Peripheral Vascular/Lymphatic

The venous system is ___ _____ and ____ ______!

Low pressure, high volume

You don’t have the pressure of the what pushing the blood in the veins?

Heart

Venous return is?

Passive

The smallest vessels, very thin walls for exchanging nutrients and gases

Capillaries

What helps with immune function and fluid balance?

Vessels and nodes

Lymphatic flow in the arms drains into which nodes?

Epitrochlear, axillary, infraclavicular

In the lower extremities, lymph primarily drains into which nodes?

Inguinal

Which test helps determine if a pt has PAD?

Ankle-brachial index

Deep vein thrombosis signs/symptoms?

Unilateral edema, pain/achiness, erythema, warmth

PAD signs/symptoms?

Claudication, rest pain, shiny legs, no hair on legs, etc

What is claudication?

Pain with walking (cramping pain), but feels better with rest.

What therapy is immediately needed with DVT?

Anticoagulant therapy

What may result from a DVT?

Pulmonary embolism

What are the 7 P’s to focus on for patients with PAD and symptoms of arterial occlusion?

Pain, pallor, poikilothermia, paresthesia, pulselessness, paralysis, perfusion

Which risk factors are associated with PAD?

Smoking, diabetes mellitus, aging, limited activity, high fat diet, hypertension

What should be monitored and managed for patients with PAD?

Cholesterol and triglycerides

What is critical to maintain to slow the progression of PAD?

Glycemic control and blood pressure

Which is a limb threatening situation?

Complete arterial occlusion

Common symptoms for abdominal aortic aneurysm?

Bruit, laterally pulsating abdominal mass

Raynaud phenomenon and disease signs/symptoms?

Numbness/tingling, pain, coolness, extreme pallor

Chronic venous insufficiency signs/symptoms?

Edema of the extremity, dull aching pain

Thrombophlebitis signs/symptoms?

Same as DVT, but also include a palpable mass or cord along the vein

Neuropathy signs/symptoms?

Burning pain, pins/needles, numbness, paresthesias

Chronic venous disease may result in a ______ _______ in the ankle area

Brownish discoloration

What can be reversed if caught early?

Lymphedema

Teaching about methods of decreasing venous pressure.

Walk around daily every so often, elevate legs if needed, wear compression hose, etc

Lymphedema sign/symptom?

Unilateral swelling. Not painful like DVT

What findings are always very concerning?

Unilateral

Edema is often related to venous or lymphatic issues. However, if there is edema all over the body, it can be a __________ issue

Cardiovascular

If you find atrophy or delayed wound healing or weak/no felt pulses in extremities (arms for ex.), could be?

Arterial disease

The Allen test is used to determine adequacy of?

Collateral circulation

What is a normal value for the ankle-brachial index?

1 - 1.4, or 100-104%

What does a greater than 1.4 number mean for the ankle-brachial index?

Noncompressible arteries

What does a 90%, or 0.9 or less mean for the ankle-brachial index?

Abnormal, early narrowing

The higher the number on the Wells Score, the greater the risk for?

DVT

What is redness when the legs are hanging off the table? Is it severe?

Rubor, yes

Define pulsus alternans.

Irregular rate, sometimes weak sometimes strong

Define pulsus bigeminus.

Alternating beats, one normal one premature.

Why might you have pulsus bigeminus?

Usually due to premature ventricular or atrial contractions (PVC or PAC)

Define pulsus bisferians.

Two pulses per beat, aortic regurgitation

Define pulsus paradoxus

Decrease in pulse amplitude during quiet inspiration (normal breathing)

With PAD, smoking cessation is of upmost importance!! Always ask pt for their readiness to?

Stop smoking

With neuropathy, we want to encourage good ______ ______.

Glycemic control

What other disease has the same risk factors as DVT?

Thrombophlebitis