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182 Cards in this Set
- Front
- Back
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Which of these statements is true regarding the arterial system?
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C. The arterial system is a high-pressure system. |
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The nurse is reviewing the blood supply to the arm. The major artery supplying the arm is the _____ artery.
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C. brachial |
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The nurse is preparing to assess the dorsalis pedis artery. Where is the correct location for palpation?
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D. Lateral to the extensor tendon of the great toe |
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A 65-year-old patient is experiencing pain in his left calf when he exercises that disappears after resting for a few minutes. The nurse recognizes that this description is most consistent with _________ the left leg.
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C. ischemia caused by partial blockage of an artery supplying |
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The nurse is reviewing venous blood flow patterns. Which of these statements best describes the mechanism(s) by which venous blood returns to the heart?
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C. Intraluminal valves ensure unidirectional flow toward the heart. |
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Which of these veins are responsible for most of the venous return in the arm?
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D. Superficial |
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A 70-year-old patient is scheduled for open-heart surgery. The surgeon plans to use the great saphenous vein for the coronary bypass grafts. The patient asks, "What happens to my circulation when the veins are removed?" The nurse should reply:
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A. "Because the deeper veins in your leg are in good condition, this vein can be removed without harming your circulation." |
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The nurse is reviewing risk factors for venous disease. Which of these situations best describes a person at highest risk for development of venous disease?
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D. Person who has been on bed rest for 4 days |
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The nurse is teaching a review class on the lymphatic system. A participant shows correct understanding of the material with which statement?
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A. "The flow of lymph is slow compared with that of the blood." |
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When performing an assessment of a patient, the nurse notices the presence of an enlarged right epitrochlear lymph node. What should the nurse do next?
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A. Examine the patient's lower arm and hand, and check for the presence of infection or lesions. |
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The nurse is examining the lymphatic system of a healthy 3-year-old child. Which finding should the nurse expect?
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C. The presence of palpable lymph nodes |
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During an assessment of an older adult, the nurse should expect to notice which finding as a normal physiologic change associated with the aging process?
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B. Peripheral blood vessels growing more rigid with age, producing a rise in systolic blood pressure |
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A 67-year-old patient states that he recently began to have pain in his left calf when climbing the 10 stairs to his apartment. This pain is relieved by sitting for about 2 minutes; then he is able to resume his activities. The nurse interprets that this patient is most likely experiencing:
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D. claudication. |
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During an assessment, the nurse uses the "profile sign" to detect:
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C. early clubbing. |
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The nurse is performing an assessment on an adult. The adult's vital signs are normal and capillary refill time is 5 seconds. What should the nurse do next?
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D. Consider this a delayed capillary refill time and investigate further. |
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When assessing a patient the nurse notes that the left femoral pulse as diminished, 1+/4+. What should the nurse do next?
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C. Auscultate the site for a bruit. |
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When performing a peripheral vascular assessment on a patient, the nurse is unable to palpate the ulnar pulses. The patient's skin is warm and capillary refill time is normal. The nurse should next:
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A. consider this a normal finding and proceed with the peripheral vascular evaluation. |
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The nurse is preparing to perform a modified Allen test. Which is an appropriate reason for this test?
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D. To evaluate the adequacy of collateral circulation before cannulating the radial artery |
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A patient has been diagnosed with venous stasis. Which of these findings would the nurse most likely observe?
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B. A brownish discoloration to the skin of the lower leg |
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The nurse is attempting to assess the femoral pulse in an obese patient. Which of these actions would be most appropriate?
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D. Ask the patient to bend his or her knees to the side in a froglike position. |
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How should the nurse document mild, slight pitting edema present at the ankles of a pregnant patient?
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C. 1+/0-4+ |
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When assessing a patient's pulse, the nurse notes that the amplitude is weaker during inspiration and stronger during expiration. When the nurse measures the blood pressure, the reading decreases 20 mm Hg during inspiration and increases with expiration. This patient is experiencing pulsus:
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B. paradoxus |
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The nurse is performing a peripheral vascular assessment on a bedridden patient and notices the following findings in the right leg: increased warmth, swelling, redness, tenderness to palpation, and a positive Homan's sign. The nurse should:
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B. seek emergency referral because of the risk of pulmonary embolism. |
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During an assessment the nurse has elevated a patient's legs 12 inches off the table and has had him wag his feet to drain off venous blood. After helping him to sit up and dangle his legs over the side of the table, the nurse should expect a normal finding at this point would be:
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B. venous filling within 15 seconds |
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During a clinic visit, a woman in her seventh month of pregnancy complains that her legs feel "heavy in the calf" and that she often has foot cramps at night. The nurse notices that the patient has dilated, tortuous veins in her lower legs. Which condition is reflected by these findings?
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C. Varicose veins |
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During an assessment, the nurse notices that a patient's left arm is swollen from the shoulder down to the fingers, with nonpitting brawny edema. The right arm is normal. The patient had a left-sided mastectomy 1 year ago. The nurse suspects which problem?
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A. Lymphedema |
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When using a Doppler ultrasonic stethoscope, the nurse recognizes venous flow when which sound is heard?
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C. Swishing, whooshing sound |
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The nurse is describing a weak, thready pulse on the documentation flow sheet. Which statement is correct?
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A. "Hard to palpate, may fade in and out, easily obliterated by pressure." |
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B. an arterial ischemic ulcer. |
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The nurse is reviewing an assessment of a patient's peripheral pulses and notices that the documentation states that the radial pulses are "2+." The nurse recognizes that this reading indicates what type of pulse?
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D. Normal |
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A function of the venous system is... |
To hold more blood when blood volume increases |
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The organs that aid the lymphatic system are... |
spleen, tonsils, and thymus |
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Ms. T. has come for a prenatal visit. She complains of dependent edema, varicosities in the legs, and hemorrhoids. The best response is... |
"The symptoms are caused by the pressure of the growing uterus in the veins. They are usual conditions of pregnancy." |
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A pulse with an amplitude of 3+ would be considered... |
increased, full |
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Inspection of a person's right hand reveals a red, swollen area. To further assess for infection, you would palpate the... |
epitrochlear node |
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To screen for deep vein thrombosis, you would... |
measure the widest point with a tape measure |
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During the examination of the lower extremities, you are unable to palpate the popliteal pulse. You should... |
proceed with the examination. It is often impossible to palpate this pulse. |
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While reviewing a medical record, a notation of 4+ edema in the right leg is noted. The best description of this type of edema is... |
very deep pitting, indentation lasts a long time |
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The examiner wishes to assess for arterial deficit in the lower extremities. After raising the legs 12 inches off the table and then having the person sit up and dangle the leg, the color should return in... |
10 seconds or less |
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A 54-year woman with 5 children has varicose veins of the lower extremities. Her most characteristic sign is... |
dilated, tortuous superficial bluish vessels |
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Atrophic skin changes that occur with peripheral arterial insufficiency include... |
thin, shiny skin with loss of hair |
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Intermittent claudication is... |
muscular pain brought on by excercise |
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A known risk factor for venous ulcer development is... |
obesity |
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Brawny edema is... |
nonpitting |
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Arteriosclerosis is the... |
loss of elasticity of the walls of the blood vessels |
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Raynauds's phenomenon occurs... |
in hands and feet as a result of exposure to cold, vibration, and stress |
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Allen test |
Determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin colors as evidence of patency of the other artery |
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Aneurysm |
Defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect |
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Arrhythmia |
Variation from the heart's normal rhythm |
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Arteriosclerosis |
Thickening and loss of elasticity of the arterial walls |
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Atherosclerosis |
Plaques of fatty deposits formed in the inner layer (intima) of the arteries |
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Bradycardia |
Slow heart rate, <50 beats per min in the adult |
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Bruit |
Blowing, swooshing sound heard through a stethoscope when an artery is partially occluded |
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Cyanosis |
Dusky blue mottling of the skin and mucous membranes due to excessive amt of reduced hemoglobin in the blood |
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Diastole |
the heart's filling phase |
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Homan's sign |
Calf pain that occurs when the foot is sharply dorsiflexed (pushed up toward the knee); may occur with deep vein thrombosis, phlebitis, Achilles tendinitis, or muscle injury |
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Ischemia |
Deficiency of arterial blood to a body part, due to constriction or obstruction of a blood vessel |
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Lymphedema |
Swelling of extremity due to obstructed lymph channel, nonpitting |
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Lymph nodes |
Small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels |
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Pitting edema |
Indentation left after examiner depress the skin over swollen edematous tissue |
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Profile sign |
Viewing the finger from the side in order to detect early clubbing |
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Pulse |
Pressure wave created by ea heartbeat, palpable at body sites where the artery lies close to the skin and over a bone |
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Pulsus alternans |
Regular rhythm, but force of pulse varies with alternating beats of large and small amplitude |
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Pulsus bigeminus |
Irregular rhythm, every other beat is premature; premature beats have weakened amplitude |
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Pulsus pardoxus |
Beats have weaker amplitude with respiratory inspiration, stronger with expiration |
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Systole |
The heart's pumping phase |
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Tachycardia |
Rapid heart rate, >100 beats per min in the adult |
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Thrmobophlebitis |
Inflammation of the vein associated with thrombus formation |
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Varicose Vein |
Dilated tortuous veins with incompetent valves |
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Ulcer |
Open skin lesion extending into dermis with sloughing of necrotic inflammatory tissue |
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What is the job of the peripheral vascular system? |
Deliver oxygen and nutrients to the tissues and eliminate carbon dioxide and waste products from cellular metabolism |
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How is the rate of blood flow controlled in the arteries? |
VSM (vascular smooth muscle) VSM contracts or dilates, changes diameter of the arteries. Each heartbeat creates a pressure wave (pulse) |
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What are the arteries you want to check for a pulse? (9) |
Temporal Carotid Brachial Radial Ulnar Femoral Popliteal Dorsalis Pedis Posterior Tibial |
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A deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel |
Ischemia |
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Ischemia |
A deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel |
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What types of veins should you inspect during assessment? |
Jugular veins Superficial and Deep in Arm Deep, Superficial, and Perforators in the legs |
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What veins in the arm are responsible for most of the venous return? |
Superficial |
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What veins in the leg are most responsible for venous return? |
Deep veins - Femoral and popliteal |
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If the deep leg veins are in tact, can the superficial veins be excised? |
Yes! |
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What are the superficial veins of the legs |
Great Saphenous (Inside Leg) Small Saphenous (outside leg) |
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What are perforators and what is their job? |
Join the two sets of veins in the legs Have one way valves that foute blood from the superficial into the deep veins |
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Are Veins a low or high pressure system? |
Low |
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Are arteries a low or high pressure system? |
High |
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How do veins keep the blood moving? |
Contract skeletal muscles that lead blood back to the heart Pressure gradient caused by breathing Intraluminal valves insure unidirectional flow
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What is considered the peripheral heart? |
The calf muscle - while walking the calf muscles alternate systole and diastole |
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Do veins or arteries have thinner walls? |
Veins
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Do veins or arteries have a larger diameter? |
Veins |
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Do veins or arteries expand more? |
Veins |
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The ability of veins to stretch is called? |
Capacitance vessels |
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Who is most at risk for a venous disease? |
People who undergo prolonged standing, sitting, or bed rest because they don't benefit from the milking action of the calf muscles |
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What increases your risk for venous disease? |
Hypercoagulable statmes and vein wall trauma Incompetent veins (varicous) |
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Retrieves fluid from the tissue spaces and returns it to the blood stream = |
Lymphatic vessel system |
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Without lymphatic drainage, what would happen? |
Fluid would build up in the interstitial spaces and produce edema becaues there's more fluid in the capillaries than the veins can absorb. |
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What are the two main trunks of the lymphatic system? |
Right lymphatic duct Thoracic Duct |
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Empties into the righ subclavian vein, drains the right side of the head, and neck, right arm, right thorax, righ lung and pleura, right side of heart, right upper section of liver |
Right lymphatic duct |
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Right lymphatic duct |
Empties into the righ subclavian vein, drains the right side of the head, and neck, right arm, right thorax, righ lung and pleura, right side of heart, right upper section of liver |
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Drains everything that the right lymphatic duct doesn't drain |
Thoracic duct |
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What are the functions of the lymphatic system? |
Conserve fluid and plasma proteins that leak out of the capilaries Form a major part of immune system - defends body Absorb lipids from the intestinal tract |
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Describe lymphatic vessels |
Start as microscopic open ended tubes Siphon interstitial fluid From vessels drain lymph into larger vessels |
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Is the flow of lymph shorter or faster than blood? |
Slower
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Role of lymph nodes = |
Filter fluid before it is returned to the blood stream and filter our microorganisms that could be harmful |
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What are the four types of superficial nodes? |
Cervical Axillary Epirochlear(arm) Inguinal |
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Where is the spleen located? What is it's function? |
Left upper quadrant Destroy RBC Produce antibodies Store RBC Filter microorganisms in the blood |
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Role of tonsils |
Respond to local inflammation |
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Role of thymus and location |
Superior mediastnum Develop T lymphocytes Mature B lymphocytes (born in bone marrow) |
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When does lymphoid tissue reach adult size? |
Age 6 |
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Are lymphnodes relatively large or small in children? |
Large - more easily palpated |
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How is the lymph system changed during pregnancy? |
Uterus obstructs drainage of the iliac veins to the inferior vena cava Low blood flow and increased venous pressure Causes dependent edema (legs, vulva, hemorrhoids) |
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When peripheral blood vessels grow more rigid with age = |
Arteriosclerosis |
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Deposition of fatty plaques on the intima of the arteries |
atherosclerosis |
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What happens to lymphnodes in the aging adult? |
Loss of lymphatic tissue leads to fewer number of lympnodes Decrease in size of remaining nodes |
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The number of blocks walked or stairs climbed to produce pain |
Claudication distance |
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Claudication distance |
The number of blocks walked or stairs climbed to produce pain |
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What is night leg pain common in older adults? |
Ischemic resp pain of PVD Severe night muscle cramping Restless leg syndrome |
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Is arterial disease associated with coolness or warmth? |
Coolness |
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When is edema bilateral? When is it unilateral? |
Bilateral = Cuase is generalized (heart failure) Unilateral = Result of local obstruction or inflammation |
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What might you suspect if there is edema in the upper extremities? |
Lymphatic drainage is obstructed |
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When does a full/boudning pulse happen? |
Hyperkinetic states - exercise, anxiety, fever Anemia Hyperthyroidism |
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When does a weak/thready pulse happen |
Shock Peripheral arterial disease |
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What is the modified Allen Test? When is it used? |
Used to evaluate circulation Occlude ulnar and radial pulses Pt makes fists several times Open hand Release Ulnar side HOw long does it take for color to return? 2-5 seconds is good |
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How long should it take color to return during the Allen's Test? |
2-5 seconds |
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If pallor exists during the allen's test, what can that mean? |
Occlusion of the collateral arterial flow |
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When do the legs have pallor? |
Vasonconstriction erythema vasodilation cyanosis |
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What does malnutritioned skin look like? |
Thin shiny atrophic |
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If lower legs are asymmetric, what does this indicate? |
DVT Deep vein thrombosis |
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When measuring the diameter of both calves, what could each difference be? 1 cm 1-3 cm 3-5 cm 5 cm |
1 - Abnormal - refer person for DVP 1-3 - Mild lymphedema 3-5 - Moderate lymphedema 5+ - Severe lymphedema |
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Where do venous ulcers usually occur? |
Medial malleolus |
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What could a unilateral cool foot or temperature drop as you move down the leg indicate? |
Arterial deficit |
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Calf pain with flexion/extension = |
Positive homan sign - 35% are DVT |
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When does bilateral pitting edema occur? |
Heart failure, diabetic neuropathy, hepatic cirrhosis |
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Pitting Edema grading 1+ 2+ 3+ 4+ |
1 = Mild, no leg swelling 2 = Moderate, indentation subsides rapidly 3 = Deep, indentation remains, swollen legs 4 = Very deep, indentation remains for a long time, leg grossly swollen/distorted |
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What does elevation pallor indicate? |
Arterial insufficiency |
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Dependent rubor (deep red/blue) indicates...? |
Severe arterial insufficieny |
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What device do you use to detect a weak peripheral pulse? |
Doppler ultrasonic stethoscope |
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Can vaccinations produce local lymphadenopathy? |
Yes |
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Is pitting edema normal in pregnancy? When? |
Yes, end of day into the third trimester |
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What pulse is hardest to find on an adult? |
Dorsalis pedis and posterior tibial |
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Episodes of abrupt, progressive tricolor change of the fingersin respose to cold, vibration or stress |
Raynaud's Pheonmenon |
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Raynaud's Pheonmenon |
Episodes of abrupt, progressive tricolor change of the fingers in respose to cold, vibration or stress (white, blue, red |
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Cold or numbness, pain alowith with pallor and cyanosis - burning throbbing pain, swelling along with rubor |
Reynaud's |
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Reynauds |
Cold or numbness, pain alowith with pallor and cyanosis - burning throbbing pain, swelling along with rubor |
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What predisposes someone to Reynauds? |
Several drugs, smoking can increase symptoms Bilaterally |
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Lymphedema |
High protein swelling of the limb - most common to breast cancer treatment. Surgical removal or damage to lymphnodes impedes drainage of lymph. |
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High protein swelling of the limb - most common to breast cancer treatment. Surgical removal or damage to lymphnodes impedes drainage of lymph. |
Lymphedema |
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Stagnant lymph increases... |
Risk of infection, delayed wound healing, chronic inflammation, fibrosis surrounding tissue |
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Symptoms: Tired, thick heavy arm, jewelry too tight, swelling or tingling Objective: Unilateral swelling, non pitting. |
Lymphedema |
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Lymphedema is common is what kind of cancer? |
Breast - 42% |
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Effective interventions for lymphedema |
Complete decongestive physiotherapy and compression bandaging |
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Chronic arterial symptoms |
Deep muscle pain in foot/leg Cramp, numbness, tingle, coolness Chronic pain, after exertion Pain with elevation and activity Relieving - Rest |
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Deep muscle pain in foot/leg Cramp, numbness, tingle, coolness Chronic pain, after exertion Pain with elevation and activity Relieving - Rest |
Chronic arterial |
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Who is at risk for chronic arterial? |
Older adults - males Htn, smoking, diabetes, high cholesterol, obesity, vascular disease |
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Chronic venous symptoms |
Calf, lower leg Aching tiredness, fullness Chronic pain increaing at EOD Prolonged sitting/standing aggravates Elevation, lying, walking relieves Edema, varicosities, weeping ulcers at ankles |
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6 Ps of Acute arterial symptoms |
Pain, pallor, pulselessness, parathesia, poikilothermia (cold), paralysis |
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Calf, lower leg Aching tiredness, fullness Chronic pain increaing at EOD Prolonged sitting/standing aggravates Elevation, lying, walking relieves Edema, varicosities, weeping ulcers at ankles |
Chronic Venous Symptoms |
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Those most at risk for chronic venous symptoms |
Job with prolonged sitting or standing, obesity, pregnancy, prolonged bedrest, heart failure, varicosities, thrombophlebitis, crushed veins (surgery/trauma) |
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Arterial Ischemic Ulcer |
Atherosclerosis Arteriosclerosis Deep muslce pain in calf/foot Pain with walking Coolness, Pallor elevational pallor, dependent rubor, diminished pulses |
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Coolness, Pallor elevational pallor, dependent rubor, diminished pulses |
Arterial Ischemic Ulcer |
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Atherosclerosis Arteriosclerosis Deep muslce pain in calf/foot Pain with walking Coolness, Pallor elevational pallor, dependent rubor, diminished pulses |
Arterial Ischemic Ulcer |
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Venous Stasis Ulcer Cause |
After acute DVT or chronic imcompetent valves in deep veins |
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Cause of arterial ischemic ulcer |
Atherosclerosis Arteriosclerosis |
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After acute DVT or chronic imcompetent valves in deep veins |
Venous stasis ulcer |
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Venous stasis ulcer - signs |
Aching pain, lower calf or leg Worse at EOD, prolonged sitting, standing Firm Brawny edema, coarse thickened skin Normal pulse Brown pigment discoloration and petechiae (RBC leaking out) |
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Aching pain, lower calf or leg Worse at EOD, prolonged sitting, standing Firm Brawny edema, coarse thickened skin Normal pulse Brown pigment discoloration and petechiae (RBC leaking out) |
Venous stasis ulcer signs |
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Superficial varicose veins - cause |
Imcompetent valves permit reflux of blood Produces dilated tortous veins |
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Imcompetent valves permit reflux of blood Produces dilated tortous veins |
Superficial varicose veins - cause |
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Symptoms of varicose veins |
Aching, heaviness in calf Easily fatigues Night leg or foot cramps Dilated tortous veins |
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Aching, heaviness in calf Easily fatigues Night leg or foot cramps Dilated tortous veins |
Symptoms of varicose veins |
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Who is most at risk of varicose veins? |
Women over 45 three times more likely |
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DVT Cause |
Deep vein is occluded by a thrombus Causes inflammation, blocked venous return, cyanosis and edema Virdchow's Triad
Prolonged bedrest, history of varicose veins, trauma, infection, cancer, estrogen contraceptives |
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Deep vein is occluded by a thrombus Causes inflammation, blocked venous return, cyanosis and edema Virdchow's Triad
Prolonged bedrest, history of varicose veins, trauma, infection, cancer, estrogen contraceptives |
DVT Cause |
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What is Virchow's Triad |
Classic three factors that promote thrombogenesis 1. Stasis 2. Hypercoagulability 3. Endothial Dysfunction |
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Classic three factors that promote thrombogenesis 1. Stasis 2. Hypercoagulability 3. Endothial Dysfunction |
What is Virchow's Triad |
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Signs of DVT |
Sudden onset of intense sharp, deep, muscle pain Increased pain with dorsiflexion of the foot Increased warmth/swelling Redness, dependent cyanosis, tender |
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Do DVTs require emergency referral, why? |
YES!!! Risk for pulmonary embolism |
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Sudden onset of intense sharp, deep, muscle pain Increased pain with dorsiflexion of the foot Increased warmth/swelling Redness, dependent cyanosis, tender |
DVT |
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Cause of aneurysms |
Atherosclerosis Sac formed by dilation in the artery wall Atherosclerosis weakens the middle layer Blood pressure creates the balloon enlargement Most common site is aorta |
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Most common site for aneurysm |
Aorta |
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Sac formed by dilation in the artery wall Atherosclerosis weakens the middle layer Blood pressure creates the balloon enlargement Most common site is aorta Atherosclerosis |
Cause of aneurysm |
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Aneurysm most common in |
Men oder than 55 Women older than 70 5x more likely in men |
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Cause of occulsions |
Atherosclerosis Reduces blood flow with vital oxygen and nutrients |
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Risk factors for atherosclerosis |
Smoking, obesity, htn, diabetes M, eleveate serum cholesterol, sedentary lifestyle, famly history of hyperlipidemia |
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Smoking, obesity, htn, diabetes M, eleveate serum cholesterol, sedentary lifestyle, famly history of hyperlipidemia |
Risk factors for atherosclerosis |
