Chapter 21 Flashcards by Madison Harding

Allen Test

Test that 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

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Aneurysm

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

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Arrhythmia

Variation from the heart’s regular rhythm

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Arteriosclerosis

Thickening and loss of elasticity of the arterial walls

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Athrosclerosis

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

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Bradycardia

Slow heart rate, less than 50 beats per minutes in the adult

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Bruit

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

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Cyanosis

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

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Diastole

The heart’s filling phase

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Ischemia

Deficiency of arterial blood to body part due to constriction or obstruction of a blood vessel

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Lymph nodes

Small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels

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Lymphedema

Swelling of extremities due to obstructed lymph channel, nonpitting

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Pitting edema

Indentation left after examiner depresses the skin over swollen edematous tissue

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Profile sign

Viewing the finger from the side to detect early clubbing

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Pulse

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

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Pulsus alternans

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

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Pulsus bigeminus

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

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Pulsus paradoxus

Beats have weaker amplitude with respiratory inspiration, stronger with expiration

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Systole

The hearts pumping phase

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Tachycardia

Rapid heart rate, more than 95 beats per minute in an adult

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Thrombophlemitis

Inflammation of the vein associated with thrombus formation

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Ulcer

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

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Varicose veins

Dilated tortuous veins with incompetent valves

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Three mechanisms that help return blood to the heart (venous flow)

Valves - ensure unidirectional flow
Muscle contractions - milk blood proximally
Pressure gradient - negative pressure vacuum created on inspiration

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Capacitance vessels

The ability of the veins to stretch. | Helps when blood volume increases to reduce preload on the heart

Risk factors for venous stasis

``` Hypercoaguability No body movement (prolonged sitting, standing, bed rest) Endothelial injury (smoking, hypertension) ```

Functions of the lymphatic system

Conserve fluid that leak out of the capillaries Major part of the immune system Absorb lipids from small intestine

Organs related to the lymphatic system

Spleen Tonsils Thymus

Characteristics of an arterial ulcer

``` Pallor Defined edges No bleeding Dry On bony prominences ```

Characteristics of a venous ulcer

``` Bleeding Beefy red Uneven edges Weepy Hemosiderin staining Granulated ```

If a patient has 3+ pitting edema what characteristics would they present?

Deep pitting, indentation remains for a short time

Raynaud Phenomenon

Tricolor (white, blue, red) change of the hands/feet in response to cold, stress, or vibration

A function of the venous system includes:

Holding more blood when blood volume increases

Mrs, T has come in for a prenatal visit. She reports dependent edema, varicosities in the leg, and hemorrhoids. Normal/Abnormal

Normal | The symptoms are caused by the pressure of the growing uterus on the veins

A patient's pulse is 3+ this means the pulse is ___ ___

Full and bounding

Inspection of the right hand reveals it is red and swollen, what is the next step?

Palpate the epitrochlear node

To screen of a DVT you would:

Measure the widest point of the calf with a tape measure

After checking for elevation pallor, you ask the patient to swing their legs off the table. What are you looking for?

``` Color to return within 10 sec Dependent rubor (bad sign) ```

Sking changes associated with arterial insufficiency

Thin, shiny skin with loss of hair

Intermittent claudication

Muscular pain brought on by exercise

Peripheral Artery disease (PAD) caused by:

Atherosclerosis (most common) Embolism Hypercoagulable states Arterial dissection

Deep veins on the legs

Femoral | Popliteal

Superficial veins in the legs

Great saphenous | Small saphenous

What is also known as the peripheral heart?

The calf pump

Venous pooling occurs most commonly in what 2 kinds of people?

Obese | Women following multiple pregnancies

The right lymphatic duct drains what parts of the body?

The right side of the head, neck, right arm, right thorax, right lung, right side of the heart, and upper section of the liver

The thoracic duct drain what parts of the body?

Left side of the head, left arm, both legs (All other part that the right lymphatic duct does not drain)

Cervical lymph nodes drain:

The head and neck

Axillary lymph nodes drain:

Breast and upper arm

Epitrochlear lymph nodes drain:

Antecubital fossa The hand Forearm

Inguinal lymph nodes drain:

Groin area Most of the lower extremities External genitalia Anterior abdominal wall

What symptoms may present with excessive lymphoid response in a child?

Abdominal pain with unrelated problems (inflammation of mesenteric lymph nodes of abdominal wall) Upper respiratory infection

Claudication distance

The number of blocks walked or stairs climbed to produce pain

Night leg pain may be in indicator of ___ in the aging adult

PAD

What are the 2 main risk factors for PVD?

Diabetes | Smoking

What kind of clothing should a person avoid with peripheral arterial disease?

Tight or compression clothing | It further impedes blood flow

What kind of medication may cause hypercoaguable states?

Oral contraceptives | Hormone replacements

Normal capillary refill time

Less than 2 seconds

What pulse grade would occur with shock and PAD?

1+ weak and thready

What is the normal blood refill time for the Allen test?

Less than 7 seconds

Bilateral edema occurs with:

Systemic illnesses

Unilateral edema occurs with:

DVT (usually)

If the femoral pulse is weak or diminished what should you do next?

Auscultate for bruit

Bilateral dependent pitting edema occurs with:

Heart failure Diabetes neuropathy Hepatic cirrhosis

What should you do next if you find bilateral pitting edema?

Examine the neck veins

Varicosities usually occur where?

The legs (usually the saphenous veins)

What occurs with arterial deficit extremities?

Motor and sensory loss

An ABI of 0.91-1 is:

Borderline cardiovascular risk

An ABI less than 0.90 indicates ___

PAD

ABI of 0.40 - 0.30 is:

Severe PAD

What kind of people will have a falsely high ABI?

Diabetes mellitus and Chronic kidney disease | May have calcified arteries that give a false high

That scale do you use to assess the risk of a patient having a DVT?

The Wells Score

Patent ductus arteriosus

Congenital defect - opening between aorta and pulmonary artery. Causes full and bounding pulses

Diminished or absent femoral pulses in a child could be an indicator of:

Coarctation of Aorta (congenital defect)

A pregnant patient presenting with generalized edema and hypertension Normal/Abnormal

``` Abnormal Suggests Preeclampsia (dangerous condition) ```

Pulsus paradoxus is common with what other symptoms?

Cardiac Tamponade | Acute Asthma