Ch 21 PVS and Lymphatic System

Peripheral Vascular System and Lymphatic System Notes

Structure and Function of the Vascular System

Vascular System Role:

The vascular system is essential for transporting blood and lymphatic fluids to and from organs, ensuring effective delivery of oxygen and nutrients while facilitating elimination of waste products, such as carbon dioxide and metabolic waste. A compromised vascular system can impede these critical processes, leading to tissue damage.

Arteries

  • Function: Act as a high-pressure system, delivering oxygenated blood and nutrients to tissues.

  • Heart's Role: The heart pumps oxygenated blood into the arteries, which are structurally designed with thick walls to withstand high pressure. The elasticity of arteries allows them to accommodate the surge of blood with each heartbeat.

  • Major Arteries in the Arm:

    • Brachiocephalic artery

    • Common carotid artery

    • Subclavian artery

    • Axillary artery

    • Radial artery (pulse site)

    • Ulnar artery (pulse site)

    • Brachial artery (pulse site)

  • Major Arteries in the Leg:

    • Femoral artery (pulse site)

    • Popliteal artery (pulse site)

    • Anterior tibial artery

    • Posterior tibial artery

    • Dorsalis pedis artery (pulse site)

Lymphatic System

Function:

The lymphatic system plays a crucial role in maintaining fluid balance by draining excess fluid and plasma proteins from interstitial spaces back into the bloodstream. It also serves as an integral part of the immune system, providing help in fighting infections and protecting against disease. Additionally, it absorbs lipids and fat-soluble vitamins from the intestinal tract, contributing to nutrition.

Lymph Nodes:

Clusters of lymphatic tissue located along the vessels, lymph nodes are important for inspection to assess lymphatic status and respond to pathogens. During infections, lymph nodes can become swollen or tender as they work to filter harmful substances.

Lymphatic Ducts and Drainage:

  • Right Lymphatic Duct: Drains lymph from the right side of the head, neck, and upper body into the right subclavian vein.

  • Thoracic Duct: The larger duct that drains lymph from the rest of the body into the left subclavian vein, making significant connections with various groups of lymph nodes.

Immune-Related Organs

Key components associated with the lymphatic and immune systems include:

  • Tonsils: Pharyngeal (adenoid), palatine, and lingual tonsils function to trap pathogens entering through the mouth and nose.

  • Thymus Gland: Site of T-cell maturation, crucial for adaptive immunity.

  • Spleen: Filters blood and helps fight infections.

  • Bone Marrow: Responsible for the production of blood cells, including leukocytes for immune responses.

  • Peyer Patches: Lymphoid tissues located in the intestinal wall, playing a role in monitoring intestinal bacteria and preventing the growth of pathogenic bacteria.

Developmental Competence

Infants and Children:

  • Infants and children typically have larger lymph nodes which are often palpable when healthy. Swelling of these nodes may indicate infection; hyperplasia indicates an immune response.

Pregnant Women:

  • Hormonal changes lead to vasodilation and lower blood pressure, which can cause dependent edema and varicosities in extremities, and potentially hemorrhoids.

Aging Adults:

  • With age, arteries become rigid, increasing the risk of Peripheral Artery Disease (PAD). Assessment for intermittent claudication, or leg pain during exertion, is critical. Risk of Deep Vein Thrombosis (DVT) also increases.

Risk Factors and Conditions Related to Vascular Health

Traditional Risk Factors for PAD:

  • Include smoking, diabetes, hypertension, high cholesterol, obesity, and chronic kidney disease. Notably, depression has been linked to an increased risk, especially among women. Certain ethnic groups, like non-Hispanic blacks, exhibit disproportionate effects.

Assessment of Peripheral Vascular System

Subjective DATA:

Symptoms to assess may include:

  • Leg pain or cramps related to exertion or rest.

  • Skin color changes (cyanosis or pallor), temperature variations, and swelling.

  • Enlargement of lymph nodes could suggest an underlying issue or infection.

Objective DATA:

Skin Assessment:

  • Thoroughly check for skin color, temperature, and capillary refill time as indicators of vascular health.

Pulse Assessment:

  • Measure pulse force using a grading scale:

    • 3+: Bounding pulse

    • 2+: Normal pulse

    • 1+: Weak pulse

    • 0: Absent pulse

Edema Assessment:

  • Evaluate pretibial edema using grading methods:

    • 1+: Mild, slight indentation

    • 2+: Moderate, quick subsiding

    • 3+: Deep, stays indented

    • 4+: Very deep, grossly swollen

Doppler Assessment of Pulses:

  • A Doppler probe can assist in measuring weak peripheral pulses and determining blood pressure in lower extremities. This is particularly useful when peripheral pulses are difficult to palpate.

Objective Data - Abnormal Findings / DVT Assessment:

  • Deep Vein Thrombosis (DVT) is a serious condition characterized by the formation of a blood clot in a deep vein, often in the legs. Assessment should consider:

    • Swelling in one leg compared to the other.

    • Pain or tenderness, especially in the calf (characteristic of Homan's sign, although this test is not always reliable).

    • Changes in skin color (redness or increased warmth) in the affected area.

  • Given the risk for complications, such as pulmonary embolism, prompt assessment and intervention are critical.