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61 Cards in this Set
- Front
- Back
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Arteries |
Carry oxygenated blood to peripheral tissues |
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Partial arterial occlusion |
Leads to decreased O2 delivery to distal tissues Tissue ischemia |
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Untreated arterial occlusion |
Tissue death and loss of limb |
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Exercise |
Aggravates arterial ischemia r/t increased O2 demand Exacerbates symptoms |
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Veins |
Consist of superficial and deep veins Return venous blood to the heart |
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Venous return |
Dependent on skeletal muscle contraction: moves blood proximally Functional valves to prevent backflow: valves open toward the heart Patent lumen: keep maximum forward flow Respirations: helps flow by decreasing thoracic pressure and increasing abd pressure |
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Bedrest |
Decreases venous return |
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Lower extremity Deep veins |
Responsible for most venous return Femoral and popliteal |
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Lower extremity superficial veins |
Great saphenous vein Site for CABG Removal does not compromise venous return since deep veins return most blood to heart |
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Perforators |
Connect to the veins |
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History |
Vascular problems, inflammatory conditions, heart disease Enlarged lymph nodes (painful, chronic, acute) |
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Arterial insufficiency |
Decreased arterial blood to tissues |
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Intermittent claudication |
Muscle ischemia Usually affects gastrocnemius muscle (calf) Calf-pain with exercise, relieved by rest High occlusive disease may manifest in pain in thigh or buttock |
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Smoking |
Vasoconstrics Worsens ischemia and related symptoms |
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Venous insufficiency |
Decreased venous return MAJOR SYMPTOM: swelling |
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Swelling |
Unilateral (venous occlusion) vs bilateral (HF) Precipitating factors: prolonged standing, sitting, travel Associated symptoms: SOB, nocuria (HF) Nutritional status: hypoalbuminemia (low protein) |
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Arterial assessment |
All palpable pulses 7 sites |
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Sites of pulses |
Temporal Carotid Brachial Radial Ulnar Femoral Popliteal Posterior tibial Dorsalis Pedis |
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Grade pulses |
4+ Bounding 3+ Full/increased (may be normal) 2+ Normal 1+ weak, barely palpable 0 absent |
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Doppler |
As needed Detects weak pulses |
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Auscultatory sites |
Assess bruits Temporal, carotid, renal, iliac, femoral Listen with bell for swishing (partial occlusion) |
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Capillary refill |
CRT < 2 sec > 2 sec: arterial occlusion, hypothermia, hypovolemic shock |
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Changes of arterial insufficiency |
Decreased or absent pulses Pallor of extremity Cool skin Thin, shiny, atrophic skin Thick, ridged nails Loss of hair Ulcers and gangrene ***** does not cause swelling ***** |
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Loss of hair |
Commonly seen on dorsum of toes |
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Ulcers r/t arterial insufficiency |
Typically seen on lateral surface of leg/ankle |
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Leg elevation |
Special tests of arterial patency Supine pt raises leg until blanches, then sit and dangle legs Note time of color return Arterial occlusion is a delay in return of color, severe disease if > 2 minutes
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Ankle-brachial index |
Special tests of arterial patency Ratio of BP in lower extremities to arms Lower BP in legs could mean arterial occlusion |
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Allen test |
Special tests of arterial patency Assess patency of radial and ulnar arteries |
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Venous Assessment: Edema |
Accumulation of fluid in extracellular/interstitial spaces Grade 1+ to 4+ Pedal Pretibial - directly over bone Dependent Anasarca Pitting vs non-pitting |
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Pedal edema |
On the foot |
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Pretibial edema |
Anterior leg along tibia Press directly over bone |
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Dependent edema |
Feet, sacrum, r/t positioning Asses in bedridden pt by turning |
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Anasarca |
Entire body |
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Pitting vs non-pitting |
Brawney edema: skin too taught to pit |
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Edema scale |
1+ 2 mm pit, disappears rapidly 2+ 4 mm pit, disappears in 10-15 seconds 3+ 6 mm pit, may last more than 1 minute 4+ 8 mm pit, lasts 2-5 minutes |
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Most difficult edema to assess |
1+ 2+ |
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Venous insufficiency skin |
Redness (rubor) or brown discoloration Leg ulcers |
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Superficial thrombophlebitis |
Not as serious because it is superficial Redness, thickening, tenderness along a superficial vein Seen in pt with PIV |
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Deep Vein Thrombosis |
May be life-threatening, predisposes pt to PE Pain, warmth, tenderness, swelling over vein Asymmetric calf size, low grade fever, tachycardia Homan's sign Can occur gradually or as a result of trauma/prolonged immobilization |
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Homan's sign |
Calf pain on dorsiflexion of foot Unreliable Better to assess with doppler |
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Risk factors for DVT |
Bedrest or immobility (casted leg): decreased skeletal muscle activity Trauma Hypercoagulable state Varicosities: genetic, obesity, pregnancy Hormonal contraceptives: risk higher with smoking, older than 35 yrs |
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Varicosities |
Creates incompetent valves |
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Varicose veins |
Dilated and swollen vessels r/t incompetent venous valves or proximal vein obstruction Decreased venous return makes veins engorged Risk for DVT Pressure, heavy legs after standing Women are 4x more likely to have them, in pregnancy in particular, increased hormone levels weaken vessels Genetic predisposition, tobacco use, sedentary lifestyle, increased BMI |
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Spider veins |
Superficial veins Cosmetic treatment only |
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Chronic Arterial Insufficiency |
Exercise: pain with activity relieved with rest Pulses: diminished or absent Color: pale if elevated, blue if dependent Skin: smooth, thin, shiny, decreased hair, thick toenails Ulcers: Lateral malleolus Temp: cool |
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Chronic venous insufficiency |
Exercise: discomfort after exercise Pulses: not affected Color: brown hyperpigmentation Skin: may have varicose veins Ulcers: medial malleolus Temp: normal |
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Hyper pigmentation |
r/t hemosideran (iron) deposits at ankles and lower legs Increased venous pressure causes RBCs to leak out of veins |
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Venous stasis ulcers |
Medial foot, ankle |
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Lymph node assessment |
Epitrochlear: arms, near brachial pulse Inguinal: legs/groin Should not be palpable |
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Raynaud's disease |
Commonly in young women, increases with exposure to cold Secondary raynaud's r/t connective tissue disease: scleroderma, lupus Painful, white hands that improve with rewarming Idiopathic, intermittent exaggerated spasm of arterioles in digits May last for minutes to hours |
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Abdominal aortic aneurysm |
US preventative services task force screening: Males who have smoked: one-time ultrasound ages 65-75 Male non-smokers: no screening Females: no screening (4x more common in men) Localized dilation, causes weakness to arterial walls result of artherosclerosis, tobacco use, family history Generally asymptomatic unless they dissect or compress an adjacent structure Dissection: ripping, severe pain, pulsatile welling, thrill or bruit |
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Carotid palpation |
Never palpate both sides simultaneously Carotid sinus massage can cause HR to slow |
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Temporal arteritis |
Giant cell arteritis Inflammatory disease of branches of aortic arch, including temporal arteries can lead to thrombosis and ischemia to masseter muscle, tongue, or optic nerve >50 yrs, flu-like symptoms, HA in temporal region, loss of vision, tongue or jaw pain, swollen at temporal site, temporal pulse may be strong/weak/absent |
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Arteriovenous fistula |
Communication between and artery and a vein Congenital or acquired, damage to vessels r/t catheterization, may be significant arterial to venous shunting, may result in aneurysmal dilation Lower extremity edema, vericose veins, claudication, continuous bruit or thrill |
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Peripheral arterial disease |
PAD: stenosis of the blood supply to extremities by atherosclerotic plaque DM, HTN, dysplipidemia, tobacco all high risk, seen in vascular trauma, radiation therapy, vasculitis Pain in active muscle that is relieved by rest, weak or absent pulses, cold, numb, skin changes |
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Arterial embolic disease |
AFib can lead to clot formation and emboli can be dispersed through arterial system Atherosclerotic plaques, infections material from fungal or bacterial endocarditis, atrial myxomas (mass of connective tissue) Painful, paresthesias, occlusion of small arteries and necrosis Endocarditis: splinter hemorrhages in nail bed |
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Tricuspid regurge |
Backflow of blood into RA Mild degree seen in 75% of adults Commonly r/t dilation of RV, HTN, PE, rarely from primary valvular disease Symptoms: severe TR shows as RHF, holosystolic murmur, pulsatile liver, peripheral edema |
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Coarctation of aorta |
Stenosis in descending aortic arch near left subclavian and ligamentum arteriosum Frequently congenital, or r/t inflammatory aortic disease, severe arthersclerosis Asymptomatic unless severe HTN and vascular insufficiency develops, HF symptoms, differences in BP between arm and legs, femoral pulses weak or absent |
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Kawasaki Disease |
Acute small vessel vasculitic illness in young males more than females Coronary artery aneurysm may develop Unknown cause, immune mediated blood vessel damage can result in vascular stenosis and aneurysm formation Diffuse symptoms, fever > 5 days, weight loss, fatigue, myalgia, arthritis, strawberry tongue, conjenctival injection, edema or hands and feet, LAD, polymorphous nonvesicular rashes |
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Preeclampsia-Eclampsia |
HTN that occurs after 20th week of pregnancy Proteinuria, can lead to seizures Combination of vascular and immunologic abnormalities within uteroplacental circulation Visual changes, proteinuria, HA, abd pain, pulmonary edema SBP>160, DBP>110 |
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Venous stasis ulcers |
Lack of venous flow leads to lower extremity venous HTN May be result from incompetent valves, obstructed flow, loss of pumping effect of leg muscles Leg heaviness, edema, ulceration, medial aspects of lower limbs, induration, edema, hyperpigmentation |
