Chapter 20 Peripheral Vascular System and Lymphatic System Flashcards
When a question says peripheral always think-
Legs
Intermittant Claudication
Always think Arteries-
Think smoking, diabetes, athlosclerosis, hypertension as possible causes.
Intermittent claudication- is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.
The nurse is assessing a patient’s risk for developing a deep vein thrombosis (DVT). The patient considered at the highest risk is a 60-year-old patient who:
A. has been on bed rest for 3 days.
B. has been receiving physical therapy for left knee replacement.
C. has calf and thigh measurements that have less than an inch of variation on both legs.
D.was admitted to the hospital with asthma exacerbation.
A. has been on bed rest for 3 days.
Mechanisms that keep blood moving toward the heart
Skeletal muscles
Valves
Pressure gradient created by respirations
PERIPHERAL VASCULARDevelopmental Considerations-Pregnancy
Total blood volume increases 40%
Blood pressure changes
Increased venous pressure and venous pooling causing peripheral edema, varicosities, and hemorrhoids
Lymphatic System Functions:
Production of lymphocytes within the lymph nodes, tonsils, adenoids, spleen and bone marrow
Production of antibodies
Phagocytosis
Maintenance of fluid balance thru movement of lymph fluid
Note: Is also a pathway for spread of malignant diseases.
LYMPH SYSTEM
Developmental Considerations
Infants: lymph nodes are generally not palpable
Children: nodes up to 1cm in the cervical or inguinal areas are usually no concern (Cervical nodes larger than 1 cm are considered abnormal)
Older adults: lymph nodes become more fibrotic
Thrombophlebitis-
Thrombophlebitis is phlebitis (vein inflammation) related to a thrombus (blood clot).
The following symptoms are often (but not always) associated with thrombophlebitis:
pain in the part of the body affected
skin redness or inflammation (not always present)
swelling (edema) of the extremities (ankle and foot)
palpable cord-like veins
PERIPHERAL VASCULAR & LYMPH SYSTEM
Subjective Data-
Leg pain or cramps
Skin changes on arm or legs
Swelling
Lymph node enlargement
Medications
Dizziness?
PERIPHERAL VASCULAR & LYMPH SYSTEM
PMH subjective data-
SB, HTN, DM, AF
Surgery
Recurrent infections
Thrombophlebitis
PERIPHERAL VASCULAR & LYMPH SYSTEM
Family History subjective data-
Malignancy: Hodgkin’s disease, Lymphoma
Tuberculosis
PERSONAL/SOCIAL HISTORY
TOBACCO USE… NUTRITION… EXERCISE… ALCOHOL USE… OTC DRUGS… OCCUPATION
PERIPHERAL VASCULAR
OLDER ADULTS - HISTORY
LEG EDEMA?…
CLAUDICATION?…
CAROTID STENOSIS?…
VARICOSE VEINS…
Peripheral Arteries Accessible to Exam are-
Arteries
Temporal artery
Carotid artery
Arteries in the arm
Brachial
Ulnar
Radial
Arteries in the leg
Femoral
Popliteal
Dorsalis pedis
Posterior tibialPulse Deficit-
is the difference between the apical and radial pulses
Orthostatic Hypotention change should be no more than ______mmHg from lying to standing.
15mmHg
There should not be a change greater than ______mmHg from right to left arm.
10mmHg
Structure and function Temporal artery:
The temporal artery can be palpated in front of the ear
ch 13 pg 267, temporal arteries may look twisted and prominent in some elderly adults
Structure and function Carotid artery:
The carotid artery is palpated in the groove between the sternomastoid muscle and the trachea.
The corotid artery is a central artery (it is close to the heart) so its timing closely coincides with ventricular systole. p463
Structure and function of the Arteries in the arm-
Brachial artery- is the major artery that supplies the arm. It runs in the bicep-triceps furrow of the upper arm and surfaces at the antecubital fossa in the elbow medial to the bicepts tendon.
Immediately below the elbow, the brachial artery bifurcates into the radial and ulnar arteries. These run distally and form the two arches that supply the hand.
Ulnar artery is difficult to feel.
Radial artery pulse lies just medial to the radius on the wrist.
pg 500
Artery blood flow from neck to hands:
common carotid artery -> Subclavian artery -> Axillary artery -> Brachial artery -> (brachial pulse site) -> brachial splits into radial and ulnar arteries at the pulse site and travels to the hands.
Structure and function of the arteries in the leg:
The major artery in the leg is the femoral artery which passes under the inguinal ligament. It travels down the thigh, and when it gets to the lower thigh it courses posteriorly. When this happens it becomes the popliteal artery.
Below the knee, the popliteal artery divides into the anterior and posterior tibial arteries.
The anterior tibial artery runs down the front of the shin onto the dorsum of the foot where it then becomes the dorsal pedis.
The posterior tibial artery travels down the medial malleous (back of the leg, calf area) and in the foot forms the plantar arteries.
Function of arteries:
The function of the arteries is to supply oxygen and essiential nutrients to the tissues.
Ischemia-
is a deficient suppy of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel.
A complete blockage leads to tissue death of the distal tissue.
A partial blockage creates an insufficient supply and the ischemia may be apparent only at exercise when the oxgen needs increase.
