CH20 Peripheral Vascular System

Question 1

Deep veins on leg

Answer 1

femoral vein; popliteal vein.`

Question 2

Superficial veins on leg

Answer 2

great and small saphenous veins.

Question 3

Veins keep blood moving by

Answer 3

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.

Question 4

Venous stasis is due to problems with

Answer 4

contraction of skeletal muscles, and/or competent valves in the veins, and/or a patent lumen.

Question 5

Other risk for venous disease

Answer 5

Hypercoagulable state
Vein wall trauma
Incompetent valves created by dilated and tortuous veins

Question 6

Lymphatic system function

Answer 6

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

Question 7

Lymph vessels drain into the venous system at the

Answer 7

subclavian veins.

Question 8

Right Lymphatic dict

Answer 8

into right subclavian vein

Question 9

thoracic duct

Answer 9

drain most of the body; empties into the left subclavian vein

Question 10

Superficial nodes accessible to palpation

Answer 10

Cervical—head and neck
Axillary—breast and upper arm
Epitrochlear—hand and lower arm
Inguinal—lower extremities, external genitalia, anterior abdominal wall

Question 11

Organs with involvement in the lymph system

Answer 11

spleen, tonsils, thymus gland

Question 12

Infants and Children

Answer 12

lymph nodes larger; superficial nodes may be palpable

Question 13

Aging Adult

Answer 13

peripheral blood vessels become rigid
Arteriosclerosis—increased BP
Enlargement of intramuscular calf veins
29% over 70—have PAD
Increased risk for PAD: smoking, DM, dyslipidemia, HTN
Increased risk for DVT: prolonged BR, prolonged immobilization, heart failure

Question 14

SD: Pain

Answer 14

PQRST
Symptoms while walking
Night leg pain: ischemic rest pain of PVD or severe night muscle cramping or restless leg symptoms

Question 15

SD: List all but pain

Answer 15

Skin changes; sores or lesions
Edema
Enlarged lymph nodes
Medications
Smoking history

Question 16

OD:

Answer 16

Cap refill

Question 17

check OD: Leg Exam

Answer 17

Skin color, temperature
Hair distribution
Venous pattern
Size (swelling or atrophy)
Symmetry
Skin lesions or ulcers

Question 18

the epitrochlear node is in the

Answer 18

antercubital fossa and drains the hand and lower arms

Question 19

Brown discoloration—venous stasis—why?

Answer 19

red blood cells dying and venous insufficiency hemosiderin resurfacing

Question 20

Elevational pallor could mean

Answer 20

arterial insufficiency

Question 21

Dependent rubor

Answer 21

deep blue-red color—severe arterial insufficiency

Question 22

arterial insufficiency causes

Answer 22

chronic hypoxia—loss of vasomotor tone—pooling of blood in vessels

Question 23

DC: aging adult

Answer 23

Pulses may be more difficult to find
Trophic (skin) changes associated with arterial insufficiency—also occur with normal aging!
Thin, shiny skin
	   Thick-ridged nails
   	   Loss of hair on lower legs

Question 24

Enlarged tonsils are a familiar sign of

Answer 24

respiratory infection

Question 25

excessive lymphoid response also may account for children symptoms of

Answer 25

abdominal pain with seeming unrealted problems such as URI

Question 26

DC: agining adults; arteriosclerosis

Answer 26

pbv growing more rigid with agin

Question 27

DC: agining adults; atherosclerosis

Answer 27

deposition of fatting plaques on the intima of the arteries

Question 28

the ethnic group with pad who also have the highest risk of theses pad factors are

Answer 28

non-hispanic blacks

Question 29

with PAD, blood flow cannot match muscle demand during

Answer 29

exercise; therefore people feel muscle fatigue or pain when walking (claudication). But only 10% of those with PAD have these classic symptoms 40% do not have leg pain and 50% have varying leg symptoms

Question 30

Leg pain in aging adult

Answer 30

is common, may indicate the ischemic rest pain of PVD, sever night miscle cramping, or rls

Question 31

aortoiliac occlusion is associated with

Answer 31

ED

Question 32

coolness occurs with

Answer 32

PAD

Question 33

Full bounding pulse (3+) occurs with

Answer 33

hyperkinetic states (exercise anxiety, fever) anemia, and hyperthyroidism

Question 34

Weak thready pulse (1+) occurs with

Answer 34

shock and PAD

Question 35

Edema of the upper extremities occurs when

Answer 35

lymphatic drainage is obstructed after breast surgery or radiation.

Question 36

and enlarged epitrochlear node occurs with

Answer 36

infection of the hand or forearm and is a condition of generalized lymphadenopty

Question 37

modified allen test is

Answer 37

used to evaluate the adequacy of collateral circulation before cannulating to the radial artery

Question 38

how to admin modified allen test

Answer 38

1) firmly occlude both ulnar and radial arteries of one hand 2) have person make a first several times 3) ask the person to open the hand without hyperextending. 4) normal circulation/color should return at 2-5 seconds

Question 39

malnutrition,, pallor, coolness, ulcers, gangrene all occur with

Answer 39

arterial insufficiency

Question 40

Diffused B/L edema occurs with

Answer 40

systemic illnesses

Question 41

acute/ unilateral painful swelling and asymmetry of calves of ___ or more is abnormal; refer to person to detemine if DVT is present

Answer 41

1cm

Question 42

Asymmetry of __ to ___ in calfs occurs with mild lympedema | Asymmetry of __ to ___ in calfs occurs with sever lympedema

Answer 42

1-3cm | 3-5cm

Question 43

B/L pitting edema clls for

Answer 43

examination of the neck vessels. If the neck veins are abnormally distended, the peripheral edema may be r/t to heart disease or pulmonary hypertension. If neck veins are normal,s omething else may be the cause such as leiver disease, nephrosis, chronic venous insufficiency, antihypertensive or hormonal meds.

Question 44

motor and sensory loss occurs with

Answer 44

arterial insufficiency

Question 45

Aging Adult

Answer 45

DP and TP pulses may become more difficult to find. Trophic changes occur with arterial insufficeincy (thin, shiny skin; thick ridged nails; loss of hear in lower legs) also occurs with normal aging