NURS 203: Unit 3 - Cardiovascular System II: Peripheral Vascular System and Lymphatics (Lab 3 Review)

Major Arteries

- Temporal

- Carotid

- Arteries in the arm

- Arteries in the leg

Temporal Artery

The artery that lies superior to the temporalis muscle, and its pulsation is palpable anterior to the ear

Carotid Artery

The major neck vessel that carries oxygenated blood from the heart to the head

Major Arteries in the Arm

- Brachial

- Ulnar

- Radial

Brachial Artery

The major artery that supplies the arm with blood

Ulnar Artery

One of the two arteries that supply the hand with blood; can be palpated medial to the ulna and is usually deeper

Radial Artery

One of the two arteries that supply the hand with blood; can be palpated medial to the radius and is usually more superficial

Major Arteries in the Legs

- Femoral

- Popliteal

- Dorsalis pedis

- Posterior tibial

Femoral Artery

The major artery that supplies the leg with blood; found in the thigh

Popliteal Artery

The artery found behind the knee

Dorsalis Pedis

The artery found at the top of the foot arch

Posterior Tibeal Artery

The artery supplying the foot, found behind the medial ankle

Major Veins

- Jugular

- Veins in the arm

- Veins in the leg

2 Parts of the Jugular Veins

- External

- Internal

External Jugular Veins

The more superficial jugular vein that lies lateral to the sternocleidomastoid and above the clavicle

Internal Jugular Veins

The deeper jugular vein that lies medial to the sternocleidomastoid

3 Types of Veins in the Leg

- Deep leg

- Superficial leg

- Perforators

The 2 Deep Leg Veins

- Femoral

- Popliteal

Femoral Vein

The deep vein found in the thigh

Popliteal Vein

The deep vein found behind the knee

The 2 Superficial Leg Veins

- Great saphenous

- Small saphenous

Great Saphenous Vein

The superficial vein in the leg that starts at the medial side of the dorsum of the foot., then ascends in front of the medial malleolus. It crosses the tibia obliquely and ascends along the medial side of the thigh

Small Saphenous Vein

The superficial vein in the leg that starts on the lateral side of the dorsum of the foot and ascends behind the lateral malleolus and up the back of the leg, where it joins the popliteal vein

Perforators

Connecting veins that join two sets; connects the superficial veins to the deep veins in the legs

Arteries

- Blood vessels that carry blood away from the heart

- High-pressure system

Veins

- Blood vessels that carry blood towards the heart

- Low-pressure system

How Venous Blood Flow is Accomplished

1.) Contraction of the skeletal muscles

2.) Pressure gradient caused by breathing

3.) Intraluminal valves

4.) Calf pump

Inspiration decreases . . .

Thoracic pressure

3 multiple choice options

Inspiration increases . . .

Abdominal pressure

3 multiple choice options

Intraluminal Valves

Valves within the veins that opens toward the heart and closes to prevent back flow of blood

Calf Pump (Peripheral Heart)

The phenomenon that occurs when the calf muscles alternately contract and relax during systole and diastole respectively

The 2 Major Lympathic Vessels

- Right lymphatic duct

- Thoracic duct

Right Lymphatic Duct

The lymphatic vessel that drains the right side of the upper body and empties into the right subclavian vein

Thoracic Duct

The lymphatic vessel that drains the rest of the body and empties into the left subclavian vein

Functions of the Lymphatic System

- Conserve fluid and plasma proteins

- Form a major part of the immune system

- Absorb lipids from the intestinal tract

Major Lymph Nodes

- Cervical

- Axillary

- Epitrochlear

- Inguinal

- Cisterna chyli

Cervical Lymph Nodes (10)

- Preauricular

- Posterior auricular

- Occipital

- Submental

- Submandibular

- Jugulodigastric (tonsil)

- Superficial cervical

- Deep cervical chain

- Posterior cervical

- Supraclavicular

(Party People Often Sell Sardines Just So Dogs Pee Silver)

Preauricular Lymph Node

Lymph node in front of the ear (1)

Posterior Auricular Lymph Node

Lymph node behind the ear (2)

Occipital Lymph Node

Lymph node at the base of skull (3)

Submental Lymph Node

Lymph node under the chin (4)

Submandibular Lymph Node

Lymph node along base of mandible (5)

Jugolodigastric (Tonsillar) Lymph Node

Lymph node under the angle of the mandible (6)

Superficial Cervical Lymph Node

Lymph node overlying the sternomastoid muscle (7); can feel enlarged even when there are no problems

Deep Cervical Chain Lymph Node

Lymph node located on the posterior triangle of the neck (8)

Posterior Cervical Chain Lymph Node

Lymph node in the posterior triangle along the edge of the trapezius muscle (9)

Supraclavicular Lymph Node

Lymph node just above and behind the clavicle, at the sternomastoid muscle (10)

Axillary Lymph Node

The superficial lymph node in the armpit

Epitrochlear Lymph Node

The lymph node in the depression above and behind the medial condyle of humerus; normally not palpable

Inguinal Lymph Node

Superficial lymph node located on the upper inner thigh

Cisterna Chyli

An enlarged pouch on the thoracic duct that serves as a storage area for lymph moving toward its point of entry into the venous system

4 Functions of the Spleen

- Destroy old RBC

- Produce antibodies

- Store RBCs

- Filter micro-organisms from blood

Tonsils

Masses of lymphatic tissue in the back of the oropharynx; reacts to local inflammation

The 3 Tonsils in the Mouth

- Palatine

- Adenoid

- Lingual

Palatine Tonsil

One of a pair of almond-shaped masses of lymphatic tissue in the oropharynx

Adenoid Tonsil

Pharyngeal tonsil

Lingual Tonsil

Tonsil located at the base of tongue

Thymus Gland

- A flat, pink-grey organ, located in the superior mediastinum behind the sternum and in front of the aorta

- Develops T lymphocytes in children, but is useless to adults

Developmental Considerations for Infants and Children Related to the Peripheral Vascular and Lymphatic System

- Lymph nodes are relatively large and palpable

- Respiratory infection and enlarged tonsils

- Transient acrocyanosis and skin mottling

Transient Acrocyanosis

Cyanosis of the hands, feet, or phase

Developmental Considerations for Pregnant Individuals Related to the Peripheral Vascular and Lymphatic System

- Growing uterus obstructs drainage of iliac vein and inferior vena cava

- Dependent edema and varicose veins

Dependent Edema

Swelling in the lower body caused by fluid pooling due to gravity

Pitting Edema

The indentation left after the examiner depresses the skin over swollen tissue

Varicose Veins

Dilated tortuous veins with incompetent valves

Developmental Considerations for Older Adults Related to the Peripheral Vascular and Lymphatic System

- Arteriosclerosis

- Atherosclerosis

- Increased risk of deep vein thrombosis (DVT)

- Dorsalis pedis and posterior tibial pulses become more difficult to palpate

- Trophic changes associated with arterial insufficiency

Arteriosclerosis

Hardening of the arteries

Atherosclerosis

Condition in which fatty deposits called plaque build up on the inner walls of the arteries, which can cause an occlusion

Deep Vein Thrombosis (DVT)

A blood clot in a deep vein, most often an extremity

Subjective Data to Assess for the Peripheral Vascular and Lymphatic System

- Leg pain/cramps

- Skin changes on arms/legs

- Swelling in arms/legs

- Lymph node enlargement

- Medication

Claudication Distance

Number of blocks walked or stairs climbed to produce pain

Modified Allen Test

An advanced practice that involves occluding both ulnar and radial arteries and asking the patient to open and close their hands. You then release the pressure on the ulnar artery and see if the colour of the skin returns within 2-5 seconds (if it doesn't, the circulation is not adequate)

Ankle-Brachial Index

Ankle pressure/brachial pressure (<0.9 suggests peripheral vascular disease)

3 multiple choice options

2 Types of Compression Stockings

- Anti-embolism

- Medical

Anti-Embolism Compression Stockings/Thrombo-Embolic-Deterrent (T.E.D.)

Type of compression stockings used to increase blood flow to prevent blood clots from forming in non-ambulatory patients

Medical Compression Stockings

Type of compression stockings designed for ambulatory patients

People who Should Wear Compression Stockings

- Family history of venous disorders

- Advanced age

- DVT risk

- Smoking

- Obesity

- Sedentary

- Hormonal changes

- Long-distance travelling

- Athletes

- Occupational risks (Ex. prolonged sitting/standing)

- Lymphedema or lipedema

4 Levels of Compression Stockings

- 15-20 mmHg

- 20-30 mmHg

- 30-40 mmHg

- 40 mmHg

Who Uses 15-20 mmHg Compression Stockings

People who have leg fatigue from prolonged sitting/standing or for the prevention of any complications

Who Uses 20-30 mmHg Compression Stockings

People who have heavily fatigued, aching legs and already have mild symptoms (Ex. edema and varicose veins)

Who Uses 30-40 mmHg Compression Stockings

People who already have moderate varicose and/or edema

Who Uses 40 mmHg Compression Stockings

People who have severe varicose veins and/or edema

CEAP Classification

- Clinical symptoms

- Etiology

- Anatomy

- Pathophysiology

Objective Data to Assess for the Arms

- Skin colour

- Edema/lesions

- Finger profile/capillary refill

- Temperature

- Texture

- Turgour

- Radial pulse

- Brachial pulse

- Epitrochlear node

Objective Data to Assess for the Legs

- Skin colour

- Size (symmetry)

- Hair distribution

- Venous pattern

- Lesions/ulcers

- Temperature

- Tenderness

- Inguinal lymph nodes

- Femoral artery

- Popliteal artery

- Posterior tibial artery

- Dorsalis pedalis artery

Raynaud's Disease

A peripheral vascular disease characterized by episodes of abrupt progressive tricolour change of the fingers in response to cold, vibration, or stress

Lymphedema

A peripheral vascular disease characterized by swelling due to an abnormal accumulation of lymph fluid within the tissues; common after breast cancer treatment

Aneurysm

A sac formed by dilation in the artery wall

Arterial/Ischemic Ulceration

- Ulcerations that result from the buildup of fatty plaques on intima (atherosclerosis) plus hardening and calcification of the arterial wall (arteriosclerosis)

- Occur at toes, metatarsal heads, heels, and lateral ankle

- Characterized by well-defined edges and no bleeding

Venous/Stasis Ulceration

- Ulcerations that occur after acute DVT or with chronic incompetent valves in deep veins

- Occur at medial malleolus

- Characterized by bleeding and uneven edges

- Brown discolouration can occur if chronic

Virchow's Triad

- Stasis

- Hypercoagulability

- Endothelial dysfunction

Signs/Symptoms of DVT

- Redness

- Warmth

- Edema

- Pain

Risk Factors for a Pulmonary Embolism with DVT

- Sudden SOB

- Pain with breathing

- Hypotension

- Tachycardia

- Tachypnea

- Hypoxia

Treatment for DVT

- Elevate limbs

- Avoid pressure

- Notify health care provider

Peripheral Vascular Disease (PVD)

Disease of blood vessels away from central region of body, most typically in legs; symptoms include pain, numbness, and impaired circulation

Peripheral Arterial Disease (PAD)

- Disease affecting the arteries supplying the limbs

- Usually caused by atherosclerosis and less commonly by embolism, hypercoagulable states, or arterial dissection

Characteristics of PVD Chronic Arterial Symptoms

- Deep muscle pain, usually in calf, but may be in lower leg or dorsum of foot

- Intermittent claudication that feels like cramping, numbing, tingling, or cold

- Onset gradual after exertion

- Aggravated by activity and elevation

- Relieved by rest and dangling

- Associated with a cool, pale skin

Characteristics of PVD Acute Arterial Symptoms

- Varies, distal to occlusion, may involve entire leg

- Feels like throbbing

- Sudden onset

- Associated with the 6 Ps

Characteristics of PVD Chronic Venous Symptoms

- Calf, lower leg

- Characterized by aching, tiredness, and feeling of fullness

- Increases at the end of day

- Aggravated by prolonged standing/sitting

- Relieved by elevation, lying, and walking

- Associated with edema, varicosities, and weeping ulcers at the ankles

Characteristics of PVD Acute Venous Symptoms

- Intense, sharp; deep muscle tender to touch

- Sudden onset

- Pain can increase by sharp dorsiflexion of foot

- Associated with red, warm, swollen legs

Characteristics of Good Foot Care

- Check feet everyday

- Keep blood flowing to feet

- Wear comfortable-fitting shoes

- Fit shoes to larger foot

- Wear low-heeled shoes

- Keep skin soft and smooth