objective 15

Question 1

consists of the vessels of the body which transport fluid such as the blood or lymph

Answer 1

vascular system

Question 2

heart pumps freshly oxygenated blood through the ____ to all body tissues

Answer 2

arteries

Question 3

what do arteries contain?

Answer 3

elastic fibers
muscle fibers

Question 4

allow the walls to stretch with systole and recoiled with diastole

Answer 4

elastic fibers

Question 5

control the amount of blood delivered to the tissues

Answer 5

muscle fibers

Question 6

created by each heartbeat which makes the arteries expand and then recoil

Answer 6

pressure wave

Question 7

projects the blood through like a wave

Answer 7

recoil

Question 8

what are the arteries that are accessible to examin?

Answer 8

temporal
carotid
arm: brachial, ulnar, radial
leg: femoral, popliteal, dorsalis pedis, posterior tibial, plantar

Question 9

lead to death of the distal tissue

Answer 9

complete blockages

Question 10

causes insufficient supply and may only be noted during exercise, when oxygen needs increase

Answer 10

partial blockage

Question 11

what are the deep veins?

Answer 11

femoral and popliteal

Question 12

what are the superficial veins?

Answer 12

great and small saphenous veins

Question 13

drain deoxygenated blood and waste products from the tissues and return it to the heart
are a low pressure system
have a mechanism to keep blood moving

Answer 13

veins

Question 14

how do veins keep the blood moving?

Answer 14

contracting the skeletal muscles that milk the blood back to the heart
a pressure gradient caused by breathing
intraluminal valves which ensure unidirectional flow

Question 15

mechanism in the legs in which during walking the calf muscles alternately contract and relax. due to the intraluminal valves, the blood can only go in one direction which is toward the heart

Answer 15

calf pump or peripheral heart

Question 16

how do veins and arteries differ?

Answer 16

veins are thinner than arteries
veins have larger diameter
veins can expand and hold more blood when blood volume increased

Question 17

forms a completely separate vessel system, which retrieves excess fluid from the tissue spaces and returns it to the bloodstream.

Answer 17

lymphatic system

Question 18

what are the functions of the lymphatic system?

Answer 18

• Conserve fluids and plasma proteins that leak out of the
  capillaries
• Form a part of the immune system
• Absorb lipids from the intestinal tract

Question 19

converge and drain into 2 main trunks

Answer 19

lymph vessels

Question 20

what are the 2 main trunks of the lymph vessels?

Answer 20

right lymphatic duct
thoracic duct

Question 21

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

Answer 21

right lymphatic duct

Question 22

drains the rest of the body

Answer 22

thoracic duct

Question 23

what are lymph nodes?

Answer 23

• Small oval clumps of lymphatic tissue
• Located in intervals along the vessels
• Mostly arranged in groups in the body
• Superficial and deep

Question 24

what are lymph nodes able to do?

Answer 24

filter the fluid before it returns to the bloodstream; filter out
microorganisms that could be harmful to the body

Question 25

what are the superficial nodes that are accessible for inspection and palpation?

Answer 25

cervical axillary epitrochlear inguinal

Question 26

drain head and neck

Answer 26

cervical node

Question 27

drain the breast and upper arm

Answer 27

axillary node

Question 28

drain the hand and lower arm

Answer 28

epitrochlear node

Question 29

drain most of the lymph of the lower extremity, the external genitalia, and the anterior abdominal wall

Answer 29

inguinal node

Question 30

what are the cultural and developmental considerations during pregnancy?

Answer 30

* Hormonal changes cause vasodilation – blood pressure drops in first and second trimesters * Venous pressure increases because the growing uterus obstructs drainage of the iliac veins and inferior vena cava * Can causes dependent edema, varicosities in the legs and vulva, and hemorrhoids

Question 31

what are the cultural and developmental considerations of older adults?

Answer 31

* Peripheral blood vessels get more rigid with age – this results in arteriosclerosis (causes rise in systolic blood pressure) * Intramuscular calf veins enlarge * Fewer number of lymph nodes and lymph nodes size decreases * Dorsalis pedis and posterior tibial pulses may become more difficult to find * Trophic changes associated with arterial insufficiency also occur normally with aging

Question 32

how do we prep for examination of peripheral vascular and lymphatic system?

Answer 32

* Examination includes: peripheral vascular characteristics, skin (ch.13), musculoskeletal findings (ch.24), and neurological findings (ch.25) * Room temperature should be warm, but not hot (avoid vasoconstriction and vasodilation) * Compare findings bilaterally

Question 33

what is the equipment we need?

Answer 33

* Stethoscope * Paper tape measure * Tourniquet or blood pressure cuff * Doppler

Question 34

how do we inspect the hands?

Answer 34

* Note: Colour of the skin and nail beds, temperature, texture, and turgor of the skin * Note: Presence of lesions, edema, clubbing (profile sign) * Check capillary refill

Question 35

how do we inspect the arm?

Answer 35

Note: whether the arms are symmetrical in size (normal finding) * Asymmetry can occur with edema from obstructed lymphatic drainage (i.e. after breast surgery) * Note: presence of scars

Question 36

what pulses do we palpate?

Answer 36

radial and brachial

Question 37

how do we inspect and palpate the epitrochlear lymph node?

Answer 37

* Location: depression above and behind the medial condyle of the humerus * Assessment: * “shake hands” with the client * Reach the other hand under the client’s elbow to the groove between the biceps and triceps muscles, above the medial epicondyle

Question 38

what are the normal and abnormal findings of epitrochlear lymph node?

Answer 38

* Normal: node is not palpable * Abnormal: enlarged (infection in hand or arm; conditions of generalized lymphadenopathy)

Question 39

how do we inspect the legs?

Answer 39

* skin colour, hair distribution, venous pattern, skin lesions, ulcers * skin discolouration, skin ulcers, gangrene * size (swelling and atrophy) and symmetry in size

Question 40

what are the abnormal findings of the legs?

Answer 40

* Diffuse bilateral edema – systemic illnesses * Acute unilateral, painful swelling and asymmetry of calves 1 cm or more (refer client to determine is DVT is present) * Asymmetry - lymphedema (mild, moderate, severe) * Mild (1-3 cm), moderate (3-5 cm), severe (>5 cm) * If asymmetry noted or if DVT suspected, measure the calf circumference with a non-stretchable tape measure * Measure at the widest point at the exact same place for both legs (measure the number of cm down from the patellar) * If lymphedema is suspected, measure at the ankle, distal calf, knee, and thigh

Question 41

how do we palpate the legs?

Answer 41

* Palpate for temperature * Palpate the inguinal lymph nodes * It is not unusual to palpate small nodes (1 cm or less) that are moveable and non-tender * Abnormal: nodes that are enlarged, tender, or fixed * Pulses: * Palpate the pulses in both legs * Grade the pulses on the four point scale * Femoral, popliteal (more diffuse pulse, can be difficult to localize – can use 2 approaches), posterior tibial, dorsalis pedis

Question 42

how do we assess the venous system?

Answer 42

* Ask client to stand and note any visible, dilated, and tortuous veins * Assess for arterial deficit (colour change test): * Raise client legs approx. 30 cm off the table and ask client to wag the feet for approximately 30 seconds * Then, ask the client to sit up with the legs over the side of the examination table * Compare the colour of both feet – note the time it takes for the colour to return (normal: 10 seconds or less), note when the superficial veins fill (normally about 15 seconds) * Test the lower legs for strength (ch.24) * Test the lower leg for sensation (ch.25)

Question 43

what is the doppler ultrasonic stethoscope used for?

Answer 43

* Detect a weak peripheral pulse * Monitor blood pressure in infants and children * Measure a low blood pressure * Measure blood pressure in a lower extremity

Question 44

what is the procedure for using the ultrasonic stethoscope?

Answer 44

* Position the client * Place coupling gel on the end of the transducer * Place the transducer over the pulse site at a 45 degree angle * Apply very light pressure * The pulse is located when the swishing, whooshing sound is heard