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Peripheral Vascular System and Lymphatics : A&P and Assessment

Peripheral Vascular System and Lymphatics : A&P and Assessment. Jensen, ch 18. Arteries. High pressure system Heart is pump for system Elastic, tough, thick, strong Recoil allows stretching Made of vascular smooth muscle so meds that affect VSM will affect arteries. Veins.

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Peripheral Vascular System and Lymphatics : A&P and Assessment

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  1. Peripheral Vascular System and Lymphatics: A&P and Assessment Jensen, ch 18

  2. Arteries • High pressure system • Heart is pump for system • Elastic, tough, thick, strong • Recoil allows stretching • Made of vascular smooth muscle so meds that affect VSM will affect arteries

  3. Veins • Low pressure system • More veins than arteries • Large diameter allows expansion of holding of large amounts of blood (capacitance vessels) • Do not have pump, but valves • Valves, calf muscles, and respiratory cycle facilitate venous return

  4. Lymphatics • Completely separate system of microscopic, open-ended tubes • Prevents edema by siphoning excess fluid from tissue spaces that is not reabsorbed by veins • Absorbs lipids from intestinal tract • Conserves fluid and plasma proteins that leak out of capillaries

  5. Lymphatics (cont’d) • Nodes are the filters • Flow is propelled by valves, respiratory cycle, muscles and lymph vessel contractions • Forms major part of immune system

  6. Lymphatics cont’d • Two main trunks: • Right lymphatic that drains right side of head and neck, right arm, right thorax and lung, right heart, RUQ of liver. Empties into right subclavian vein • Thoracic duct drains rest of body and empties into left subclavian

  7. Related Organs • Spleen—destroys old RBCs and stores new ones, produces antibodies, filters blood • Tonsils—palatine, adenoid, lingual—respond to inflammation • Thymus—develops T lymphocytes in children

  8. Developmental Considerations • Lymph tissue adult size by age 6; twice adult size by puberty; back to adult size by age 18 • Somewhat large and palpable in children (shoddy) even when not inflamed, but should not be hard, tender, or immovable • Vessels and nodes atrophy and vessels grow rigid in older adults • Rise in systolic pressure and peripheral arterial dz (PAD) are common in older adults

  9. Assessment: History • Risk factors: • Arterial—nonmodifiable and modifiable same as for cardiac dz (499) • Venous—bedrest, prolonged sitting and standing, hypercoagulation, vein wall trauma, genetics, obesity, pregnancy, BCPs

  10. History cont’d • Ask about: • Leg pain • Color changes (red, white, blue, brown) • Ulcerations • Edema • Swollen glands • Sx of hypertension (if any) • Meds (esp hormones, antihypertensives, anticoagulants)

  11. Physical Assessment • Accessible arteries for examination: • Temporal • Carotid • Brachial • Radial • Ulnar • Femoral • Popliteal • Pedal (dorsalis pedis, posterior tibial)

  12. Assessment cont’d • Accessible lymph nodes: epitroclear, inguinal • Accessible veins for examination: • Jugular • Brachial • Cephalic • Femoral • Popliteal • Saphenous (great and small)

  13. Assessment cont’d • Assess in semi-Fowler’s position • Inspect for peripheral tissue perfusion—color, clubbing, hair distribution, ulcerations • Six Ps are important in some patients to assess neurovascular status (499) • Auscultate temporal, carotid, and femoral arteries for bruits; auscultate blood pressure

  14. Assessment cont’d • Palpate for: • Rate, rhythm, symmetry, amplitude (506) • Edema—pitting or not, grade as 1-4+ (506) • Temperature • Texture • Cap refill • Epitroclear and inguinal nodes • Measure for calf size and symmetry

  15. Assessment cont’d • Tests for PV system: • Allen test (508), positional color changes (512), and Doppler (arterial) (511) • Ankle-brachial index (ABI) to assess for peripheral vascular dz (PVD) (511) • Homan’s sign (venous)

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