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19 Cards in this Set
- Front
- Back
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Arteries |
-carry oxygenated blood to peripheral tissues -partial arterial occlusion (leads to decreased O2 delivery to distal tis & tiss ischemia) -Untreated total occlusion (may result in tiss death and loss of limb) -Exercise (aggravates ischemia due to increased O2 needs) |
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Veins |
(consist of superficial & deep veins) -Return venous blood to the heart -Venous return depends on: 1. skeletal muscle contractions (moves blood proximally)- BR decreases return 2. funct'l valves to prevent backflow (valves open towards the heart) 3. A patent lumen (to keep max forward flow) 4. Respirations (help flow by decreasing thoracic pressure & increasing ABD pressure) |
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What veins are responsible for most venous return? |
Deep veins |
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Leg veins |
-Deep veins: (femoral & popliteal veins) -Superficial veins (great saphenous vein (medial surf)-site for CABG (coronary artery bypass graft)); removal does not significantly compromise venous return since the deep veins return most blood to the heart -perforators (connect the veins) |
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Subjective Data (history) |
1. general questions 2. arterial insufficiency 3. venous insufficiency |
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general questions for subjective data |
(ask factors that could affect vascular system) 1. past hx of vascular problems, inflammatory conditions, heart disease 2. enlarged lymph nodes (painful, chronic, acute)
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Arterial Insufficiency subjective data |
(decreased arterial blood supply to the tissue) 1. intermittent claudication (muscle ischemia)- usually affects gastrocnemius muscle -classic symptoms (calf pain w/exercise; relieved by rest) -high occlusive disease may manifest as pain in thigh or buttock 2. smoking (vasoconstriction) worsens ischemia & the related symptoms |
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Venous insufficiency subjective data |
1. swelling -unilateral (venous occlusion) -bilateral (HF) -Precipitating factors (prolonged standing/sitting, travel (airplanes) -Associated symptoms (SOB, nocturia)-may be HF -nutritional status (hypoalbuminemia may lead to edema) 2. varicose veins 3. blood clots 4. hormonal contraceptives- increase risk of venous thrombosis |
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Objective data |
1. arterial assessment 2. Special tests of arterial patency 3. venous assesment 4. venous disoders 5. Lymph Node assessment |
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Arterial assessment |
1. assess all palpable pulses -head & neck (temporal, carotid) -arms (brachial, radial, ulnar) -legs (femoral, popliteal, posterior tibial, dorsalis pedis) 2. grade pulses 4+ (bounding; ABN) 3+ (full/increased; may be normal) 2+ (normal) 1+ (weak, barely palpable) 0 (absent) -Use doppler as needed 3. Ausculatory Sites -assess bruits (temporal, carotid aortic, renal, iliac, femoral) using bell of stethoscope 4. assess cap refill (normal = CRT <2 sec) -color return >2 sec indicates (arterial occlusion, hypothermia, hypovolemic shock) 5. Typical Changes of Arterial Insufficiency -Decreased or absent pulses -Pallor of extremity -Cool skin -Thin, shiny, atrophic skin -Thick ridged nails -Loss of hair (check dorsum of toes) -Ulcers & gangrene |
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Does an occluded artery cause swelling? |
NO |
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Special tests of arterial patency |
1. Leg elevation -w/pt supine, raise the leg until it blanches -then have pt sit and dangle legs (note the time of color return) -arterial occlusion = delay in color return of many seconds or minutes -severe disease = delay in color return of >/= 2 min 2. Ankle-Brachial Index -measures fall in BP to legs (a sign of arterial insufficiency) -the ration of BP in lower leg compared to arms -a lower BP in the leg is a sign of arterial occlusion 3. Allen test (assess patency of the radial and ulnar arteries) -hold hand up & clench fist -Occlude radial and ulnar arteries -release pressure on radial artery (should pink up immediately) *repeat procedure to test ulnar artery |
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venous assessment |
1. edema -Grade 1+ to 4+ -Pedal (foot) -Pretibial (ant leg along tibia) press directly over bone -dependent (feet, sacrum, etc.) -Anasarca (entire body) d/t HF or renal failure -pitting versus non pitting (brawny edema-so much edema makes skin too tight to pit) 2. Skin changes (redness or brown discoloration, leg ulcers) |
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Edema Scale |
1+ (2 mm pit; disappears rapidly) 2+ (4 mm pit; disappears in 10-15 sec) 3+ (6 mm pit; may last more than 1 minute) 4+ (8 mm pit; lasts 2-5 minutes) |
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Venous disorders |
1. superficial thrombophlebitis -redness, thickening, tenderness along a superficial vein (not serious; occurs in superficial veins; e.g., inflamm by catheter insertion) 2. DVT (may be life threatening; predisposes to a pulmonary embolis) -pain, warmth, edema and tenderness over a vein -asymmetric calf size -Homan's sign (calf pain on dorsiflexion of foot) UNRELIABLE; better to assess w/a venous doppler 3. Varicose Veins -dilated and swollen vessels d/t incompetent venous valves or proximal vein obstruction |
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risks for DVT |
1. BR or immobility (casted leg)- increased risk b/c of decreased skeletal muscle activity 2. Trauma 3. Hypercoagulable state (increased clotting) 4. Varicosities (genetic, obesity, pregnancy)- creates incompetent valves 5. Hormonal contracepives (increased risk w/smoking)-esp after age 35 |
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Chronic Arterial Insufficiency |
1. Pain w/exercise; relieved by rest 2. Diminished pulses/absent 3. Pale if elevated; bluish if dependent 4. Skin is smooth, thin, shiny, decreased hair, thick toenails 5. Ulcers located on lateral malleolus 6. cool temperature |
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Chronic Venous Insufficiency |
1. Discomfort after exercise 2. Pulses not affected 3. May have brown hyperpigmentation d/t hemosideran (iron) deposits at ankles & lower legs (from increased venous pressure causing RBC to leak out of veins) 4. Skin may have vericose veins 5. Ulcers located on medial malleolus 6. Normal temperature |
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Lymph Node assessment |
1. palpate the epitrochlear nodes (arm, by elbow) 2. palpate inguinal lymph nodes |
