Peripheral and vascular system

Arterial system

Bring oxygen and nutrient rich blood away from the heart to the body

The arterial system includes -

Aorta, arteries, arterials, capillaries, and smooth endothelial cell lining

Pathology of arterial system

Diseases affecting arterial system

-Narrowing, rupture or dissection, and thrombosis

Venous system

Brings deoxygenated blood back to the heart

-ONLY OXYGENATED BLOOD IN VEINS IS PULMONARY VEIN

The venous system includes -

Veins, ventless, superior and inferior vena cava (what used blood drains into)

-Requires surrounding musclar contractions to help blood flow back to the heart

Pathology of the venous system

Obstruction, valve incompetence, trauma

Capillaries

Site of exchange of oxygen, nutrients, and gasses

-Smallest of blood vessels

Tonsils

Filter inhaled or swallowed materials, aids in early immunity

-In tonsils

Thymus

Processes and stimulates lymphocytes in active immunity

-In chest

Spleen

Filters blood and destroys old RBCs

-LUQ of abdomen

Appendix

May aid in the development of immunity

-RLQ (attached to large intestine)

Peyer patches

Protect against invading microorganisms

-In the lining of the intestines

The superficial lymph nodes are -

Axillary, infraclavicular, submandibular, inguinal, cervical

Lymphatic system functions

Returns excess fluid and proteins from tissues to bloodstream 

-Protects body from impurities 

-Absorbs digested fats from small intestine

Lymph nodes in neck, armpit, chest, and groin functions

Filters lymph (fluid)

-Left side and entire abdomen and lower body drains into THORACIC DUCT

-Right side of body drains into RIGHT LYMPHATIC DUCT

Safety alerts-extremities

S/sx of extremity numbness, coolness, or color changes can be a complete arterial occlusion which is a medical emergency

Safety alerts-PE

A pulmonary embolism can result from a dislodged DVT

-Dyspnea, SOB, diaphoresis, tachycardia, anxiety, chest pain

Safety alerts-critically ill patients

Often have s/sx related to shock that can lead to decreased peripheral perfusion 

-If capillary refill is > 5 seconds, skin is mottling, and limbs are cool- this is a medical emergency

Why estrogen is a factor of peripheral vascular / lymphatic disease problems

Estrogen influences vascular health by affecting blood vessel elasticity and inflammation

-Low estrogen levels can contribute to vascular complications and lymphatic issues

Skin changes questions

-Changes in arms or legs color or temperature

-Changes in appearance

-Use of support items or treatment

-Any eg sores or ulcers, and if so, where on legs?

-Swelling and or associated symptoms

-Alleviating factors versus worsening factors

Upper extremity assessment

-Inspect hands (color of skin, nail beds / clubbing, temperature, texture, tugor, lesions, edema, ecchymosis)

-Check capillary refill

-Check radial pulses: grade amplitude on a 3-point scale

0

1+

2+

3+

Absent=BAD

Weak=BAD

Normal

Increased, full bounding (MAY be bad)

-Scale to grade pulses

Lower extremity assessment

Uncover and inspect legs 

-Note asymmetric legs, skin discoloration, skin ulcers, gangrene (note size and location), temperature, lower extremity pulses, neurovascular status

-Test lower legs for strength and sensation

Pulses to palpate and compare

-Radial

-Brachial

-Femoral (groin area halfway between pubis and anterior superior iliac spines)

-Popliteal (behind knee) 

-Posterior tibial (between malleolus and achilies tendon)

-Dorsal pedis (lateral to and parallel with extensor tendon of big toes)

Doppler ultrasonic probe

Device that magnifies pulsatile sounds from blood vessels to detect a weak peripheral pulse

Health promotion and education

-Foot care

-Inspection to identify abnormalities and skin breakdown

-Exercise to improve circulation and pay attention to seated positions during the day

-Wear comfortable shoes

Pitting edema

Condition where pressure applied to the skin causes indentations that persist for several seconds

-Indicates fluid retention or underlying health conditions like HF, Kidney Disease, Lymphedema

Non-pitting edema

Condition where skin remains smooth without indentations when pressure is applied

-Associated with conditions like DVT and allergic reactions