Ha T3- Ch. 20 Vascular/lymphatic System

Front 1

what is Claudication distance?

Back 1

It is the number of blocks walked or stairs climbed to produce pain.

Front 2

What does night Leg pain indicate?

Back 2

It is common in aging adults and may indicate ischemic rest pain of PVD (peripheral Vascular Dz), severe night muscle cramping or the restless leg syndrome.

Front 3

what do leg ulcers indicate?

Back 3

They occur with chronic arterial and chronic venous dz.

Front 4

Edema (Bilateral vs Unilateral)

Back 4

Bilateral: Generalized HF

Unilateral: results from a local obstruction or inflammation

Front 5

What does exam of the arms and legs include?

Back 5

-Peripheral Vascular Characteristics

-Skin

- Musculoskeletal Findings

- neurologica findings.

Front 6

Order of Physical assessment of arms and legs

Back 6

1. Inspect and palpate arms.
-Inspect hands
-Check capillary refill
-check force of radial pulse
-palpate brachial
-check epitrocheal nodes
-Perform Modified Allen Test

2. Inspect and Palpate the Legs
-inspect skin on legs, symmetry, color, etc.
-palpate for temperature down legs
-palpate inguinal nodes
-palpate Femoral, popliteal, dosalis, pedis and posterior tibial pulses.
-check for Edema
-Manual Compression Test
-color changes
3. Inspect feet (color, etc)
-lower leg strength
-Check Ankle-Brachial Index (ABI)

Front 7

what is Profile Sign?

Back 7

Viewing the fingers from a side to detect early clubbing. Normal nail bed angle is 160 degrees

-Flattening of angle or clubbing occurs with congenital heart disease and cor pulmonale

Front 8

Definition of Capillary Refill

Back 8

Index of peripheral perfusion and CO. Normal: less than 3 seconds

>3 sec signifies vasoconstriction or decreased CO

Front 9

When does a full bounding pulse (+3) occur?

Back 9

Occurs with Hyperkinetic states (exercise, anxiety and fever) Anemia, hyperthyroidism

Front 10

When does weak thready pulse (+1) occur?

Back 10

Occurs with shock, and peripheral arterial disease.

Front 11

Are epitochlear lymph nodes usually palpable?

Back 11

No- an enlarged node occurs with infection of the arm or forearm, and occur with conditions like generalized lymphadenopathy: Lymphoma, chronic Lymphocytic leukemia, sarcoidosis, infections, mononucleosis

Front 12

Modified Allen Test

Back 12

-used to evaluate the adequacy of collateral circulation before cannulating the radial artery.

A) firmly occlude both ulnar and radial arteries while pt makes a fist several times until hand blanches.

B) Ask the person to open the hand (without hyperextending), then release pressure on ulnar artery while maintaining Radial Artery.

-Adequate circulation+ palmar blush within 2-5 seconds

Pallor Suggests occlusion of collateral arterial flow. Avoid cannulation.

Front 13

CM of Malnutrition in legs

Back 13

-Thin shiny atrophic skin

-thick ridged nails

- loss of hair

-Ulcers

- gangrene

Front 14

Homan Sign

Back 14

Flexing the knee and then compressing calf against the tibia should produce no tenderness.
if it does, this is a positive Homan's sign

Occurs with 35% of cases of DVT but can occur with other disorders.

Front 15

How to perform a manual compression test

Back 15

While pt is standing, test the length of the varicose vein to determine whether its valves are competent.
-Place hand on the lower part of the vein, and compress the vein with other hand about 15-20 cm higher.
-competent valves will prevent wave transmission, and you will feel no change.

Front 16

When would you use the doppler ultrasonic stethoscope?

Back 16

When there is a weak peripheral pulse, or to measure low BP in lower extremities.

-the doppler magnifies pulsatile sounds from the heart and blood vessels.

Front 17

Ankle Branchial Index (ABI)

Back 17

Use the doppler to assess extent of peripheral arterial disease (PAD)
divide angle systolic pressure by arm systolic pressure

ABI of <0.90 indicates PAD

0.90-0.70- mild claudication
0.7-0.4- moderate to severe claudication
0.4-0.3: severe
<0.3- ischemia with impending loss of tissue

Front 18

Changes seen in Elderly

Back 18

Pedal pulses may become difficult to find.

Trophic changes occur r/t arterial insufficiency

Front 19

Water-Hammer (corrigan) Pulse-3+

Back 19

Its greater than normal force, the collapses suddenly

occurs with Aortic valve regurgitation, patent ductus arterioles

Front 20

Pulsus Bigeminus

Back 20

Rhythm is coupled, every other beat comes early or normal beat followed by a premature beat. Force of premature beat is decreased (because of shortened cardiac filling time)

-occurs with conduction disturbances (premature atrial or vent contraction)

Front 21

Pulsus Alternans

Back 21

Rhythm is regular, but force varies with alternating beats of large and small amplitude.

-Occurs with severe left vent failure, ischemic heart dz, vulvar heart disease, HTN or cardiomyopathy

Front 22

Pulsus Paradoxus

Back 22

Beats have weaker amplitude, with inspiration, stronger with expiration. Best determined during BP measurement; reading decreases >10 mmhg during insp and increases with exp.

-common in pericardial effusion where CO is blocked, also severe bronchospasm of acute asthma

Front 23

pulsus bisferiens

Back 23

Each pulse has two strong systolic peaks, with a dip in between. Best assessed at the carotid artery.

-occurs with aortic valve stenosis plus regurgitation

Front 24

Reynaud's phenomenon

Back 24

Abrupt progressive tricolor changes in fingers in response to cold, vibration or stress.
Three stages:
1) pallor
2) cyanosis
3) redness in heel as the blood returns

- cold, numbness, pain in first two stages.
-Burning throbbing in third stages.

-can last minutes to hours, occurs bilaterally.
-smoking can increase symptoms

Front 25

Lymphedema

Back 25

High-protein swelling of the limb common to breast cancer tx (cuz nodes have been removed)
-early Sx: heavy arms, swelling, tingling.
-without tx, it is chronic and progressive.

Front 26

Arterial- ischemic Ulcer

Back 26

Buildup of fatty plaque in intima (atherosclerosis + hardening, calcification of arteriolar wall (arteriosclerosis)

-Ulcers occur at toes, metatarsal heads, heels, ankles.
-characterized by bale ischemic base, well defined edges and no bleeding

Front 27

Venous stasis Ulcer

Back 27

Occurs After acute DVT or chronic incompetent valves in deep veins.
-ulcers occur at medial malleolus and are characterized by bleeding, uneven edges.

Front 28

Diabetic ulcers

Back 28

Ischemic ulcers, with generalized dysfunction in all arterial areas. R/t diabetic neuropathy.

Front 29

superficial Varicose Veins

Back 29

Incompetent Valves permit reflux of blood, producing dilated tortuous veins.

over the age of 45, occurrence is three times more common in women than in men.

Front 30

Deep Veing Thrombophlebitis (DVT)

Back 30

Deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis and edema.
-Virchow's triad of 3 factors that promote DVT:
1) stasis
2) hypercoagulability
3) endothelial dysfunction.