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Flashcards in Peripheral Vascular System and Lymphatic System Deck (346):
1

Peripheral Vascular System and Lymphatic System

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2

STRUCTURE AND FUNCTION

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The vascular system consists of the vessels of the body. Vessels are tubes for transporting fluid, such as the blood or lymph. Any disease in the vascular system creates problems with delivery of oxygen and nutrients to the tissues or elimination of carbon dioxide and waste products from cellular metabolism.
A)true
B)false

A

4

The _________ system consists of the vessels of the body.

Vascular

5

________ are tubes for transporting fluid, such as the blood or lymph.

Vessels

6

Any disease in the vascular system creates problems with delivery of oxygen and nutrients to the tissues or elimination of carbon dioxide and waste products from cellular metabolism.
A)true
B)false

A

7

ARTERIES

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8

The artery walls are strong, tough, and tense to withstand pressure demands. Arteries contain elastic fibers, which allow their walls to stretch with systole and recoil with diastole. Arteries also contain muscle fibers (vascular smooth muscle, or VSM), which control the amount of blood delivered to the tissues. The VSM contracts or dilates, which changes the diameter of the arteries to control the rate of blood flow.
A)true
B)false

A

9

The ______ walls are strong, tough, and tense to withstand pressure demands. ________ contain elastic fibers, which allow their walls to stretch with systole and recoil with diastole.

Arteries

10

_________ also contain muscle fibers (vascular smooth muscle, or VSM), which control the amount of blood delivered to the tissues. The VSM contracts or dilates, which changes the diameter of the arteries to control the rate of blood flow.

Arteries

11

The __________ contracts or dilates, which changes the diameter of the arteries to control the rate of blood flow.

VSM

12

Each heartbeat creates a pressure wave, which makes the arteries expand and then recoil. It is the recoil that propels blood through like a wave.
A)true
B)false

A

13

Each heartbeat creates a pressure wave, which makes the arteries expand and then recoil. Which therefore creates a pulse
A)true
B)false

A

14

The following arteries are accessible to examination:

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15

Temporal Artery. The temporal artery is palpated in front of the ear.
A)true
B)false

A

16

Carotid Artery. The carotid artery is palpated in the groove between the sternomastoid muscle and the trachea.
A)true
B)false

A

17

The major artery supplying the arm is the brachlal artery, which runs in the biceps-triceps furrow of the upper arm and surfaces at the antecubital fossa in the elbow medial to the biceps tendon.
A) true
B)false

A

18

The major artery supplying the arm is the _______ artery, which runs in the biceps-triceps furrow of the upper arm and surfaces at the antecubital fossa in the elbow medial to the biceps tendon

Brachial

19

Immediately below the elbow, the brachial artery bifurcates into the ulnar and radial arteries.
A)true
B)false

A

20

The radial pulse lies just medial to the radius at the wrist;
A)true
B)false

A

21

This pulse lies medially to the radius

Radial pulse

22

the ulnar artery is in the same relation to the ulna, but it is deeper and often difficult to feel.
A)true
B)false

A

23

Ulnar pulse is difficult to feel
A)true
B)false

A

24

The major artery to the leg is the femoral artery, which passes under the inguinal ligament.
A)true
B)false

A

25

This artery lies next to the and , which passes under the inguinal ligament

Femoral artery

26

The femoral artery travels down the thigh. At the lower thigh, it courses posteriorly; then it is termed the popliteal artery. Below the knee, the popliteal artery divides. The anterior tibial artery travels down the front of the leg on to the dorsum of the foot, where it becomes the dorsilis pedis. In back of the leg, the posterior tibial artery travels down behind the medial malleolus and in the foot forms the plantar arteries
A)true
B)false

A

27

The femoral artery travels down the thigh.
>At the lower thigh, it courses posteriorly; then it is termed the popliteal artery.
>Below the knee, the popliteal artery divides. >The anterior tibial artery travels down the front of the leg on to the dorsum of the foot, where it becomes the dorsilis pedis.
>In back of the leg, the posterior tibial artery travels down behind the medial malleolus and in the foot forms the plantar arteries

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The function of the arteries is to supply oxygen and essential nutrients to the tissues
A)true
B)false

A

29

The function of the _______ is to supply oxygen and essential nutrients to the tissues

Arteries

30

Ischemia is a deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel. A complete blockage leads to death of the distal tissue. A partial blockage creates an insufficient supply, and the ischemia may be apparent only at exercise when oxygen needs increase.
A) true
B)false

A

31

_________ is a deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel. A complete blockage leads to death of the distal tissue. A partial blockage creates an insufficient supply, and the _________ may be apparent only at exercise when oxygen needs increase.

Ischemia

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A complete blockage leads to death of the distal tissue.

Ischemic

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A partial blockage creates an insufficient supply, and the _________ may be apparent only at exercise when oxygen needs increase.

Ischemic

34

VEINS

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The course of veins parallels that of arteries, but the body has more veins and they lie closer to the skin surface.
A)true
B)false

A

36

The body has mor veins than arteries
A)true
B)false

A

37

The following veins are accessible to examination(VEINS)

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38

Jugular Veins are palatable
A)true
B)false

A

39

Veins in the Arm. Each arm has two sets of veins: superficial and deep. The superficial veins are in the subcutaneous tissue and are responsible for most of the venous return.
A)true
B)false

A

40

Superficial veins are in the subcutaneous layer and is responsible for venous return
A)true
B)false

A

41

Veins in the Leg. The legs have three types of veins;

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I. The deep veins run alongside the deep arteries and conduct most of the venous return from the legs. These are the femoral and popliteal veins. As long as these veins remain intact, the superficial veins can be excised without harming the circulation.
A)true
B) false

A

43

The deep veins run alongside the deep arteries and conduct most of the venous return from the legs. These are the femoral and popliteal veins.
A)true
B)false

A

44

2. The superficial veins are the great and small saphenous veins. The great saphenous vein, inside the leg, starts at the medial side of the dorsum of the foot. You can see it ascend in front of the medial malleolus; then it crosses the tibia obliquely and ascends along the medial side of the thigh. The small saphenous vein, outside the leg, starts on the lateral side of the dorsum of the foot, ascends behind the lateral malleolus, up the back of the leg, where it joins the popliteal vein.
A)true
B)false

A

45

2. The superficial veins are the great and small saphenous veins. The ________ saphenous vein, inside the leg, starts at the medial side of the dorsum of the foot. You can see it ascend in front of the medial malleolus; then it crosses the tibia obliquely and ascends along the medial side of the thigh.

Great

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2. The superficial veins are the great and small saphenous veins. . The ________ saphenous vein, outside the leg, starts on the lateral side of the dorsum of the foot, ascends behind the lateral malleolus, up the back of the leg, where it joins the popliteal vein.

Small

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VENOUS FLOW

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Veins drain the deoxygenated blood and its waste products from the tissues and return it to the heart.
A)true
B)false

A

49

Veins carry deoxygenated blood and waste product to the heart
A) true
B)false

A

50

veins are a low-pressure system.
A)true
B) false

A

51

Veins is a low pressure system in the body
A)true
B)false

A

52

Because veins do not have a pump to generate their blood flow, the veins need a mechanism to keep blood moving.This is accomplished by
(l) the contracting skeletal muscles that milk the blood proximally, back toward the heart; (2) the pressure gradient caused by breathing, in which inspiration makes the thoracic pressure decrease and the abdominal pressure increase; and
(3) the intraluminal valves, which ensure unidirectional flow. Each valve is a paired semilunar pocket that opens toward the heart and closes tightly when filled to prevent backflow of blood

True

53

In the legs, this mechanism is called the "calf pump," or "peripheral heart." While walking, the calf muscles alternately contract (systole) and relax (diastole). In the contraction phase, the gastrocnemius and soleus muscles squeeze the veins and direct the blood flow proximally. Because of the valves, venous blood flows just one way-toward the heart.
A) true
B)false

A

54

Because venous pressure is lower, walls of the veins are thinner than those of the arteries.
A)true
B)false

A

55

Vein walls are thinner than artery walls
A)true
B)false

A

56

Veins have a larger diameter and are more distensible; they can expand and hold more blood when blood volume increases. This is a compensatory mechanism to reduce stress on the heart. Because of this ability to stretch, veins are called capacitance vessels.
A)true
B)false

A

57

Veins are more stretchable and expand to reduce the stress on the heart.
A)true
B)false

A

58

Efficient venous return depends on contracting skeletal muscles, competent valves in the veins, and a patent lumen. Problems with any of these three elements lead to venous stasis.
A)true
B)false

A

59

At risk for venous disease are people who undergo prolonged standing, sitting, or bedrest, because they do not benefit from the milking action that walking accomplishes. Hypercoagulable states and vein wall trauma are other factors that increase risk for venous disease.
A)true
B)false

A

60

Also, dilated and tortuous (varicose) veins create incompetent valves, wherein the lumen is so wide the valve cusps cannot approximate. This condition increases venous pressure, which further dilates the vein. Some people have a genetic predisposition to varicose veins, but obesity and pregnancy are increased risk factors.
A)true
B)false

A

61

obesity and pregnancy are increased risk factors. Of varicose veins
A)true
B)false

A

62

LYMPHATICS

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Without lymphatic drainage, fluid would build up in the interstitial spaces and produce edema.
A)true
B)false

A

64

Without lymphatic system edema will build up
A)true
B)false

A

65

The vessels converge and drain into two main trunks, which empty into the venous system at the subclavian veins;

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66

1. The right lymphatic duct empties into the right subclavian vein. It 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, and right upper section of the liver.
2. The thoracic duct drains the rest of the body. It empties into the left subclavian vein.
A)true
B)false

A

67

The functions of the lymphatic system are;

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(1) to conserve fluid and plasma proteins that leak out of the capillaries,
(2) to form a major part of the immune system that defends the body against disease, and
(3) to absorb lipids from the intestinal tract.
A)function of the lymphatic system
B)function of vessel system

A

69

The immune system;

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It accomplishes this by phagocytosis (digestion) of the substances by neutrophils and monocytes/macrophages and by production of specific antibodies or specific immune responses by the lymphocytes.

Immune system

71

CONTD......"LYMPHATIC"

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Lymphatic capillaries start as microscopic open-ended tubes, which siphon interstitial fluid. The capillaries converge to form vessels. The vessels, like veins, drain into larger ones. The vessels have valves, so flow is one way from the tissue spaces into the bloodstream. The many valves make the vessels look beaded.
A)true
B)false

A

73

The flow of lymph is slow compared with that of the blood. Lymph flow is propelled by contracting skeletal muscles, by pressure changes secondary to breathing, and by contraction of the vessel walls themselves.
A)true
B)false

A

74

Lymph nodes are small, oval clumps of lymphatic tissue located at intervals along the vessels. Most nodes are arranged in groups, both deep and superficial, in the body.
A)true
B)false

A

75

Nodes filter the fluid before it is returned to the bloodstream and filter out microorganisms that could be harmful to the body. The pathogens are exposed to B and T lymphocytes in the lymph nodes. The lymphocytes mount an antigen-specific response to eliminate the pathogens.

Lymph nodes

76

With local inflammation, the nodes in that area become swollen and tender.

Lymph nodes

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The superficial groups of nodes are accessible to inspection and palpation and give clues to the status of the lymphatic system:

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78

>Cervical nodes drain the head and neck and
>Axillary nodes drain the breast and upper arm.
>The epitrochlear node is in the antecubital fossa and drains the hand and lower arm.
>The inguinal nodes in the groin drain most of the lymph of the lower extremity, the external genitalia, and the anterior abdomjnal wall.

True

79

Related Organs

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The spleen, tonsils, and thymus aid the lymphatic system
A)true
B)false

A

81

The spleen is located in the left upper quadrant of the abdomen. It has four functions:
(1) to destroy old red blood cells;
(2) to produce antibodies;
(3) to store red blood cells; and
(4) to filter microorganisms from the blood.

True

82

The tonsils (palatine, pharyngeal, and lingual) are located at the entrance to the respiratory and gastrointestinal tracts and respond to local inflammation.

True

83

The thymus is the flat, pink-gray gland located in the superior mediastinum behind the sternum and in front of the aorta. It is relatively large in the fetus and young child and atrophies after puberty. It is important in developing the T lymphocytes of the immune system in children. The B lymphocytes originate in the bone marrow and mature in the lymphoid tissue.

True

84

The_______ is the flat, pink-gray gland located in the superior mediastinum behind the sternum and in front of the aorta. It is relatively large in the fetus and young child and atrophies after puberty. It is important in developing the T lymphocytes of the immune system in children. The B lymphocytes originate in the bone marrow and mature in the lymphoid tissue.

thymus

85

DEVELOPMENTAL COMPETENCE
Infants and Children

M

86

The lymphatic system has the same function in children as in adults
A)true
B)false

A

87

It is well developed at birth and grows rapidly until age 10 or 11 years. By age 6 years, the lymphoid tissue reaches adult size; it surpasses adult size by puberty, and then it slowly atrophies. It is possible that the excessive antigen stimulation in children causes the early rapid growth.
A)true
B)false

A

88

It is possible that the excessive antigen stimulation in children causes the early rapid growth.
A)true
B)false

A

89

Lymph nodes are relatively large in children, and the superficial ones often are palpable even when the child is healthy.
A)true
B)false

A

90

With infection, excessive swelling and hyperplasia occur. In lymph nodes
A)true
B)false

A

91

Enlarged tonsils are familiar signs in respiratory infections.
A)true
B)false

A

92

The excessive lymphoid response also may account for the common childhood symptom of abdominal pain with seemingly unrelated problems such as upper respiratory
infections. Possibly the inflammation of mesenteric lymph nodes produces the abdominal pain.
A)true
B)false

A

93

DEVELOPMENTAL COMPETENCE
The Pregnant Woman

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Hormonal changes cause vasodilation and the resulting drop in blood pressure
A)pregnant woman
B)aging adult

A

95

The growing uterus obstructs drainage of the iliac veins and the inferior vena cava. This condition causes low blood flow and increases
venous pressure. This, in turn, causes dependent edema, varicosities in the legs and vulva, and hemorrhoids.
A)true
B)false

A

96

DEVELOPMENTAL COMPETENCE
The Aging Adult

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Peripheral blood vessels grow more rigid with age, resulting in a condition called arteriosclerosis. This condition produces the rise in systolic blood pressure.
A)aging adult
B)infant

A

98

Arteriosclerosis rises systolic BP in the aging adult
A)TURE
B)false

A

99

Do not confuse this process with another one, atherosclerosis, or the deposition of fatty plaques on the intima of the arteries.
A)true
B)false

A

100

Aging produces a progressive enlargement of the intramuscular calf veins. Prolonged bedrest, prolonged immobilization, and heart failure increase the risk for deep venous thrombosis and subsequent pulmonary embolism. These conditions are common in aging and also with malignancy and myocardial infarction (MI). Low-dose anticoagulant medication reduces the risk for venous thromboembolism.
A)true
B)false

A

101

. Prolonged bedrest, prolonged immobilization, and heart failure increase the risk for deep venous thrombosis and subsequent pulmonary embolism.
A)aging adult
B)false

A

102

Low-dose anticoagulant medication reduces the risk for venous thromboembolism.
A)true
B)false

A

103

Loss of lymphatic tissue leads to fewer numbers of lymph nodes in older people and to a decrease in the size of remaining nodes.
A)true
B)false

A

104

SUBJECTIVE DATA

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105

1. Leg pain or cramps
2. Skin changes on arms or legs
3. Swelling
4. Lymph node enlargement
A)subjective data
B)objective data

A

106

Leg pain or cramps. Any leg pain (cramps)? Where? • Describe the type of pain; is it burning, aching, cramping, stabbing? Did this come on gradually or suddenly? • Is it aggravated by activity, walking?
A)I am assessing for Peripheral vascular disease (PVD
B)none

A

107

How many blocks (stairs) does it take to produce this pain?
A)Claudication distance is the number of blocks walked or stairs climbed to produce pain
B)false

A

108

Has this amount changed recently? Is the pain worse with elevation? Worse with cool temperatures?
A). Note sudden decrease in claudication distance or pain not relieved by rest.
B)none

A

109

Does the pain wake you up at night?
A)Night leg pain is common in aging adults. It may indicate the ischemic rest pain of PVD, severe night muscle cramping (usually the calf), or the restless leg syndrome.
B)none

A

110

_________ is common in aging adults. It may indicate the ischemic rest pain of PVD, severe night muscle cramping (usually the calf), or the restless leg syndrome.

Night leg pain

111

Any recent change in exercise, a new exercise, increasing exercise?
A)Pain of musculoskeletal origin rather than vascular.
B)none

A

112

What relieves this pain: dangling, walking, rubbing? Is the leg pain associated with any skin changes?
A)assessments of leg pain
B)none

A

113

Is it associated with any change in sexual function (males)?
A)Aortoiliac occlusion is associated with impotence (Leriche syndrome).
B) none

A

114

Any history of vascular problems, heart problems, diabetes, obesity, pregnancy, smoking, trauma, prolonged standing, or bedrest?
A)assessment of leg pain
B)none

A

115

Skin changes on arms or legs. Any skin changes on arms or legs? What color: redness, pallor, blueness, brown discolorations? Any change in temperature-excess warmth or coolness?
A)Coolness is associated with arterial disease.
B)false

A

116

Skin Coolness is associated with _________ disease

arterial disease.

117

Do your leg veins look bulging and crooked? How have you treated these? Do you use support hose?
A)assessment of varicose veins
B)none

A

118

Any leg sores or ulcers? Where on the leg? Any pain with the leg ulcer?
A)Leg ulcers occur with chronic arterial and chronic venous disease
B)none

A

119

________ ulcers occur with chronic arterial and chronic venous disease

Leg

120

Swelling in the arms or legs. Swelling in one or both legs? When did this swelling start?
A)Edema is bilateral when the cause is generalized (heart failure) or unilateral when it is the result of a local obstruction or inflammation.
B)none

A

121

Edema that is bilateral is associated with heart failure
A)true
B)false

A

122

Edema is unilateral when it is the result of a local obstruction or inflammation.
A)true
B)false

A

123

What time of day is the swelling at its worst: morning, or after up most of the day? • Does the swelling come and go, or is it constant? What seems to bring it on: trauma, standing all day, sitting? • What relieves swelling: elevation, support hose? • Is swelling associated witl1 pain, heat, redness, ulceration, hardened skin?
A) assessment of edema
B)none

A

124

Lymph node enlargement. Any "swollen glands" (lumps, kernels)? Where in body? How long have you had them?
A)Enlarged lymph nodes occur with infection, malignancies, and immunologic diseases.
B)none

A

125

_________ lymph nodes occur with infection, malignancies, and immunologic diseases.

Enlarged

126

• Any recent change? How do they feel to you: hard, soft? • Are the swollen glands associated with pain, local infection?
A)assessment of lymph node enlargement
B)none

A

127

Medications. What medications are you taking (e.g., oral contraceptives, hormone replacement)?
A)true
B)false

A

128

OBJECTIVE DATA

M

129

PREPARATION

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130

During a complete physical examination, examine the arms at the very beginning when you are checking the vital signs-the person is sitting. Examine the legs directly after the abdominal examination while the person is still supine. Then stand the person up to evaluate the leg veins.
A)true
B)false

A

131

Examination of the arms and legs includes peripheral vascular characteristics
A)true
B)false

A

132

Room temperature should be about 22° C (72° F) and draftless to prevent vasodilation or vasoconstriction
A)true
B)false

A

133

Use inspection and palpation. Compare your findings with the opposite extremity.
A)true
B)false

A

134

EQUIPMENT NEEDED

,

135

Occasionally need:
Paper tape measure
Tourniquet or blood pressure cuff
Stethoscope
Doppler ultrasonic stethoscope

True

136

INSPECT AND PALPATE THE ARMS

,

137

Lift both the person's hands in your hands. Inspect, then turn the person's hands over, noting color of skin and nail beds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing.
A)true
B)false

A

138

Use the profile sign (viewing the finger from the side) to detect early clubbing. The normal nail-bed angle is 160 degrees.
A)true
B)false

A

139

Profile sign is used to detect early clubbing of the fingers, the normal angle of the nail is 160
A)true
B)false

A

140

Flattening of angle and clubbing (diffuse enlargement of terminal phalanges) occur with congenital cyanotic heart disease and cor pulmonale.
A)abnormal finding
B)normal finding

A

141

With the person's hands near the level of his or her heart, check capillary refill.This is an index of peripheral perfusion and cardiac output. Depress and blanch the nail beds; release and note the time for color return. Usually, the vessels refill within a fraction of a second.
A)true
B)false

A

142

Consider it normal if the color returns in less than I or 2 seconds. Note conditions that can skew your findings: a cool room, decreased body temperature, cigarette smoking, peripheral edema, and anemia.
A)capillary refill
B)none

A

143

a cool room, decreased body temperature, cigarette smoking, peripheral edema, and anemia. Can affect your capillary refill test
A)true
B)false

A

144

Refill lasting more than 1 or 2 seconds signifies vasoconstriction or decreased cardiac output (hypovolemia, heart failure, shock). The hands are cold, clammy, and pale.
A)abnormal finding
B)normal finding

A

145

Conditions that can affect capillary refill are hypovolemia, heart failure, shock.The hands are cold, clammy, and pale.
A)true
B)false

A

146

The two arms should be symmetric in size.
A)true
B)false

A

147

Edema of upper extremities occurs when lymphatic drainage is obstructed, which may occur after breast surgery.
A) true
B) false

A

148

______ of upper extremities occurs when lymphatic drainage is obstructed, which may occur after breast surgery.

Edema

149

Edema may occur in upper extremities do to breast surgery
A)true
B)false

A

150

Note the presence of any scars on hands and arms. Many occur normally with usual childhood abrasions or with occupations involving hand tools.
A)true
B)false

A

151

Needle tracks in hands, arms, antecubital fossae occur with IV drug use; linear scars in wrists may signify past selfinflicted injury.
A)abnormal finding
B)normal finding

A

152

Palpate both radial pulses, noting rate, rhythm, elasticity of vessel wall, and equal force. Grade the force (amplitude) on a 3-point scale:
3+, increased, full, bounding
2+, normal
1+, weak
0,absent

True

153

Full, bounding pulse (3+) occurs with hyperkinetic states (exercise, anxiety, fever), anemia, and hyperthyroidism.
A)true
B)false

A

154

Weak, "thready" pulse (1 +)occurs with shock and peripheral arterial disease.
A)true
B)false

A

155

It usually is not necessary to palpate the ulnar pulses. If indicated, reach your hand under the person's arm and palpate along the medial side of the inner forearm, although the ulnar pulses often are not palpable in the normal person.
A)true
B)false

A

156

Palpate the brachial pulses-their force should be equal bilaterally
A)true
B)false

A

157

Check the epitrochlear lymph nodes in the depression above and behind the medial condyle of the humerus. Do this by "shaking hands" with the person and reaching your other hand under the person's elbow to the groove between the biceps and triceps muscles, above the medial epicondyle. These nodes are not palpable normally.
A)true
B)false

A

158

Check the epitrochlear lymph nodes in the depression above and behind the medial condyle of the humerus. I can check this by shaking the patient hand with my right hand and use my left hand to palpate
A)true
B)false

A

159

An enlarged epitrochlear node occurs with infection of the hand or forearm.
A)abnormal finding
B)normal finding

A

160

Epitrochlear nodes occur in conditions of generalized lymphadenopathy: lymphoma, chronic lymphocytic leukemia, sarcoidosis, infections, mononucleosis.
A)true
B)false

A

161

The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery.
(A) Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch.
(B) Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the hand's normal color in approximately 2 to 5 seconds.
A)true
B)false

A

162

The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery.
A)true
B)false

A

163

Although this test is simple and useful, it is relatively crude and subject to error- that is, you must occlude both arteries uniformly with 11 pounds of pressure for the test to be accurate.
A)Allen test
B)false

A

164

Pallor persists or a sluggish return to color suggests occlusion of the collateral arterial flow. Avoid radial artery cannulation until adequate circulation is shown.
A)positive for Allen test
B)negative for Allen test

A

165

Limitations of the modified Allen test are that it is subjective and requires patient cooperation that may not occur in emergency or critical care situations-just the times you need to cannulate the radial artery.
A)true
B)false

A

166

The laser Doppler gives a quantifiable measurement of blood flow that is recordable and reproducible. A small, flat probe is taped to the palm at the end of the patient's index finger. A baseline value for blood flow is recorded and then compared for change when the two arteries are occluded.
A)true
B)false

A

167

The __________ gives a quantifiable measurement of blood flow that is recordable and reproducible. A small, flat probe is taped to the palm at the end of the patient's index finger. A baseline value for blood flow is recorded and then compared for change when the two arteries are occluded.

laser Doppler

168

INSPECT AND PALPATE THE LEGS

,

169

Inspect both legs together, noting skin color, hair distribution, venous pattern, size (swelling or atrophy), and any skin lesions or ulcers.
A)true
B)false

A

170

Pallor with vasoconstriction; erythema with vasodilation; cyanosis.
A)abnormal finding
B) normal finding

A

171

Pallor with vasoconstriction;
A)true
B)false

A

172

erythema with vasodilation; cyanosis. For inspecting the legs
A)true
B)false

A

173

Normally, hair covers the legs. Even if leg hair is shaved, you will still note hair on the dorsa of the toes.
A)true
B)false

A

174

Malnutrition: thin, shiny, atrophic skin; thick-ridged nails; loss of hair; ulcers; gangrene. Malnutrition, pallor, and coolness occur with arterial insufficiency
A)abnormal finding
B)normal finding

A

175

Malnutrition: thin, shiny, atrophic skin; thick-ridged nails; loss of hair; ulcers; gangrene.
A)abnormal finding
B)normal finding

A

176

Malnutrition, pallor, and coolness occur with _________

arterial insufficiency

177

The venous pattern normally is flat and barely visible. Note obvious varicosities, although these are best assessed while standing.
A)true
B)false

A

178

Best to assess varcosities of a patient leg while standing
A)true
B)false

A

179

If the lower legs look asymmetric or if deep venous thrombosis is suspected, measure the calf circumference with a non-stretchable tape measure. Measure at the widest point, taking care to measure the other leg in exactly the same place-the same number of centimeters down from the patella or other landmark.
A)true
B)false

A

180

If lymphedema is suspected, measure also at the ankle, distal calf, knee, and thigh. Record your findings in centimeters.
A)true
B)false

A

181

Diffuse bilateral edema occurs with systemic illnesses
A)true
B)false

A

182

Acute, unilateral, painful swelling and asymmetry of calves of 1 cm or more is abnormal; refer the person to determine whether deep venous thrombosis is present.
A)abnormal finding
B)normal finding

A

183

Asymmetry of 1 to 3 cm occurs with mild lymphedema;
3 to 5 cm with moderate lymphedema;
and more than 5 em with severe lymphedema
A)true
B)false

A

184

In the presence of skin discoloration, skin ulcers, or gangrene, note the size and the exact location.
A)true
B)false

A

185

Brown discoloration occurs with chronic venous stasis due to hemosiderin deposits from red blood cell degradation.
A)true
B)false

A

186

_________ discoloration occurs with chronic venous stasis due to hemosiderin deposits from red blood cell degradation.

Brown

187

Venous ulcers occur usually at medial malleolus because of bacterial invasion of poorly drained tissues
A)true
B)false

A

188

_______ulcers occur usually at medial malleolus because of bacterial invasion of poorly drained tissues

Venous

189

With arterial deficit, ulcers occur on tips of toes, metatarsal heads, and lateral malleoli.
A)true
B)false

A

190

With _________, ulcers occur on tips of toes, metatarsal heads, and lateral malleoli.

arterial deficit

191

The skin should be warm and equal bilaterally. Bilateral cool feet may be due to environmental factors such as cool room temperature, apprehension, and cigarette smoking. If any increase in temperature is present higher up the leg, note if it is gradual or abrupt.
A)true
B)false

A

192

A unilateral cool foot or leg or a sudden temperature drop as you move down the leg occurs with arterial deficit.
A)abnormal finding
B)normal finding

A

193

A unilateral cool foot or leg or a sudden temperature drop as you move down the leg occurs with ___________

arterial deficit.

194

Flex the person's knee, and then gently compress the gastrocnemius (calf) muscle anteriorly against the tibia; no tenderness should be present. Or you may sharply dorsiflex the foot toward the tibia. Flexing the knee first exerts pressure on the posterior tibial vein. Normally this does not cause pain.
A)true
B)false

A

195

Calf pain with these maneuvers is a positive Homan sign, which occurs in about 35% of cases of deep vein thrombosis. It is not specific for this condition because it occurs also with superficial phlebitis, Achilles tendinitis, gastrocnemius and plantar muscle injury, and lumbosacral disorders.
A)abnormal finding
B)normal finding

A

196

Calf pain with these maneuvers is a positive __________, which occurs in about 35% of cases of deep vein thrombosis. It is not specific for this condition because it occurs also with superficial phlebitis, Achilles tendinitis, gastrocnemius and plantar muscle injury, and lumbosacral disorders.

Homan sign

197

Palpate the inguinal lymph nodes. It is not unusual to find palpable nodes that are small ( 1 cm or less), movable, and non tender.
A)true
B)false

A

198

Enlarged nodes, tender, or fixed in area.
A)abnormal finding
B)normal finding

A

199

Palpate these peripheral arteries in both legs: femoral, popliteal, dorsalis pedis, and posterior tibial. Grade the force on the 3-point scale. Locate the femoral arteries just below the inguinal ligament halfway between the pubis and anterior superior iliac spines.
A)true
B)false

A

200

Locate the femoral arteries just below the inguinal ligament halfway between the pubis and anterior superior iliac spines.
A)true
B)false

A

201

To help expose the femoral area, particularly in obese people, ask the person to bend his or her knees to the side in a froglike position. Press firmly and then slowly release, noting the pulse tap under your fingertips. If this pulse is weak or diminished, auscultate the site for a bruit.
A)true
B)false

A

202

If pulse is week auscultate for a bruit
A)true
B)fase

A

203

A bruit occurs with turbulent blood flow, indicating partial occlusion
A)abnormal finding
B)normal finding

A

204

A _____ occurs with turbulent blood flow, indicating partial occlusion

bruit

205

The popliteal pulse is a more diffuse pulse and can be difficult to localize. With the leg extended but relaxed, anchor your thumbs on the knee and curl your fingers around into the popliteal fossa. Press your fingers forward hard to compress the artery against the bone (the lower edge of the femur or the upper edge of the tibia). Often it is just lateral to the medial tendon.
A)popliteal pulse
B)brachial pulse

A

206

If you have difficulty with finding the popliteal pulse, turn the person prone and lift up the lower leg. Let the leg relax against your arm, and press in deeply with your two thumbs. Often a normal popliteal pulse is impossible to palpate.
A)true
B)false

A

207

For the posterior tibial pulse, curve your fingers around the medial malleolus. You will feel the tapping right behind it in the groove between the malleolus and the Achilles tendon. If you cannot, try passive dorsiflexion of the foot to make the pulse more accessible.
A)posterior tibial pulse
B)brachial pulse

A

208

The dorsalis pedis pulse requires a very light touch. Normally it is just lateral to and parallel with the extensor tendon of the big toe. Do not mistake the pulse in your own fingertips for that of the person.
A)dorsalis pedis
B)radial

A

209

Normally it is just lateral to and parallel with the extensor tendon of the big toe. Do not mistake the pulse in your own fingertips for that of the person. What pulse is this
A)dorsalis pedis
B)radial

A

210

In adults older than 45 years, occasionally either the dorsalis pedis or the posterior tibial pulse may be hard to find, but not both on the same foot.
A)true
B)false

A

211

Hard to find In dorsalis pedis or the posterior tibial pulse in adults older than 45 years.
A)true
B)false

A

212

Check for pretibial edema. Firmly depress the skin over the tibia or the medial malleolus for 5 seconds and release. Normally, your finger should leave no indentation, although a pit commonly is seen if the person has been standing all day or during pregnancy.
A)true
B)false

A

213

Check for ___________ Firmly depress the skin over the tibia or the medial malleolus for 5 seconds and release. Normally, your finger should leave no indentation, although a pit commonly is seen if the person has been standing all day or during pregnancy.

pretibial edema.

214

Bilateral, dependent pitting edema occurs with heart failure, diabetic neuropathy, and hepatic cirrhosis
A)true
B)false

A

215

Bilateral, dependent pitting edema occurs with
A)heart failure
B)diabetic neuropathy
C)hepatic cirrhosis
D)all the above

D

216

If pitting edema is present, grade it on the following scale:
1+ Mild pitting, slight indentation, no perceptible swelling of the leg
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains for a short time, leg looks swollen
4+ Very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted

True

217

If pitting edema is present, grade it on the following scale:
1+ Mild pitting, slight indentation, no perceptible swelling of the leg
A)true
B)false

A

218

If pitting edema is present, grade it on the following scale:
2+ Moderate pitting, indentation subsides rapidly
A)true
B)false

A

219

If pitting edema is present, grade it on the following scale:
3+ Deep pitting, indentation remains for a short time, leg looks swollen
A)true
B)false

A

220

If pitting edema is present, grade it on the following scale:
4+ Very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted
A)true
B)false

A

221

Unilateral edema occurs with occlusion of a deep vein. Unilateral or bilateral edema occurs with lymphatic obstruction. With these factors, it is "brawny" or nonpitting and feels hard to the touch.
A)abnormal finding
B)Normal finding

A

222

Unilateral edema occurs with occlusion of a deep vein.
A)true
B)false

A

223

Unilateral or bilateral edema occurs with lymphatic obstruction.
A)true
B)false

A

224

Because peripheral edema is a common clinical sign in a great number of conditions, it is important to detect true changes in the most accurate way available. Be aware of the limitations of traditional assessment methods, and check with your own institution to conform with a consistently used scale.
A)true
B)false

A

225

Ask the person to stand so that you can assess the venous system. Note any visible, dilated, and tortuous veins.
A)true
B)false

A

226

To asses venous system have the pt stand
A)true
B)false

A

227

Varicosities occur in the saphenous veins
A)true
B)false

A

228

By assessing the patient venous system by having the pt stand an abnormal finding would be Varicosities that occur in the saphenous veins
A)true
B)false

A

229

Manual Compression Test

,

230

While the person is still standing, test the length of the varicose vein to determine whether its valves are competent. Place one hand on the lower part of the varicose vein, and compress the vein with your other hand about 15 to 20 cm higher. Competent valves will prevent a wave transmission, and your distal (lower) fingers will feel no change.
A)Manual Compression Test
B)color test

A

231

A palpable wave transmission occurs when the valves are incompetent.
A)positive for Manual Compression Test
B)negative for Manual Compression Test

A

232

Color Changes

,

233

If you suspect an arterial deficit, raise the legs about 30 cm (12 inches) off the table and ask the person to wag the feet for about 30 seconds to drain off venous blood. The skin color now reflects only the contribution of arterial blood. A light-skinned person's feet normally will look a little pale but still should be pink. A dark-skinned person's feet are more difficult to evaluate, but the soles should reveal extreme color change.
A)true
B)false

A

234

A dark skinned person assess the sole of the feet
A)true
B)false

A

235

Elevational pallor (marked) indicates arterial insufficiency
A)abnormal finding
B)normal finding

A

236

Now have the person sit up with the legs over the side of the table. Compare the color of both feet. Note the time it takes for color to return to the feet-the normal time is 10 seconds or less. Note also the time it takes for the superficial veins around the feet to fill the normal time is about 15 seconds. This test is unreliable if the person has concomitant venous disease with incompetent valves.
A)true
B)false

A

237

Dependent rubor (deep blue-red color) occurs with severe arterial insufficiency
A)abnormal finding
B)normal finding

A

238

Chronic hypoxia produces a loss of vasomotor tone and a pooling of blood in the veins.
A)abnormal finding
B)normal finding

A

239

____________ produces a loss of vasomotor tone and a pooling of blood in the veins.

Chronic hypoxia

240

Delayed venous filling occurs with arterial insufficiency. With legs over the side of the table is an
A)abnormal finding .
B)normal finding

A

241

Test the lower legs for strength
A)Motor loss occurs with severe arterial deficit
B)false

A

242

Test the lower legs for sensation
A)Sensory loss occurs with arterial deficit, especially diabetes
B)false

A

243

The Doppler Ultrasonic Stethoscope

,

244

Use this device to detect a weak peripheral pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity.
A)The Doppler Ultrasonic Stethoscope
B)none

A

245

The Doppler stethoscope magnifies pulsatile sounds from the heart and blood vessels. Position the person supine, with the legs externally rotated so you can reach the medial ankles easily. Place a drop of coupling gel on the end of the handheld transducer. Place the transducer over a pulse site at a 90-degree angle. Apply very light pressure; locate the pulse site by the swishing, whooshing sound.
A)The Doppler Ultrasonic Stethoscope
B)none

A

246

The Ankle-Brachial Index (ABI)

,

247

Use of the Doppler stethoscope is a highly specific, noninvasive, and readily available way to determine the extent of peripheral arterial disease (PAD). The patient is supine. Apply a regular arm blood pressure cuff above the ankle and determine the systolic pressure in either the posterior tibial or dorsalis pedis artery. Then divide that figure by the systolic pressure of the brachial artery.
A)true
B)false

A

248

In people with diabetes mellitus, the ABI is less reliable because of calcification (which makes their arteries non-compressible) and may give a falsely high ankle pressure. Thus the presence or severity of PAD may be underestimated.
A)true
B)false

A

249

An ABI of 0.90 or less indicates peripheral arterial disease (PAD):
• 0.90 to 0.70-mild claudication
• 0.70 to 0.40-moderate to severe claudication • 0.40 to 0.30-severe claudication, usually with rest pain except in the presence of diabetic neuropathy

True

250

DEVELOPMENTAL COMPETENCE
Infants and Children

,

251

Pulse force should be normal and symmetric. Pulse force also should be the same in the upper and lower extremities.
A)infant and children
B)false

A

252

Weak pulses occur with vasoconstriction of diminished cardiac output.
A)in an infant
B)in an adult

A

253

Full, bounding pulses occur with patent ductus arteriosus as a result of the large left-to-right shunt.
A)in an infant
B)in an adult

A

254

Diminished or absent femoral pulses while upper extremity pulses are normal suggest coarctation of aorta.
A)in an infant
B)in an adult

A

255

Palpable lymph nodes occur often in healthy infants and children. They are small, firm (shotty), mobile, and nontender. They may be the sequelae of past infection, such as inguinal nodes from a diaper rash or cervical nodes from a respiratory infection. Vaccinations also can produce local lymphadenopathy.
A)true
B)false

A

256

. Vaccinations also can produce local lymphadenopathy. In an infant
A)true
B)false

A

257

Note characteristics of any palpable nodes and whether they are local or generalized
A)true
B)false

A

258

Enlarged, warm, tender nodes indicate current infection. Look for source of infection
A)abnormal finding
B)normal finding

A

259

DEVELOPMENTAL COMPETENCE
The Pregnant Woman

,

260

Expect diffuse bilateral pitting edema in the lower extremities, especially at the end of the day and into the third trimester. Nearly 80% of pregnant women have some peripheral edema.
Varicose veins in the legs also are common in the third trimester.
A)true
B)false

A

261

Varicose veins in the legs also are common in the third trimester.
A)true
B)false

A

262

Remain alert for generalized edema plus hypertension, which suggests preeclampsia, a dangerous obstetric condition.
A)abnormal finding for pregnant women
B)none

A

263

DEVELOPMENTAL COMPETENCE
The Aging Adult

,

264

The dorsalis pedis and posterior tibial pulse may become more difficult to find. Trophic changes associated with arterial insufficiency (thin, shiny skin; thickridged nails; loss of hair on lower legs) also occur normally with aging.
A)true
B)false

A

265

Trophic changes associated with arterial insufficiency (thin, shiny skin; thickridged nails; loss of hair on lower legs) also occur normally with aging.
A)aging adult
B)younger adult

A

266

PROMOTING A HEAL THY LIFESTYLE: FOOT CARE Take Care of Your Feet!

M

267

Keeping blood flowing to your feet.
• Walking is one of the best exercises for overall circulation.
• When an individual is not able to walk, putting the feet up when sitting or lying down, stretching, wiggling toes, having a gentle foot massage, and warm foot bath are great alternatives.
• Do not cross legs for long periods.
• Do not smoke.

,true

268

Wearing shoes that fit and are comfortable.
• The best time to measure feet is toward the end of the day, when feet tend to be the largest.
• Individuals often have one foot that is larger than the other. It is recommended that shoes are fit to the larger foot.
• Select shoes that are shaped like one's feet. The ball of the foot should fit comfortably into the widest part of the shoe. Toes should not be crowded.
• For women, low-heeled shoes are safer and less damaging than high-heeled shoes

True

269

Keeping skin soft and smooth.
• A thin coat of skin lotion over the tops and bottoms of one's feet help keep skin soft and smooth. However, this extra moisture should not go between the toes.
• Use mild soap.
• Be careful about adding oils to bath water. They can make your feet and the bathtub both very slippery.

True

270

ABNORMAL FINDINGS ------------------------------------------------------------------------

M

271

Hard to palpate, need to search for it, may fade in and out, easily obliterated by pressure. Decreased cardiac output, peripheral arterial disease, aortic valve stenosis
A)Weak, "Thready" Pulse--1 +
B)Full, Bounding Pulse-3+

A

272

Easily palpable, pounds under your fingertips.Hyperkinetic states (exercise, anx.iety, fever), anemia, hyperthyroidism
A)Full, Bounding Pulse-3+
B)Water-Hammer (Corrigan) Pulse-3+

A

273

Greater than normal force, then collapses suddenly. Aortic valve regurgitation, patent ductus arteriosus
A)Water-Hammer (Corrigan) Pulse-3+
B)Pulsus Bigeminus Rhythm

A

274

Rhythm is coupled, every other beat comes early, or normal beat followed by premature beat. Force of premature beat is decreased because of shortened cardiac filling time. Conduction disturbance (e.g., premature ventricular contraction, premature atrial contraction)
A)Pulsus Bigeminus
B)Pulsus Alternans

A

275

Rhythm is regular, but force varies with alternating beats of large and small amplitude. When heart rate (HR) is normal, pulsus alternans occurs with severe left ventricular failure, which in turn is due to ischemic heart disease, valvular heart disease, chronic hypertension, or cardiomyopathy
A)Pulsus Alternans
B)Pulsus Paradoxus

A

276

Beats have weaker amplitude with inspiration, stronger with expiration. Best determined during blood pressure measurement; reading decreases (>10 mm Hg) during inspiration and increases with expiration. A common finding in cardiac tamponade (pericardia] effusion in which high pressure compresses the heart and blocks cardiac output); also in severe bronchospasm of acute asthma
A)Pulsus Paradoxus
B)Pulsus Bisferiens

A

277

Each pulse has two strong systolic peaks, with a dip in between. Best assessed at the carotid artery. Aortic valve stenosis plus regurgitation
A)Pulsus Bisferiens
B)none

A

278

ABNORMAL FINDINGS FOR ADVANCED PRACTICE

,

279

Peripheral Vascular Disease in the Arms

,

280

Episodes of abrupt, progressive tricolor change of the fingers in response to cold, vibration, or stress:
(1) white (pallor) in top figure from arteriospasm and resulting deficit in supply;
(2) blue (cyanosis) in lower figure from slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of hemoglobin;
(3) finally, red (rubor) in heel of hand due to return of blood into the dilated capillary bed or reactive hyperemia.
A)Raynaud's Phenomenon
B)edema

A

281

May have cold, numbness, or pain along with pallor or cyanosis stage; then burning, throbbing pain, swelling along with rubor. Lasts minutes to hours; occurs bilaterally. Several drugs predispose to the episodes, and smoking can increase the symptoms.
A)Raynaud's Phenomenon
B)Lymphedema

A

282

is high-protein swelling of the limb, most commonly due to breast cancer treatment. Surgical removal of lymph nodes or damage to lymph nodes and vessels with radiation therapy impedes drainage of lymph. Protein-rich lymph builds up in the interstitial spaces, which further raises local colloid oncotic pressure and promotes more fluid leakage. Stagnant lymphatic fluid increases risk for infection, delayed wound healing, chronic inflammation, and fibrosis of surrounding tissue.
A)Lymphedema
B)edema

A

283

Lymphedema after breast cancer is common (42%) 13 but usually mild. Early symptoms include self-reported sensations of a tired, thick, heavy arm, jewelry too tight, swelling, or tingling. Objective data include a unilateral swelling, nonpitting brawny edema, with overlying skin indurated. Early recognition is important because there is evidence to support effective interventions, such as complete decongestive physiotherapy, compression bandaging, and others.
18 Without treatment, lymphedema is chronic and progressive, which is psychologically demoralizing as a threat to body image and constant reminder of the cancer.
A)true
B)false

A

284

Pain Profiles of Peripheral Vascular Disease

,

285

Arterial disease causes symptoms and signs of oxygen deficit.
A)true
B)false

A

286

Chronic Arterial Symptoms

,

287

>Deep muscle pain, usually in calf, but may be lower leg or dorsum of foot
>Intermittent claudication, feels like "cramp," "numbness and tingling," "feeling of cold" >Chronic pain, onset gradual after exertion >Activity (walking, stairs); "Claudication distance" is specific number of blocks, stairs it takes to produce pain
>Elevation (rest pain indicates severe involvement)
>Rest (usually within 2 min [e.g., standing]) >Dangling (severe involvement) Cool, pale skin >Older adults, more males than females, inherited predisposition, history of hypertension, smoking, diabetes, hypercholesterolemia, obesity, vascular disease
A)Chronic Arterial Symptoms
B)Acute Arterial Symptoms

A

288

Acute Arterial Symptoms

,

289

>Varies, distal to occlusion, may involve entire leg
>Throbbing Sudden onset (within 1 hr)
>Six Ps: pain, pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis (indicates severe)
>History of vascular surgery; arterial invasive procedure; abdominal aneurysm (emboli); trauma, including injured arteries; chronic atrial fibrillation
A)Acute Arterial Symptoms
B)none

A

290

Venous disease causes symptoms and signs of metabolic waste buildup.
A)true
B) false

A

291

>Calf, lower leg
>Aching, tiredness, feeling of fullness
>Chronic pain, increases at end of day >Prolonged standing, sitting
>Elevation, lying, walking
>Edema, varicosities, weeping ulcers at ankles Job with prolonged standing or sitting; obesity; pregnancy; prolonged bed rest; history of heart failure, varicosities, or thrombophlebitis; veins crushed by trauma or surgery
A)Chronic Venous Symptoms
B)acute venous symptoms

A

292

>Calf Intense, sharp; deep muscle tender to touch
>Sudden onset (within 1 hr)
>Pain may increase with sharp dorsiflexion of foot
>Red, warm, swollen leg
A)Acute Venous Symptoms
B)none

A

293

Leg Ulcers: Arterial, Venous, or Diabetic

,

294

Chronic Arterial Insufficiency

A

295

Buildup of fatty plaques on intima (atherosclerosis) plus hardening and calcification of arterial wall (arteriosclerosis).
S: Deep muscle pain in calf or foot, claudication (pain with walking), pain at rest indicates worsening of condition.
0: Coolness, pallor, elevational pallor, and dependent rubor; diminished pulses; systolic bruits; signs of malnutrition (thin, shiny skin; thick-ridged nails; atrophy of muscles); distal gangrene.
Ulcers occur at toes, metatarsal heads, heels, lateral ankle, and are characterized by pale ischemic base, well-defined edges, and no
bleeding.
A)Arterial-Ischemic Ulcer
B)none

A

296

Chronic Venous Insufficiency

,

297

Ulcer After acute deep vein thrombosis or chronic incompetent valves in deep veins.
S: Aching pain in calf or lower leg, worse at end of the day, worse with prolonged standing or sitting.
0 : Firm, brawny edema; coarse, thickened skin; pulses normal; brown pigment discoloration; petechiae; dermatitis.
-Venous stasis causes increased venous pressure, which then causes red blood cells (RBCs) to leak out of veins and into the skin.
--The RBCs break down and leave hemosiderin (iron deposits) behind, which are the brown pigment deposits. A weepy, pruritic stasis dermatitis may be present.
>Ulcers occur at medial malleolus and are characterized by bleeding, uneven edges.
A)Venous (Stasis)
B)none

A

298

Diabetes hastens changes described with ischemic ulcer, with generalized dysfunction in all arterial areas: peripheral, coronary, cerebral, retina, kidney. Peripheral involvement is associated with diabetic neuropathy. Without careful vigilance of pressure points on the feet, ulcer may go unnoticed. Pain and sensation are decreased, and surrounding skin is calloused.
A)true
B)false

A

299

________hastens changes described with ischemic ulcer, with generalized dysfunction in all arterial areas: peripheral, coronary, cerebral, retina, kidney. Peripheral involvement is associated with diabetic neuropathy. Without careful vigilance of pressure points on the feet, ulcer may go unnoticed. Pain and sensation are decreased, and surrounding skin is calloused.

Diabetes

300

Peripheral Vascular Disease in the Legs

,

301

Chronic Venous Disease

,

302

Incompetent valves permit reflux of blood, producing dilated, tortuous veins. Unremitting hydrostatic pressure causes distal valves to be incompetent and causes worsening of the varicosity. Over age 45 years, occurrence is three times more common in women than in men.
S: Aching, heaviness in calf, easy fatigability, night leg or foot cramps.
0 : Dilated, tortuous veins.
A)Superficial Varicose Veins
B)none

A

303

Acute Venous Disease

,

304

A deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema. Virchow's triad is the classic 3 factors that promote thrombogenesis: stasis, hypercoagulability, and endothelial dysfunction.Cause may be prolonged bed rest; history of varicose veins; trauma; infection; cancer; and, in younger women, the use of oral estrogenic contraceptives. Requires emergency referral because of risk for pulmonary embolism. Note that upper-extremity DVT is increasingly common due to frequent use of invasive lines such as central venous catheters.
A)Deep Vein Thrombophlebitis (DVT)
B)ulcers

A

305

S: Sudden onset of intense, sharp, deep muscle pain; may increase with sharp dorsiflexion of foot.
0 : Increased warmth; swelling (to compare swelling, observe the usual shoe size as in above photo); redness; dependent cyanosis is mild or may be absent; tender to palpation; Homan sign is present only in few cases.
A)Deep Vein Thrombophlebitis (DVT)
B)none

A

306

Peripheral Artery Disease

,

307

_________in the arteries are caused by atherosclerosis, which is the chronic gradual buildup of (in order) fatty streaks, fibroid and thrombus formation. This reduces blood flow with vital oxygen and nutrients. Risk factors for atherosclerosis include obesity, cigarette smoking, hypertension, diabetes mellitus, elevated serum cholesterol, sedentary lifestyle, and family history of hyperlipidemia.
A)Occlusions
B)anyerisum

A

308

An_________ is a sac formed by dilation in the artery wall. Atherosclerosis weakens the middle layer (media) of the vessel wall. This stretches the inner and outer layers (intima and adventitia), and the effect of blood pressure creates the balloon enlargement. The most common site is the aorta, and the most common cause is atherosclerosis. The incidence increases rapidly in men older than 55 years and women older than 70 years; the overall occurrence is four to five times more frequent in men.
A)aneurysm
B)heart failure

A

309

Summary Checklist: Peripheral Vascular Examination

,

310

1- Inspect arms for color, size, any
2- Palpate pulses: radial, brachial.
3- Check epitrochlear node.
4- Inspect legs for color, size, any lesions, trophic skin changes.
5- Palpate temperature of feet and legs
6- Palpate inguinal nodes.
7- Palpate pulses: femoral, popliteal, posterior tibial, dorsalis pedis.

True

311

EXTRA INFORMATION

,

312

one of the legs deep veins is the
A)popliteal
B)tibial

A

313

the femoral and popliteal veins are the deep veins of the body
A)true
B)false

A

314

beats have weaker amplitude with inspiration and stronger with expiration
A)pulsus paradoxus
B)pulsus bigeminus

A

315

the rhythm is irregular and coupled, every other beat comes early or premature
A)pulsus bigeminus
B)nomne

A

316

a weak and thready pulse may result in deficiency of arrterial blood to a body part
A)true
B)falseee

A

317

the rhythm is regular but the force varies with alternating beats of large and small amplitude
A)pulsus alternans
B)none

A

318

the swelling of an extremity caused by an obstructed lymph channel

lymphedema

319

a water hammer "corrigan" pulse is associated with
A)aortic valve regurgitation
B)none

A

320

hyperkinetic states occurs with full bonding pulse
A)TRUE
B)FLASE

A

321

DECREASED CARDIC OUTPUT OCCURS WITH WEAAK TREADY PULLSE
A)TRUEE
B)FALSE

A

322

pulsus bigeminus occurs with conduction disturbance
A)true
B)false

A

323

claudication is caused by
A)arterial insufficiency
B)None

A

324

the patient has severe bilateral lower extremity edema, the most likely cause is.
A)heart failure
B)an aortic aneurysm

a

325

What creates the pressure gradient that regulates blood flow in the venous system? Select all that apply.

Select all that apply:
A
Cardiac output
B
Activity level
C
Intraluminal valves
D
Skeletal muscle contraction
E
Respiration

C D E

326

A patient with hypertension is at increased risk of what? Select all that apply.

Select all that apply:
A
Abdominal aneurysms
B
Deep vein thrombosis
C
Cerebrovascular disease
D
Varicose veins
E
Lower-extremity PAD

A C E

327

Symptoms of complete arterial occlusion include what? Select all that apply.

Select all that apply:
A
Pain
B
Erythema
C
Color change
D
Heat
E
Numbness

A C E

328

Which vessels return the lymph fluid to circulation?

Choose one of the following
A
Epitrochlear ducts
B
Internal jugular ducts
C
Infraclavicular ducts
D
Thoracic ducts

D

329

A patient with a venous occlusion will have pain, edema, and warmth of the affected extremity.

Choose one of the following
A
True
B
False

A

330

The nurse is assessing a patient with diabetes for PAD. This patient's risk of PAD is how many times that of the normal population?

Choose one of the following
A
4 times
B
2 times
C
3 times
D
5 times

A

331

Healthy People goals, although not specific for peripheral vascular disease, focus on areas of risk. What are these areas of modifiable risk? Select all that apply.

Select all that apply:
A
Family history
B
Ethnicity
C
Overweight
D
Smoking
E
Lack of exercise

C D E

332

Blood pressure is controlled in the arterioles.

Choose one of the following
A
True
B
False

A

333

Raynaud's phenomenon and Raynaud's disease are_________ disorders that predominantly affect women.

vasospastic

334

Calcification of the arteries causes them to become more rigid in older adults.
A)true
B)false

A

335

Aortic aneurysms are seen with what congenital disorder?

Choose one of the following
A
Marfan's syndrome
B
Chronic lymphadenopathy
C
Raynaud's disease
D
PAD

A

336

The six Ps of peripheral arterial occlusion include what?

Choose one of the following
A
Piloerection
B
Paresthesia
C
Pilonidal
D
Pilocarpine

B

337

A patient with hypovolemia would be expected to have a weak pulse.

Choose one of the following
A
True
B
False

A

338

Veins often are referred to as capacitance vessels, because they can stretch and accommodate large volumes of fluid.
A)true
B)false

A

339

Veins often are referred to as _________, because they can stretch and accommodate large volumes of fluid.

capacitance vessels

340

PAD, the most prevalent vascular disease, has been found highest in what genders and ethnicities? Select all that apply.

Select all that apply:
A
African American women
B
Native American men
C
Mexican American men
D
African American men
E
Native American women
F
Mexican American women

A D F

341

The veins of the upper extremities drain directly into the right atrium.

Choose one of the following
A
True
B
False

B

342

The most common cause of arterial diseases is arteriosclerosis.

Choose one of the following
A
True
B
False

B

343

Arterial diseases involve narrowing of the vessels, weakening of the vessel walls, and thrombus formation. Risk factors are the same as for coronary artery disease (CAD): smoking, diabetes, hypertension, hypercholesterolemia, and family history of arterial problems. Atherosclerosis is the most common cause of these disorders.
A)true
B)false

A

344

Pulsus paradoxus occurs with pericardial tamponade, constrictive pericarditis, and obstructive lung disease.
A)true
B)false

A

345

The Trendelenburg test allows for evaluation of the saphenous vein valves and retrograde filling of the superficial veins.
A)true
B)false

A

346

Older adults tend to get arteriosclerosis. What is the cause of this disease process?

Choose one of the following
A
Low LDL
B
Plaque buildup in the arteries
C
Calcification of the arteries
D
High-fat diets

C