The major artery in the arm that is more difficult to palpate

Answer 30

Brachial

Question 31

The artery in the wrist that is easy to palpate and used to check a pulse

Answer 31

Radial

Question 32

The artery in the arm that can be used to assess for circulation

Answer 32

Ulnar

Question 33

The major artery in the leg located in the groin area

Answer 33

Femoral

Question 34

The artery behind the knee

Answer 34

Popliteal

Question 35

The artery in the back of the ankle

Answer 35

Posterior tibial

Question 36

The artery in the top of the foot

Answer 36

Dorsalis pedis

Question 37

Deep veins typically run along the side of an..

Answer 37

Artery

Question 38

How does venous flow keep blood moving

Answer 38

Skeletal muscles in the legs contract and this brings the blood proximally or back towards the heart

Question 39

This causes thoracic and abdominal pressure to decrease causing differences in pressure gradients

Answer 39

Inspiration

Question 40

Brings smaller and larger veins together

Answer 40

Perforators

Question 41

How does the venous flow of a calf pump work

Answer 41

As you walk, your calf contracts and rests just like systole and diastole, and returns blood to the heart and the rest of the body

Question 42

Is arterial or venous pressure lower?

Answer 42

Venous pressure is lower than arterial

Question 43

Who is at risk for venous stasis

Answer 43

``` Pregnant women because they have an increased blood flow Genetics People who sit or stand a long time Best rest patients Obese patients People who clot too fast People who have vein wall trauma People who have varicose veins People who have poor valves allowing blood to seep backwards ```

Question 44

Retrieves excess fluid from the tissue space and helps to return it back to the blood stream Helps conserve the fluid and the plasma proteins that leak out of the capillaries and help return that to the circulatory system

Answer 44

Lymphatic system

Question 45

The fluid leaves the capillaries faster than the veins can absorb so if there isnt adequate lymphatic drainage you can develop...

Answer 45

Edema

Question 46

Why do you see edema a lot after masectomies

Answer 46

They remove the breast but also the lymph nodes as well, then they are put on arm precautions so no BP, needles, etc.

Question 47

There is also a lymphatic system in the abdomen that helps to absorb

Answer 47

Lipids form the intestines

Question 48

These drain the head and the neck

Answer 48

Cervical nodes

Question 49

These drain the breasts and upper arms

Answer 49

Axillary nodes

Question 50

These are in the arm and the antecubital fossa and drain the hand the lower arm Depression above and behind medial condyle of humerus, in the antecubital area Assessing for enlargement of that lymph node and if there is do a good inspection of the hand figure out if there is infection causing that

Answer 50

Epitrochlear nodes

Question 51

Located in the groin and drain the lymph of lower extremities, external genitalia, and anterior abdominal wall

Answer 51

Inguinal nodes

Question 52

Stores red blood cells Destroys red blood cells that are no longer functional Makes antibodies to fight off infection FIlters microorganisms from blood

Answer 52

Spleen

Question 53

Helps respond to local information Become swollen when pathogens get in the throat and try to keep it from going from going into the respiratory tract or the rest of the body Become inflamed easily

Answer 53

Tonsils

Question 54

Flat, pink, grey gland located in superior mediastinum in the chest behind the sternum More important for developing t-lymphocytes in children More in younger children Atrophies occur after the pt has reached puberty

Answer 54

Thymus

Question 55

What happens to the peripheral vascular system in older adults

Answer 55

Arteries become less efficient: arterial insufficiency (thin, shiny skin; thick nails; hair loss on legs which normally occurs with aging as well) Peripheral vessels become more rigid (thick and lose elasticity) called arteriosclerosis Develop atherosclerosis Bigger calf veins Valves become incompetent with age More varicose veins DVT and PEs increase due to bed rest

Question 56

What happens to the lymphatic system in older adults

Answer 56

Less lymph tissue because we lose lymph nodes creating an increased risk for infections

Question 57

What is it best for older adults to do as they age

Answer 57

Like to get them walking Walking prevents heart attacks Take a low dose of anticoagulants or blood thinners to prevent clots and PEs

Question 58

What subjective data do we want to know regarding peripheral vascular system

Answer 58

Leg pain or cramps possibly indicating DVT Skin changes on arms or legs possibly indicating arterial or venous disease Any swelling Any lymph node enlargements Medication list for possible increase for clots --birth control? --hormone replacement?

Question 59

How should you prepare for an examination of the peripheral vascular and lymphatic system

Answer 59

``` Full set of vitals B/P Comfy room temperature --cold can cause vasoconstriction --hot can cause vasodilation Inspect and palpate bilaterally --temp, skin, symmetry, color, cap refill, edema ```

Question 60

What equipment might you need for an examination of the peripheral vascular and lymphatic system

Answer 60

Tape measure for calf size in DVT patients Tourniquet and B/P cuff Stethoscope Doppler if unable to palpate pulses

Question 61

What are you looking for when you inspect and palpate the arms

Answer 61

Look at the hands Inspect color, nail beds, cap refill, temp, texture, turgor, lesions, edema, clubbing Cigarettes, anemia, edema can all cause cold skin

Question 62

What do you want to look at when taking the radial pulse

Answer 62

Rate (beats/min) Rhythm is regular or irregular Elasticity and force

Question 63

How do you grade the force of a pulse

Answer 63

3+ increased, full, bounding (usually with exercise or hyperthyroidism) 2+ normal 1+ weak, thready pulse 0 absent

Question 64

What are you looking for when you inspect and palpate the legs

Answer 64

Compare legs --color, hair distribution, vein size, lesions, ulcers *Hairy toes = good circulation Flex knee Check for tenderness of calf If asymmetrical legs need to measure calf size for DVT If lymphedema measure ankle, calf, knee, and thigh Palpate inguinal lymph nodes Palpate and grade the 4 arteries in the legs

Question 65

To check for edema press for how many seconds

Answer 65

5 seconds

Question 66

How do you grade pitting

Answer 66

1+ mild pitting, slight indentation, no swelling 2+ moderate pitting, indentation subsides rapidly 3+ deep pitting, indentation remains, legs look swollen 4+ very deep pitting, indentation lasts a long time, legs very swollen

Question 67

Edema that is non pitting

Answer 67

Brawny edema

Question 68

``` Detects weak pulses Check B/P Magnifies sounds of that artery Need to use gel Swivel under you hear a pulse Document that you used it ```

Answer 68

Doppler-ultrasonic stethoscope

Question 69

How do you find the ankle brachial index (ABI)

Answer 69

Divide ankle or foot systolic pressure by arm systolic pressure Leg pressure is usually higher than the arm pressure Normal ABI is 1-1.2 Less than 0.9 indicates peripheral artery disease Less reliable with diabetes patients

Question 70

What happens to pulses in older adults

Answer 70

Distal pulses (dorsalis pedis and posterior tibial pulse) hard to palpate

Question 71

Disease where you get vasospasms in response to stress or cold

Answer 71

Raynauds phenomenon

Question 72

What are the color orders in Raynauds phenomenon

Answer 72

White/pallor: vasospasms in fingers Cyanosis: arteries relax Redness: blood returns and cap beds are dilated again

Question 73

Brown discoloration over lower extremities, usually on shin area

Answer 73

Chronic venous stasis

Question 74

Pale skin occurs, cool to touch, pulses diminished, wont be much bleeding because there isnt good blood supply

Answer 74

Aterial ischemic ulcer

Question 75

Brownish skin on shin and lower legs, blood pools, gets achy and gets worse after standing, pulses will be normal because its not affecting the arterial system, edema and probably thicker skin around the area

Answer 75

Venous ulcer