NRSE 210 Exam #3

What is the vascular system?

The vessels that transport blood and lymph throughout the body.

How does vascular disease affect tissues?

Impairs oxygen and nutrient delivery and waste removal.

What is the function of arteries?

Carry oxygenated blood away from the heart to body tissues.

Why are arterial walls strong and elastic?

To withstand high pressure and stretch with each heartbeat.

What does vascular smooth muscle control?

The amount of blood delivered to tissues through constriction and dilation.

What happens to arteries in cold temperatures?

They constrict to help preserve blood flow to major organs.

Where is the temporal artery?

In front of the ear.

Where is the carotid artery?

In the neck.

Where is the brachial artery?

Above the elbow crease.

Where is the radial pulse?

At the wrist on the thumb side.

Where is the ulnar artery?

At the wrist closer to the pinky; usually less prominent than the radial pulse.

Where is the femoral pulse?

In the groin.

Where is the popliteal pulse?

Behind the knee.

Where is the posterior tibial pulse?

Behind and below the medial ankle bone.

Where is the dorsalis pedis pulse?

On top of the foot near the big toe tendon.

What is ischemia?

Inadequate oxygenated blood supply to a tissue.

Can happen anywhere in the body

Muscles start to hurt (need oxygenated blood)

What can prolonged ischemia cause?

Tissue injury or death due to inadequate oxygen.

What is cardiac ischemia?

Insufficient oxygenated blood reaching heart muscle.

What is the function of veins?

Return deoxygenated blood and waste products from tissues to the heart.

Veins lie closer to the skin surface

How do veins compare with arteries?

Veins have thinner walls and operate at lower pressure.

Where are the jugular veins?

In the neck.

What are the three types of leg veins?

Deep, superficial, and perforator veins.

What do perforator veins in the legs do?

Connect superficial veins with deep veins.

What three mechanisms assist venous return (blood movement)?

• Skeletal muscle contraction

• Inspiration

• Intraluminal valves

How do skeletal muscles promote blood movement?

Contract around veins to push blood toward the heart.

How does breathing promote blood movement?

Inhaling

Pressure changes during respiration help move blood toward the heart.

What do intraluminal venous valves do?

Maintain one-way blood flow and prevent back flow, ensuring blood flows in one direction

Valves open and close to prevent backflow and pooling of blood in lower extremities

What happens when venous valves become incompetent?

Blood flows backward and pools in the lower extremities.

What increases the risk of venous problems?

Prolonged standing, sitting, bed rest, obesity, pregnancy

At risk for incompetent intraluminal valves

What is the function of the lymphatic system?

Returns excess tissue fluid and proteins to the bloodstream and supports immunity.

Removes waste

Flow of lymph is slow

What is lymphedema?

Swelling from impaired lymphatic drainage due to damaged or blocked vessels or lymph nodes

How is lymphedema described?

Often unilateral and nonpitting, causes swelling to the effected areas

What happens when a lymph node is removed or blocked?

Fluid drainage is impaired and swelling may develop.

Where are cervical lymph nodes?

Head and neck.

Where are axillary lymph nodes?

Armpits; drain the upper extremities.

Where are epitrochlear lymph nodes?

Near the elbow; drain the hand and lower arm.

Where are inguinal lymph nodes?

Near the groin; drain the lower extremities.

What can enlarged tender lymph nodes indicate?

Inflammation or infection in the drainage area.

What subjective questions assess peripheral vascular and lymphatic health?

Ask about leg pain, cramps, skin changes, swelling, enlarged nodes, medications

What should the nurse clarify about leg pain?

Whether it affects one leg or both and when it occurs.

What skin changes should the nurse ask about in the arms and legs?

Color changes and wounds that do not heal.

What should the nurse ask about swelling?

Whether edema is unilateral or bilateral.

What is assessed when inspecting the arms?

Symmetry, skin condition, edema, and other visible changes.

Which pulses are palpated in the arms?

Radial and brachial pulses.

What is a typical normal peripheral pulse grade?

2+.

Are epitrochlear lymph nodes usually palpable?

No; they are not typically palpable in healthy adults.

What should be inspected in the legs?

Symmetry, size, skin color, hair, swelling, lesions, and visible veins.

Why measure calf circumference?

To objectively compare leg size and assess asymmetric swelling.

How should leg temperature be assessed?

Use the back of the hand, moving from thighs toward feet and comparing sides.

What is the expected temperature of healthy legs?

Warm and approximately equal bilaterally.

How should ingunial nodes be palpated?

• with fingers

• enlarged or round lymph nodes could indicate infection in genital area

Where is the popliteal pulse palpated?

Deep behind the knee; it can be difficult to locate.

Where is the posterior tibial pulse palpated?

Behind the inner ankle bone.

Easy to feel

Where is the dorsalis pedis pulse palpated?

On the top of the foot near the great toe tendon.

How is pretibial edema assessed?

Press over the shin and check for an indentation.

This is swelling that occurs over the tibia

What is pitting edema?

Swelling that leaves an indentation after pressure.

What condition may be associated with bilateral pitting edema?

Heart failure or another cause of fluid accumulation.

What is venous insufficiency or venous stasis?

Impaired venous return that causes blood to pool in the lower extremities.

What causes venous stasis?

Incompetent venous valves allowing backward blood flow.

What are signs of venous insufficiency?

Warm legs, edema, enlarged or varicose veins, brown and red skin changes, aching, and venous ulcers.

Pressure in lower extremities

Aching pain

How are pulses usually affected by venous insufficiency?

Peripheral pulses are generally preserved.

What skin changes occur with chronic venous insufficiency?

Brown or reddish discoloration and skin breakdown.

What is arterial insufficiency or peripheral arterial disease?

Reduced arterial blood flow to tissues, commonly from narrowed or blocked arteries.

Can be from plaque buildup or disease causing blocks

What is another name for peripheral arterial insufficiency?

Peripheral artery disease (PAD).

What is PAD?

Peripheral artery disease

What are signs of arterial insufficiency?

Cold extremities, shiny hairless skin, weak pulses, pain, numbness, and nonhealing wounds.

How does arterial insufficiency affect peripheral pulses?

Pulses may be weak, diminished, or absent.

How does arterial insufficiency affect leg temperature?

Affected extremities may feel cold.

What causes exertional calf pain in PAD?

Inadequate oxygen delivery to working muscles.

What is arteriosclerosis?

Thickening and hardening of arterial walls, often associated with aging.

Blood vessels become more rigid and less flexible

How can arteriosclerosis affect blood pressure?

Stiffer arteries can increase systolic blood pressure.

What is deep vein thrombosis?

DVT

Formation of a blood clot within a deep vein in lower extremities

Very dangerous

What findings may suggest a DVT?

Unilateral swelling, warmth, redness, tenderness, and calf-size asymmetry.

What is Homan's sign?

Calf discomfort during ankle dorsiflexion, historically used to assess possible DVT.

Is Homan's sign a reliable DVT test?

No; it is inaccurate and is not recommended for diagnosing DVT.

What does ABI stand for?

Ankle-brachial index.

What is the purpose of an ABI?

Screens for peripheral arterial disease by comparing ankle and arm systolic blood pressures.

How is ABI calculated?

Ankle systolic blood pressure divided by brachial systolic blood pressure.

What ABI range is listed as normal?

1.0–1.4

What ABI result suggests PAD?

0.90 or lower

What does a low ABI indicate?

Possible narrowing or blockage of arteries supplying the legs

Could be peripheral artery disease (PAD)

What is the ABI if ankle systolic pressure is 130 and arm pressure is 120?

130 ÷ 120 = 1.08, approximately 1.1 - normal

What is ABI if ankle systolic pressure is 136 and arm pressure is 168?

136 ÷ 168 = 0.81 - low and is suggesting PAD

What is PAD?

Peripheral artery disease

Narrowed peripheral arteries that reduce blood flow to the limbs

Can cause leg pain when walking

What serious conditions are associated with PAD?

Heart attack and stroke.

What is claudication?

Muscle pain, cramping, or fatigue during walking or physical activity.

Why does intermittent claudication occur?

Exercising muscles do not receive enough oxygenated blood.

What typically happens to intermittent claudication with rest?

Symptoms improve when activity stops.

How do venous and arterial insufficiency differ in temperature?

Venous insufficiency is often warm; arterial insufficiency is often cool.

How do venous and arterial insufficiency differ in pulses?

Venous pulses are usually normal; arterial pulses are diminished.

How do venous and arterial insufficiency differ in swelling?

Venous insufficiency commonly causes edema; arterial insufficiency usually causes less swelling.

What vascular changes may occur during pregnancy?

Bilateral pitting leg edema and varicose veins.

What vascular changes may occur with aging?

Stiffer arteries and more difficult-to-palpate foot pulses.

When is claudication typically seen?

Seen with DVT, PAD, and arterial insufficiency

What do the arteries do with blood?

Carry oxygenated blood away from the heart to all tissues

A - artery, A - away

Venous vs arterial insufficiency

• venous - too much blood in lower extremities

• arterial - too little blood in lower extremities

What do the veins do with blood?

Carry deoxygenated blood back to the heart

Subjective data for the vascular and lymphatic system

• any leg pain or cramps

• any skin changes in arms or legs

• any swelling

• any lymph node enlargement

• what meds are you taking?

Objective data for the vascular and lymphatic system

• arms

  • inspect

  • palpate radial + brachial pulses

• legs

  • inspect

  • palpate temperature

  • check homan’s sign

  • palpate inguinal nodes

  • palpate femoral, popliteal, posterior tibial and dorsalis pedis pulses

  • check for pretibital edema