Term
| What does the vascular system consist of? |
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Definition
Vascular system consist of vessels of the body for transporting blood and lymph.
Any disease in the vascular system creates problems w/ delivery of oxygen and nutrients to the tissues or elimination of carbon dioxide and waste products from cellular metabolism. |
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Term
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Definition
Arteries transport oxygenated blood to all body tissues.
Arteries walls are strong and contain elastic fibers that allow the walls to stretch with systole and recoil with diastole.
Arteries contain muscle fibers (vascular smooth muscle) which controls the amount of blood delivered to the tissues.
Muscle fibers contract or dilate to control the rate of blood flow.
With each heartbeat the arteries expand and recoil propelling blood through like a wave – this is the pulse felt in arteries close to the skin over bones. |
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Term
| What are the big arteries? |
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Definition
Temporal artery
Carotid artery |
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Term
| What are the arteries of the arm? |
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Definition
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Term
| What are the arteries of the leg? |
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Definition
Femoral
Popliteal
Dorsalis pedis
Posterior tibial |
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Term
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Definition
| a deficient supply of oxygenated blood to a tissue caused by obstruction of a blood vessel. |
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Term
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Definition
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Term
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Definition
Veins are parallel to the arteries and are closer to the skin surface.
Veins drain the deoxygenated blood and waste products from the tissues and return it to the heart. |
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Term
| What are the veins of the arm? |
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Definition
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Term
| What are the deep veins of the legs? |
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Definition
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Term
| What are the superficial veins of the legs? |
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Definition
Great saphenous
Small saphenous |
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Term
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Definition
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Term
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Definition
Low pressure system, have no pump to propel this blood back to the heart.
? How does this happen
The contracting skeletal muscles milk to blood proximally back toward the heart.
thorasic pressure caused by breathing makes the thoracic pressure decrease and the abdominal pressure increase
the intraluminal valves ensure unidirectional flow-prevent backflow of blood. |
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Term
| What are the Compensatory mechanisms of veins to reduce stress on the heart? |
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Definition
Veins are thinner
Have larger diameter
They can expand and hold more blood when blood volume increases. |
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Term
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Definition
Vessel system that retrieves excess fluid from the tissue spaces & returns it to the blood stream
During circulation, the BP pushes more fluid out of the capillaries than the veins can handle.
Without lymphatic drainage fld would build up in the interstitial spaces and produce edema. |
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Term
| What is the right lymphatic duct? |
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Definition
Empties into the Rt subclavian vein
Drains Rt side of: head, neck, arm, thorax, lung & pleura, heart, and upper section of liver |
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Term
| What is the thoracic duct? |
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Definition
Empties into the Lt subclavian vein
Drains everything else |
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Term
| What are the functions of the lymphatic system? |
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Definition
Conserve fluid & plasma proteins that leak out of the capillaries
Form a major part of the immune system that defends the body against disease
Absorb lipids from the intestinal track |
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Term
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Definition
Small oval clumps of lymphatic tissue located at intervals along the vessels
Filter fluid & remove microorganisms before it is returned to the bloodstream
Lymphocytes located in nodes, mount an immune response to eliminate pathogens
Localized inflammation occurs & nodes become swollen & tender |
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Term
| What do cervical nodes drain? |
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Definition
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Term
| What do axillary nodes drain? |
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Definition
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Term
| What do epitrochilear nodes drain? |
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Definition
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Term
| What do inguinal nodes drain? |
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Definition
| Lower extremities, external genitalia, anterior abdominal wall |
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Term
| What organs are apart of the lymphatic system? |
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Definition
| spleen, tonsils, and thymus |
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Term
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Definition
Spleen
Located in LUQ of abdomen
Functions:
Destroy old RBCs
Produce antibodies
Store RBCs
Filter microorganisms from the blood |
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Term
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Definition
Tonsils
Palantine, adenoid, lingual
Located at the entrance to the respiratory & GI tracts
Respond to local inflammation |
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Term
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Definition
Thymus
Located in the superior mediastinum in front of aorta
Large in young children, atrophies after puberty
Important in the developing the T lymphocytes of the immune system in children, but serves no function in adults
T & B lymphocytes originate in bone marrow, matures in lymphoid tissue |
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Term
| What subjective health history questions should you ask when assessing the vascular system? |
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Definition
Leg pain or cramps
Any? Where?
Claudication – leg pain that occurs when walking, relieved by rest
Skin changes on arm or legs
Any? What color: redness, pallor, blueness, brown discolorations?
Swelling
Swelling in one or both legs? When did this swelling start? Time of day?
Lymph node enlargement
Any “swollen glands” (lumps, kernels)? Where in body? How long have you had them?
Medications
What medications are you taking (e.g., oral contraceptives, hormone replacement)? |
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Term
| What are you looking for when inspecting and palpating the arms? |
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Definition
Skin
Profile sign
Clubbing
Capillary refill
Nml < 3 seconds
Symmetry
Radial pulse
Ulnar pulse
Brachial pulse
Modified Allen test
Depress radial & ulnar arteries
Have pt open/close fist
Release ulnar artery
Nml – Blood returns via ulnar artery
No blood return =occlusion
Do before ABG |
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Term
| When inspecting the skin, what are you looking for? |
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Definition
| note color of skin and nailbeds; temp, texture and turgor, lesions, edema, |
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Term
| When you see clubbing, what does this mean? |
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Definition
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Term
| What does capillary refill less than 3 seconds mean? |
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Definition
| vasoconstrictionor decreased CO; HF, hypovolemia, shock |
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Term
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Definition
3+ increased, full bounding- exercise
2+ normal
1+ weak- shock
0 absent- occlusion |
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Term
| When inspecting and palpating the legs, what are you looking for? |
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Definition
Skin and hair
Symmetry
Temperature
Calf muscle
Homan’s sign (not reliable)
Flex knee
Sharply dorsiflex foot toward tibia
If calf pain present, + Homan’s sign
Suggestive of DVT
Inguinal lymph nodes
Femoral pulse
Popliteal pulse
Posterior tibial pulse
Dorsalis pedis pulse
Pretibial edema
Leg veins |
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Term
| When inspecting skin, what are you looking for? |
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Definition
Skin color, hair distribution, venous pattern, edema or atrophy, skin lesions or ulcers.
Skin will be pale with vasoconstriction; or erythema with vasodilation; or cyanosis
Malnutrition, pallor, and coolness are r/t arterial insufficiency |
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Term
| When looking at venous pattern, what should you notice? |
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Definition
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Term
| What if the legs are not symmetrical? |
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Definition
| if not, may be r/t DVT, lymphedema |
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Term
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Definition
1+ mild
2+ moderate, pitting subsides rapidly
3+ Deep pitting, indentation remains for short time, leg looks swollen
4+ Very deep pitting, last long time, leg is grossly swollen and distorted. |
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Term
| What additional techniques are used when physically examining vasculature? |
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Definition
Manual compression test
Color changes
Doppler ultrasonic stethoscope
Test strength and sensation in lower extremities |
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Term
| How do you test for color changes? |
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Definition
test for arterial insufficiency: elevate leg 12 inches off table, wag feet 30 sec. skin should still be pink. If deep blue-red color+ severe arterial insufficiency.
Ask pt to hang legs over side of table, compare color of feet, note time for color to return should be 10 sec. or less |
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Term
| What does manual compression test for? |
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Definition
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Term
| What does severe arterial deficit mean? |
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Definition
| motor loss; sensory loss occurs with arterial deficit especially DM. |
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Term
| What developmental considerations should be made for infants and childreN? |
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Definition
Transient acrocyanosis (symmetric, hands/wrists, feet/ankles) & mottling may occur at birth
Palpable lymph nodes occur often
Small, firm, mobile & nontender are normal |
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Term
| What developmental considerations should be made for preggers? |
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Definition
Pitting edema
Varicose veins |
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Term
| What developmental considerations should be made for old people? |
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Definition
Pedal pulses diminished
Thin, shiny skin; decreased hair distribution on legs, thick-rigid nails
Suggestive of arterial dz |
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Term
| What are abnormal variations in arterial pulse? |
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Definition
Weak, “thready” pulse – 1+
Full, bounding pulse – 3+
Water-Hammer (Corrigan’s) pulse – 3+ (collapses suddenly)
Pulsus bigeminus
Pulsus alternans
Pulsus paradoxus
Pulsus bisferiens |
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Term
| What is pulsus big minus? |
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Definition
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Term
| What is pulsus alternans? |
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Definition
| Regular pulse but force varies |
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Term
| What is pulsus paradoxes? |
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Definition
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Term
| What is pulses bisferieins? |
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Definition
| There is a double pulse felt due to the backflow of blood in early diastole. |
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Term
| What are peripheral vascular diseases in the arms? |
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Definition
Raynaud’s syndrome- response to cold blue, white, red fingers
Lymphedema-high protein swelling of limb, CA |
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Term
| What is raynaud's syndrome? |
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Definition
| tricolor change of the fingers in response to cold, vibration, or stress; can be blue, white or red, painful, burning, lasting minutes to hours, bilaterally. R/t medication, or smoking can increased symptoms |
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Term
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Definition
Lymphedema- high-protein swelling of the limb, r/t breast cancer treatment. Protein-rich lymph builds up in the interstitial spaces, promotes more fluid leakage. Increases risk for infection, delayed wound healing, chronic inflammation, and fibrosis of surrounding tissues.
Tx: early recognition, effective interventions: complete decongestive physiotherapy, compression bandaging. |
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Term
| What are peripheral vascular diseases in the legs? |
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Definition
Arteriosclerosis—ischemic ulcer
Venous (stasis) ulcer
Superficial varicose veins
Deep vein thrombophlebitis |
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Term
| What are other general peripheral vascular diseases? |
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Definition
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Term
| What are the 3 stages of raynaud's? How does it occur? |
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Definition
Episodes of abrupt progressive tricolor change of the fingers in response to cold, vibration or stress
1st white (pallor)
Arteriospasm & resulting deficit in blood supply
2nd blue (cyanosis)
Slight relaxation of the spasm allowing trickle of blood through capillaries & O2 extraction from hgb
3rd red (rubor)
Return of blood into dilated capillary bed or reactive hyperemia
Bilaterally |
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Term
| What pain is associated with raynauds? |
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Definition
Cold, numbness, pain w/pallor or cyanosis
Burning, throbbing pain, swelling w/rubor
Lasts minutes to hours |
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Term
| What is the pathophysiology of lymphedema? |
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Definition
Occurs after removal of lymph nodes w/breast surgery or damage to lymph nodes/channels w/radiation; impedes drainage
Lymph builds up in interstitial spaces
Stagnant lymphatic fluid can lead to infection, delayed wound healing, chronic inflammation
Chronic lymphedema – unilateral swelling, nonpitting edema
Psychologically demoralizing |
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Term
| What is Arteriosclerosis? Where do they occur? |
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Definition
| An ischemic ulcer. Ulcers occur on toes, metatarsal heads, heels, lateral ankle |
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Term
| What are the characteristics of an arteriosclerosis? |
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Definition
| Characterized by pale ischemic base, well-defined edges, no bleeding |
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Term
| What are the symptoms of arteriosclerosis? |
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Definition
| Coolness, pallor, elevational pallor, dependent rubor, diminished pulses, distal gangrene |
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Term
| Who often has arteriosclerosis? |
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Definition
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Term
| Where do venous (stasis) ulcers occur? |
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Definition
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Term
| How are venous ulcers characterized? |
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Definition
| Characterized by bleeding, uneven edges |
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Term
| What are the symptoms of a venous ulcer? |
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Definition
| Edema, coarse thick skin, brown pigment discoloration, petechiae, dermatitis |
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Term
| When do venous ulcers usually occur? |
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Definition
| Occurs after acute DVT or chronic incompetent valves in deep veins |
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Term
| What are superficial varicose veins? |
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Definition
| Incompetent valves permit reflux of blood, producing dilated, tortuous veins |
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Term
| What age has an increased incidence of vv? |
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Definition
| Over age 45, occurrence is 3x more common in women than men |
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Term
| What are the symptoms of VV? |
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Definition
| c/o aching, heaviness in calf, night leg/foot cramps |
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Term
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Definition
Deep vein occluded by a thrombus
Causes inflammation, blocked venous return, cyanosis & edema |
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Term
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Definition
| Caused by prolonged bed rest, varicose veins, trauma, infection, cancer & oral contraceptive use |
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Term
| What are the symptoms of DVT? |
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Definition
| Warmth, swelling, redness, tender, + Homan’s in some pts |
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Term
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Definition
| Requires emergency referral d/t risk of pulmonary embolism |
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Term
| What are occlusions caused by? |
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Definition
Caused by atherosclerosis
Chronic gradual build up of fatty streaks, fibroid plaque, calcification of the vessel wall & thrombi |
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Term
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Definition
| Reduces blood flow w/vital oxygen/nutrients |
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Term
| Who is at risk for an occlusion? |
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Definition
Obesity
Smoking
HTN, DM
Hyperlipidemia
Sedentary lifestyle
Family hx |
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Term
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Definition
Sac formed by dilation in the artery wall
Stretching the inner & outer layers creating a balloon type enlargement |
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Term
| What is the most common site for an aneurysm? |
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Definition
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Term
| What is the most common cause for an aneurysm? |
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Definition
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Term
| What age puts men at a greater risk? Women? |
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Definition
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Term
| Which gender has a higher occurrence of aneurysm? |
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Definition
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Term
| What is the location for chronic arterial symptoms? |
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Definition
| Deep muscle pain, usually in calf, but may be lower leg or dorsum foot |
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Term
| What is the character of pain for chronic aerial symptoms? |
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Definition
| Intermittent claudication, feels like “cramp,” “numbness/tingling,” “feeling cold” |
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Term
| What is the onset and duration of chronic arterial symptoms? |
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Definition
| Chronic pain, onset gradual after exertion |
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Term
| What are the aggravating factors for chronic arterial symptoms? |
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Definition
| Activity, “claudication distance” is specific number of blocks, stairs it takes to produce pain, Elevation (rest pain indicates severe involvement) |
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Term
| What are the alleviating factors for chronic arterial symptoms? |
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Definition
| Rest (usually within 2 mins), dangling |
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Term
| What are associated symptoms with chronic arterial symptoms? |
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Definition
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Term
| Who is at risk for chronic arterial symptoms? |
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Definition
| Older adults, males > females, inherited predisposition, hx: HTN, DM, smoking, obesity, vascular dz, hypercholesterolemia |
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Term
| What is the location for acute arterial symtoms> |
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Definition
| Varies, distal to occlusion, may involve entire leg |
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Term
| What is the character of pain for acute a.s? |
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Definition
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Term
| Wghat is the onset and duration of acute a.s? |
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Definition
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Term
| What are the associated symptoms of acute arterial symptoms? |
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Definition
pain, pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis (indicates severe)
SEVERe |
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Term
| Who is at risk for acute arterial symptoms? |
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Definition
| Hx: vascular surgery, abd aneurysm, trauma, chronic A-fib |
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Term
| What are the characteristics of venous symptoms? |
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Definition
-CALF
-ACHING, TIRED, FULLNESS,
-CHRONIC PAIN, INCREASES AT END OF DAY
-AGGRIVATED BY SITTING OR STANDING TOO LONG
-RELIEVED BY ELEVATION, LYING, WALKIG
-ASSOCIATED W. EDEMA, VARICOSITIES, WEEPING ULCERS @ ANKLES
-RISK: Job w/prolonged standing or sitting; obesity; pregnancy; prolonged bed rest; hx: CHF, varicosities, thrombophlebitis, trauma, surgery |
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Term
| What is relevant when discussing claudicaiton with a patient? |
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Definition
DISTANCE!
Correct answer: B. The most important variable is the “claudication distance,” or the distance the patient can walk before calf pain begins. There is no known relationship between claudication and food, emotional state, or blood glucose levels at that moment. |
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