Exam 2- Blood Vessels (Part 1)

The palpable and sometimes visible arterial pulses are the result of?

Ventricular systole

What variables contribute to the characteristic of the pulses?

Volume of ejected blood (Stroke volume)

Distensibility of aorta and large arteries

Obstruction of blood flow

Peripheral arteriolar resistance

Viscosity of blood

The dicrotic notch is what?

Always there but can't feel it when palpating

The activity of the right side of the heart is transmitted back through the jugular veins as?

A pulse (visualized only)- not palpable like arteries are

The pulse has _________ identifiable components. _________peaks and ________ descending slopes

5 parts

3 peaks

2 descending slopes

We look at which jugular vein? Why?

Right jugular vein cause its a straight shot down into the heart

What are the 3 peaks of the venous pulse

A wave

C wave

V wave

What are the 3 desiring slopes of the venous pulse

X slope

Y slope

What is a result of a brief backflow of blood to the vena cave during right atrial contraction

A wave

What is the transmitted impulse from the vigorous backward push produced by closure of the tricuspid valve during ventricular systole

C wave

What is caused by the increasing volume and concomitant increasing pressure in the right atrium, it occurs after the c wave, late in ventricular systole

V wave

What is caused by the passive atrial filling

X slope

What reflects the open tricuspid valve and the rapid filling of the ventricle

Y slope

Why should you not let pregnant patients lie supine?

Enlarging uterus puts compression on vena cava and impairs venous return and supine makes it worse

What elevates blood pressure in older adults?

Increased peripheral vascular resistance

Atherosclerosis is a big thing we look for

What do we look for with leg pain or cramps

Onset and duration

Character

Continuous burning in toes, pain in thighs or butt

Skin changes

Limping

Waking at night with leg pain

What are we concerned about with swollen ankles

Congestive heart failure

What do we look for with swollen ankles

Onset and duration

Related circumstances

Associated symptoms

Treatment attempted

Medication

What do you ask about with family history

Hypertension (HTN)

Dyslipidemia

Diabetes

Heart disease

Thrombosis

Peripheral vascular disease (PVD)

Abdominal aortic aneurysm

Ages at time of illness and death

What do you tell pregnant women to do to help with edema in the legs?

Lay on side with legs elevated

What does it mean when there is edema in the lungs of older adults?

Left sided heart failure

What is pain from loss of circulation called in older adults?

Claudication

What peripheral arteries do you palpate?

Carotid

Brachial

Radial

Femoral

Political

Dorsalis pedis

Posterior tibial

What characteristics do you palpate for in an artery?

Rate and rhythm

Pulse contour (waveform)

Amplitude (force)

Symmetry

Obstructions

Variations

How many levels of amplitude are there with the pulse?

0-4 levels

What is a level 0 amplitude pulse

Absent, not palpable

What is a level 1 amplitude pulse

Diminished, barely palpable

What is a level 2 amplitude pulse

Expected

What is a level 3 amplitude pulse

Full, increased

What is a level 4 amplitude pulse

Bounding, aneurysmal

Where do you auscultate over arteries for bruits? Which ones do we do?

Temporal

Carotid

Subclavian

Abdominal aorta

Renal

Iliac

Femoral

Arteries in any location can become?

Stenotic (narrowed)

Diminished circulation to the tissues will lead to sings and symptomless that are related to?

Site

Degree of stenosis

Ability of collateral channels to compensate

Rapidity with which problem develops

What are the 3 P`s of occlusion?

Pain

Pallor

Pulselessness

What is pain that results from muscle ischemia referred to as?

Claudication

Claudication appears during?

Sustained exercise (walking distance)

What will relieve Claudication?

Few minutes of rest

-but recurs again with same amount of activity

What worsens Claudication?

Continues activity

After determine the distinguishing characteristics of the pain, what should you note?

Pulses

Bruits

Loss of body warmth

Pallor or cyanosis

Collapsed superficial veins

Atrophied skin and loss of hair

What is regular systolic pressure

100-129

What is regular diastolic pressure

60-79

What is pulse pressure

Difference between systolic and diastolic pressure

What is normal blood pressure

Less than 120 systolic and less than 80 diastolic

What is elevated blood pressure

120-129 systolic

Less than 80 diastolic

What is stage 1 hypertension

130-139 systolic

80-89 diastolic

What is stage 2 hypertension

140 or higher systolic

90 or higher diastolic

The jugular pulse can only be _______

Visualized

CANNOT BE PALPATED

How do you get the jugular venous pressure

Measure horizontally from meniscus of the top of the blood column and vertically from sternal angle

Add 5 cm

Should be less than 9 cm total

What conditions could make the examination of the jugular venous pressure more difficult

Severe right heart failure, tricuspid insufficiency, constrictive pericarditis, cardiac tamponade (increase pressure around heart)

Severe blood volume depletion

Obesity

How do you get the hepatojuguar reflux?

Press on belly

What is a sign of right heart failure when pressing on the belly?

Hepatojugular reflux

-exaggerated when right heart failure is present

How do you use evaluation of hand veins for central venous pressure?

Raise arm slowly

If veins collapse:

-before level of sternal angle= low venous pressure

-at level of sternal angle= normal venous pressure

-above level of sternal angle= high venous pressure

What is an acute process that may result from injury, external compression or thrombophlebitis

Venous obstruction and insufficiency

With venous obstruction and insufficiency pain occurs simultaneously with what?

Swelling and tenderness over muscles

Engorgement of superficial veins

Erythema and/or cyanosis

What are signs of venous obstruction and insufficiency?

Thrombosis

Homan sign

Varicose veins

Edema

What is calf pain with passive dorsiflexion of the foot called? What is it a sign of?

Homan sign

-sign of venous obstruction and insufficiency

How do you grade Edema?

Grade 1-4

What is grade 1 edema

Slight pitting, disappear rapidly, 2mm

What is grade 2 edema

Deeper pitting, disappears in 10-15 sec, 4mm

What is grade 3 edema

Noticeably deeper, last 60 sec, 6mm

What is grade 4 edema

Very deep, lasts 2-5 min, 8 mm or more

What is non-pitting edema of chronic venous insufficiency called

Brawny edema

What is it when tissue is so full of edema its full tight and can't compress, it results from chronic edema

Brawny edema