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Definition
veins drain the deoxygenated blood and tis waste products from the tissues and return it to the heart. its a low pressure system, do not have a pump to generate their blood flow, the veins need a mechanism to keep blood moving. this is accomplished by
1. the contracting skeletal muscles
2. pressure gradient caused by breathing, in which inspiration makes the thoracic pressure decrease and the abdominal pressure increase
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 back flow of blood.
-venous structure differs from arterial structure. walls of teh veins are thinner, have a larger diameter and are more distensible, they can expand and hold more blood when blood volume increases.
-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. at risk for venous disease are ppl who undergo prolonged standing, sitting or bed rest, bc they do not benefit from the milking action that walking accomplishes |
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Lymphatics: form a completely separate vessel system, which retrieves excess fluid from the tissue spaces and returns it to the bloodstream. during circulation, the blood pressure pushes somewhat more fluid out of the capillaries than the veins can absorb. without lymphatic drainage, fluid would build up in the interstitial spaces and produce edema.
the vessels converge and drain into two main trunks, which empty into the venous system
1. right lymphatic duct empties into right subclavian vein. drains the right Side of the head, neck, right arm, right side of the thorax, right lung and pleura, right side of the heart, and right upper section of the liver.
the functions of the lymphatic system are
1. 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
3. the absorb lipids from the intestinal tract
the lymphatic vessels have a unique structure. capillaries start as microscopic open ended tubes, which siphon interstitial fluid. the capillaries converge to form vessels. the vessles, drain into larger ones. the vessels ahve valves, so flow is unidirectional from tissue spaces into the bloodstream. look beaded. lymph flow is propelled by contracting skeletal muscles, by pressure changes secondary to breathing, and by contraction of vessel walls themselves |
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lymph nodes: filter the fluid before it is returned to the bloodstream and filter out microorganisms that could be harmful o the body. the pathogens are exposed ba dn t lymphocytes in the lymph nodes. the lymphocytes mount an antigen-specific response to eliminate pathogens. with local inflammation, the nodes in that are become swollen and tender.
epitrochlear node is in the antecubital fossa and drains the hand and lower arm. |
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spleen located in upper left quadrant of abdomen has 4 functions
1. destroy old RBCs
2. produce antibodies
3. store RBCs
4. filter microorganisms from the blood
tonsils- repsond to local inflammation
thymus- important in developing t-lymphocytes and maturation of b-lymphocytes |
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| Arteriosclerosis- peripheral blood vessels grow more rigid with age resulting in a condition called arteriosclerosis. this condition produces the rise in systolic bp |
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| Atherosclerosis: or the deposition of fatty plaques on the intima of the arteries. |
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| claudication distance: is the nubmer of blocks walled or stairs climbed to produce pain. note sudden decrease in claudication distance or pain not relieved by rest. |
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subjective data
1. leg pain or cramps
2. skin changes on arms or legs
3. swelling
4. lymph node enlargement
5. medications |
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| edema: is bilateral when cause is generalized (heart failure) or unilateral when it is the result of a local obstruction or inflammation |
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| inspect and palpate teh upper extremities |
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Definition
-check profile sign to detect clubbing
-assess skin, turgor, temp, texture, nail beds, lesions, edema.
-test capillary refill
-check epitrochlear node
-palpate radial pulses noting rhythm, elasticity of vessel wall and equal force
Abdnormal:
-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.
-Edema of the upper extremities occurs when lymphatic drainage is obstructed which may occur after breast surgery. |
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3 point scale grade the force of amplitude of pulse
3+ increased, full, bounding
2+ normal
1+ weak
0 absent
Abnormal: full bounding pulse (3+) occurs with hyperkinetic states, anemia, and hyperthyroidism.
weak "thready" pulse (1+) occurs with shock and peripheral arterial disease |
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Definition
Epitrochlear node: is in the antecubital fossa and drains the hand and lower arm.
-Check epitrochlear lymph nodes in the depression above and behind the medial condyle of 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 media epicondyle
Abnormal: and enlarge epitrochlear node occurs in infection of the hand or forearm.
epitrochlear nodes occur in conditions of generalized lyphodenopathy: lymphoma, chronic lymphocytic leukemia, sarcoidosis, infections, mononucleosis |
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| Doppler: laser doppler give a quantifiable measurement of blood flow that is recordable and reproducible. a small, flat probe is taped o the palm the palm at the end of the patient's index finder. a baseline value for blood flow is recorded and then compared for change when the two arteries are occluded |
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| Inspect and palpate the legs |
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Definition
Inspect and palpate the legs: both legs should be symmetric in size without swelling or atrophy. if the lower legs look asymmetric or if DVT i suspected measure the calf circumference with a non stretchable tape measure. measure at the widest point, taking care to measure the other let in exactly the same place- the same number of centimeter don from the patella or other land mark. if lyphodema is suspected, measure also at the ankle, distal calf, knee and thigh. record in cm.
Abnormal: diffuse bilateral edema occurs with systemic illnesses.
Acute, unilateral, painful swelling and asymmetry of calves of 1 cm or more is abnormal; refer the person to determine whether DVT is pesent
asymmetry of
1 -3 cm mild lymphedema
3-5 moderate lymphedema
more than 5 cm with severe lymphedema
-brown discoloration occurs with chronic venous stasis due to hemosiderin deposits form RBC degradation
Palpate for temperature: should be warm and equal bilaterally. if any increase in temp is present higher up in the left, note if it is gradual or abrupt.
Abnormal: unilateral cool foot or leg or a sudden drop in temperature as you move down the leg occurs with arterial deficit.
with arterial deficit, ulcers occurs on tips of toes, metatarsal heads and lateral malleoli.
venous ulcers occur usually at medial malleolus c of bacterial invasion of poorly drained tissues. |
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Flex the persons knee, and then gently compress the 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
Abnormal:calf pain in these maneuvers is a positive Homan sign, which occurs in about 35% of cases of DVT. but it i not specific for this condition |
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Checing for pretibial edema:
firmly press the skin over the tibia or 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
Abnormal: bilateral, dependent pitting edema occurs with heart failure, diabetic neuropathy and hepatic cirrhosis.
if pitting edema is present, grade it on the following scale
1+ mild pitting, slight indentation, no perceptible swelling of 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
Abnormal: unilateral edema occurs with occlusion of a deep vein. unilateral or bilateral edema occurs with lymphatic obstruction. with these factors it is "brawny" or non-pitting and feels hard tot he touch |
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Abnormal Color changes:
elevational pallor (marked) indicated arterial insufficiency
dependent rubor (deep blue-red color) occurs with severe arterial insufficiency. chronic hypoxia produces a loss of vasomotor tone and a pooling of blood in the veins
delayed venous filling occurs with arterial insufficiency |
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| Doppler ultrasonic stethoscope |
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Definition
Doppler ultrasonic stethoscope:
use this device to detect weak peripheral pulse, to monitor bp in infants and ids or to measure a low bp or blood pressure in a lower extremity. the doppler stem magnifies pulsatile sounds from the heart and blood vessels. position the person supine, with 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 transducer over a pulse site at a 90 degree angle. apply very light pressure; locate the pulse site by the swishing, whooshing sound. |
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Pulsus Paradoxus: beats have weaker amplitude with inspiration, stronger with expiration. best determined during BP measurement; readin decreases .10 mmhg during inspiration and increases with expiration.
-common finding in cardiac tamponade ( pericardial effusion in which high pressure compresses the heart and blocks cardiac output), also in severe bronchospasm of acute asthma |
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Definition
Lymphedema: 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 firbsis of surrounding tissue.
symptoms: sensations of tired, thick, heavy arm, jewelry too tight, swelling or tingling.
objective data: unilateral swelling, nonpitting brawny edema with overlying skin indurated. early recognition is imporant bc there is evidence to support effective intervention, sucha s complete decongestive physiotherapy, compression bandaging, etc.
without treatment, lyphedema is chronic and progressive, which is psychologically demoralizing as a threat to body image and constant reminder of cancer |
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Definition
DVT: a deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis and edema. Virchow's triad is the classic 3 ffactors that promote thrombogenesis:
stasis
hypercoagulability
endothelial dysfunction
cause may be prolonged bed rest, history of varicose veins, trauma infection, cancer and use of contraceptives.
requires emergency referral bc of risk for pulmonary embolism. note the upper extremity DVT is increasingly common due to frequent use of invasive lines as central venous catheters.
Subjective: sudden onset of intense, sharp deep muscle pain; may increase with sharp dorsiflexion of foot
Objective: increased warmth; swelling, redness, dependent cyanosis is mild or may be absent; tender to palpation. homan sign is present in some cases. |
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Definition
Occlusion: in the arteries are caused by athelerosclerosis, which is the chronic gradual build of
fatty streaks
fibroid plaque
calcification of vessel wall
and thrombus formation.
this reduces blood flow with vital oxygen and nutrients
risk factors for artherosclerosis include:
obesity
smoking
hypertension
DM
Elevated serum cholesterol
sedentary lifestyle
family history of hyperlipidemia |
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Definition
Aneurysm: is a sac formed by dilation int the artery wall. athelerosclerosis 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 created 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 yrs and women older than 70; overall the occurrence is 4-5 times more frequent in men.
thoracic aneurysm
aortic arch aneurysm
abdominal aortic aneurysm
femoral aneurysm
popliteal aneurysm |
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Term
PVD: symptoms of Arterial disease
chronic
acute
location
character
onset and duration
aggravating factors
alleviating factors
associates symptoms
those at risk |
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Definition
Chronic arterial symptoms: arterial disease symptoms cause symptoms and signs of oxygen deficit
location:deep muscle pain in calf lower leg or dorsum of foot.
character: intermittent claudications, cramp, numbness, tingling, feeling of cold
onset and duration: chronic pain, onset grdual after exertion
aggravating factors: activity and elevation
alleviating factors: rest,dangling
associated symptoms: cool, pale skin
those at risk: older adults, males, inherited predisposition, hypertension, smoking, diabetes, hypercholesterolemia, obesity, vascular disease.
Acute arterial symptoms:
location: varies
character: throbbing
Onset and duration: sudden onset (1hr)
asociated symptoms: Six P's: pain, pallor, pulselessness, parasthesia, poikilothermis (coldness), paralysis (severe)
those at risk: hist of vascular surgery, arerial invasive procedure, abdominal aneurysm (emboli), trauma, including injured arteries, chronic atrial fibrillation |
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Term
PVD: Symptoms of Venous Disease
chronic
acute
location
character
onset and duration
aggravating factors
relieving factors
associated symptoms
those at risk |
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Definition
Venous Sysmptoms: Venous disease cause symptoms and signs of metabolic waste build up
Chronic Venous symptoms:
location: calf, lower leg
character: aching tiredness, feeling of fullness
onset and duration: chronic pain, increases at the end of the day
aggravating factors: prolonged standing, sitting
relieving factors: elevation, lying, walking
associated symptoms: edema varicosities, weeping ulcers at ankles.
those at risk: job with prolonged standing or sitting, obesity, pregnancy, prolonged bed rest, history of heart failure, varicosities, or thrombophlebitis, veins crushed by trauma or surgery.
Acute venous symptoms:
location: calf
character: intense, sharp, deep tender touch
onset and duration: sudden onset (1hr)
aggravating factors: pain may increase with share dorsiflexion of foot.
associated symptoms: res, swollen, warm leg |
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