Combo with Peripheral Vascular & Lymphatic and 1 other

Flashcard maker : Mike Bryan
Describe the structure and function of arteries and veins
-Arteries contain elastic fibres which allow the walls to stretch with systole and recoil with diastole. Muscle fibres control the amount of blood delivered to the tissues. Carry oxygenated blood from the heart to the peripheries. Arterial walls stretch during systole and recoil during diastole resulting in a palpable pulse.
-Veins drain deoxygenated blood and its waste products from tissues and return it to the heart. Low pressure
List the pulse sites accessible to examination
-Temporal (in front of ear)
-Carotid (neck)
-Brachial (elbow)
-Ulnar (wrist)
-Radial (wrist)
-Femoral (thigh)
-Popliteal (behind knee)
-Dorsalis pedis (top of foot)
-posterior tibial (ankle)
Describe 3 mechanism that help return venous blood to the heart
1. Contracting skeletal muscles that milk the blood proximally, back towards the heart
2. Pressure gradient caused by breathing
3. one-way (intraluminal valves) ensure unidirectional flow
Describe the term capacitance vessels and explain its significance
the distensibility of blood vessels located within the body; it is inversely related to elasticity. Reduce stress on the heart. They can expand and hold more blood when blood volume increases.
List the risk factors for venous stasis
Elderly
Diabetes
Obesity
Peripheral vascular disease
Pregnancy
Prolonged standing
Inactive lifestyle
Smoking
Varicose veins
Tight clothing
Describe the function of the lymphatic system
1) conserve fluid and plasma proteins that leak out of the capillaries
2) form a major part of the immune system that defends the body against disease
3) absorb lipids from the intestinal tract
Without lymphatic drainage, fluid would build up in the interstitial spaces and produce oedema
Describe the function of the lymph nodes
Filter fluid before it is returned to the bloodstream and filter out pathogens
Name the related organs in the lymphatic system
-spleen
-tonsils
-thymus
LIST THE SYMPTOM AREAS YOU WOULD ADDRESS DURING HISTORY TAKING OF THE PERIPHERAL VASCULAR SYSTEM
AREAS– ARMS, LEGS,EPITROCHLEAR NODE

CHECK– TEMP,SWELLING, SIZE OF EXTRIMITIES, LESIONS

CHECK PULSES– RADIAL, BRACHIAL, POPLITEAL,FEMORAL, POST TIBIAL, DORSALIS PEDIA

CHECK INGUINAL AND EPITROCHLEAR NODES

Grading system for arterial pulse:
0 indicating no palpable pulse
1 + indicating a faint, but detectable pulse;
2 + suggesting a slightly more diminished pulse than normal;
3 + is a normal pulse; and
4 + indicating a bounding pulse.
Describe the procedure for doing the modified Allen’s Test.
To perform this test, the clinician instructs the patient to make a tight fist. Then compress both the radial and ulnar arteries. Now instruct the patient to open and relax his fist, revealing a blanched palm and fingers. Then release the pressure over the ulnar artery while observing the patient’s palm for changes in color. If collateral flow is adequate, the patient’s hand will \”pink up\” within 10 to 15 seconds; this constitutes a positive Allen’s test. A positive result documents that collateral blood flow is adequate and that the radial artery is an acceptable puncture site. If the test is negative (the palm does not pink up rapidly), the radial artery is not an acceptable site for puncture. In such cases, the other wrist is evaluated or the brachial artery is used for the puncture site.
List the skin characteristics expected with arterial insufficiency to the lower legs.
-A difference in the temperature of the feet
-Marked pallor
COMPARE THE CHARACTERISTICS OF LEG ULCERS ASSOCIATED WITH ARTERIAL INSUFFUCIENCY TO ULCERS WITH VENOUS INSUFFICIENCY.
ARTERIAL INSUFFICIENCY– COLD NUMBNESS TINGLING
INTERMITTENT CLAUDICATION
CRAMPS

VENOUS INSUFFICIENCY– ACHING, TIREDNESS, FEELING OF FULLNESS

Grading scale for pitting odema:
Grading edema
1+: slight pitting/2 mm, disappears rapidly,
2+: somwehat deeper pit/4 mm, disappears in 10-15 sec
3+: deep pit/6 mm, may last > 1 minute; dep extremity swollen
4+: very deep pit/8 mm, lasts 2-5 min, dep extremity grossly distorted
Describe the technique for using the Doppler ultrasound to detect peripheral pulses
-Position 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 the transducer over a pulse site, swivelled at a 45o angle.
-Apply very light pressure, locate the pulse site by the swishing, whooshing sound
Raynaud’s phenomenon has associated progressive tricolor changes of the skin from ____ to ___ then to ___.
State the mechanism for each of these color changes.
White —>Blue –> Red
(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.

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 function of the venous system is:
to hold more blood when blood volume increase
The organs that aid the lymphatic system are:
spleen, tonsils, thymus
Ms T has come for a prenatal visit. She complains of dependent edema, varicosities in the legs, and haemorrhoids. The best response is:
The symptoms are caused by the pressure of the growing uterus on the veins. They are usual conditions of pregnancy
A pulse with an amplitude of 3+ would be considered:
Increased
Inspection of a person’s right hand reveals a red, swollen are. To further assess for infection, you would palpate the
epitrochlear node
In order to screen for deep vein thrombosis, you would
measure the widest point with a tape measure
During the examination of the lower extremities, you are unable to palpate the popliteal pulse, you should:
proceed with the examination. It is often impossible to palpate this pulse
While reviewing a medical record, a notation of 4+ edema of the right leg is noted. The best description of they type of edema is:
very deep pitting, indentation lasts a long time
The examiner wishes to asses for arterial deficit in the lower extremities. After raising the legs 12 inches off the table and than having the person sit up and dangle the leg, the colour should return in:
10 seconds or less
A 54 year old woman with five children has varicose veins of the lower extremities. Her most characteristic sign is:
dilated, tortuous superficial bluish vessels
Atrophic skin changes that occur with peripheral arterial insufficiency include:
thin, shiny skin with loss of hair
Intermittent claudication is:
muscular pain brought on by exercise
A known risk factor for venous ulcer development is:
obesity
Brawny edema is:
nonpitting
Allen Test
determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery
Aneurysm
defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect
Arrhythmia
variation from the hearts normal rhythem
Arteriosclerosis
thickening and loss of elasticity of the arterial walls
Atherosclerosis
plaques of fatty deposits formed in the inner layer (intima) of the arteries
Bradycardia
slow heart rate, <50 beats per minute in the adult
Bruit
blowing swooshing sound heard through a stethoscope when an arter is partially occluded
Cyanosis
dusky blue mottling of the skin and mucous membranese due to excessive amount of reduced hemoglobin in the blood
Diastole
the hearts filling phase
Homans Sign
calf pain that occurs when the foot is sharply dorisflexed (pushed up toward the knee); may occur with deep vein thrombosis, phlebitis, Achilles tendinitis, or muscle injury
Ischemia
deficiency of arterial blood to a body part due to constiction or obstruction of a blood vessel
Lymphedema
swelling of exterminty due to obstructed lymph channel, nonpitting
Lymph Nodes
small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels
Pitting Edema
indentation left after examiner depresses the skin over swollen edematous tissue
Profile Sign
viewing the finger from the side to detect early clubbing
Pulse
pressure wave created by each heartbeat, palpable at body sites where the artery lies close to the skin and over a bone
Pulsus Alernans
regular rhythm, but force of pulse varies with alternating beats of large and small amplitude
Pulsus Bigeminus
irregular rhythm, every other beat is premature; premature beats have weakened amplitude
Pulsus Paradoxus
beats have weaker amplitue with respiratory inspiration, stronger with expirtion
Systole
the hearts pumping phase
Tachycardia
rapid heart rate, >90 beats per minute in the adult
Thrombophlebitis
inflammation of the vein associated with thrombus formation
Ulcer
Open skin lesion extending into dermis with sloughing of necrotic inflammatory tissue
Varicose Vein
dilated tortuous veins with incompetent valves

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