Ch 20 Peripheral Vascular System & Lymphatic System

A function of the venous system includes:
holding more blood when blood volume increases (walls of veins are thinner and more distensible)
Which organs aid the lymphatic system:
Spleen, thymus and tonsils
What are the four functions of the spleen?
1- destroy old red blood cells
2- produce antibodies
3- restore red blood cells
4- filter microorganisms from the blood
Tonsils (types and function)
Palantine
Lingual
Pharyngeal

*all respond to local inflamation

Function of the Thymus
Important in developing T-cells in children.
Nodes associated with the lymphatic system:
Cervical
Axillary
Epitrochlear
Inguinal
What portion of the body do the cervical nodes drain?
the head and neck
What portion of the body do the axillary nodes drain?
breast and upper arm
What portion of the body does the epitrochlear node drain and where is it located?
Located in the anticubital fossa and drains the hand and lower arm.
What do the inguinal nodes drain?
most of the lymph of the lower extremity, the external genitalia, and the anterior abdominal wall.
The right lymphatic duct:
Empties into the right subclavian vein.

It drains the:
head and neck
right arm
right side of thorax
right lung and pleura
right upper section of the liver.

The thoracic duct:
Empties into the left subclavian vein.

Empties the rest of the body.

Pitting edema grading scale:
1+ mild pitting, slight indentation, no perceptible swelling of legs (sock line)

2+ moderate pitting, indentation subsides quickly

3+ deep pitting, indentation remains for a short time, leg look swollen

4+ very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted.

Bilateral , dependent pitting edema occurs:
with heart failure

with a lymphatic obstruction

Unilateral edema occurs:
with occlusions of a deep vein

with a lymphatic obstruction

Aging has what effect on intramuscular calf veins:
a progressive enlargement
To screen for DVT you:
measure the calf circumferance at the widest point and compare with measurment of the other calf.
When examining a patient for arterial deficit in the lower extremities, color should return to the leg in:
10 seconds or less
Atrohpic skin changes that occur with peripheral arterial insufficiency include:
Appearance of thin, shiny, skin with loss of hair.
Intermittent claudication includes:
muscular pain brought on by exercise.
A know risk for venous ulcer development is:
Obesity
Arteriosclerosis is caused by:
the loss in elasticity of blood vessels as people age.
Raynaud phenomenon occurs:
in hand and feet as a result of exposure to cold, vibration, and stress.
Peripheral Vascular System of the arm and head Include:
Arteries–>
*Temporal
*Carotid
*Arteries of the arm:
Brachial
Radial
Ulnar

Veins–>
*Jugular
*Veins in the arm
Superficial/Deep

PVS of the legs include:
Arteries–>
*Femoral
*Popliteal
*Posterior Tibialis
*Doral Pedis

Veins–>
Femoral
Popliteal
Great and small sephenous

Where do you palpate an infants pulse
Brachial Artery
Mechanisms that aid in venous return:
Contracting skeletal muscles

Inspiration–>creates a pressure gradient making thoracic pressure decrease and the abdominal pressure increase

Intraluminal valves- ensure unidirectional flow (called the leg heart in the calves)

Structure of veins
Walls are thinner than arteries since venous pressure is lower

Intraluminal valves are present preventing back flow of blood.

Lack VSM (vascular smooth muscle)

Larger in diameter and more distensible.
–> called capacitance vessels due to their ability to stretch (reducing stress on the heart)

Function of Lymphatics:
Form a major part of the immune system, guarding against Disease and microorganisms.
Absorption of lipids from the small intestine
To conserve fluid and plasma proteins that leak form cappilaries
Lymph nodes in adults vs children:
Adults–>atrophy (adnoids)
Children–>enlarge
Arteriosclerosis
The thickening and hardening of wall of the arteries
Lymphatic system and aging:
arteriosclerosis–> increases SBP

progressive enlargement of intramuscular calf veins

prolonged bed rest and sitting and HF–>increased risk of DVT and PE

**Indicators of arterial insufficiency–>skin looks thin and shiny (stretched and taut) thick nails and decreased leg hair

When palpating lymph nodes note:
tenderness–>

consistency–> (firm or gel-like, fixed or mobile)

Shape–> regular (the smaller the better)

Lymph assessment Objective Data to collect for the arms.
Skin
Profile sign (of nail bed)
Capillary refill time <3sec Symmetry Brachial Pulse Epitrochlear Lymph node (mild palpation, massage down length of arm beginning in the pit of the elbow) Modified Allen Test: to assess Radial and Ulnar sufficiency
Lymph assessment Objective Data to collect for the legs:
Skin and hair
Symmetry (size, color, lesions)
Temp.
Calf muscles
Inguinal lymph nodes
Femoral Pulse
Popliteal Pulse
Posterior Tibial Pulse
Dorsalis Pedis Pulse
Pretibial edema
Leg veins

Additional Techniques: doppler ultrasonic stethoscope
Ankle brachial index:
*ankle pressure should be higher than brachial since it is further from the heart
*normal is 1.0-1.2

Calf muscle pain and size variation may indicate DVT (Holman Sign)

Abnormal findings:
Weak thready pulse- 1+ indicates: decreased CO, PAD, Aortic valve stenosis

Full bounding pulse- 3+ indicates: hyperkinetic states (exercise, anxiety, and fever), anemia, hyperthyroidism

Arterial (Ischemic) Ulcer: insufficient perfusion to areas due to hardening, calcification of arterial wall.

Venous (stasis Ulcer)- after acute DVT or chronic incompetent valves.
–>account for about 80% of lower leg ulcers

Describe the structure of arteries:
Contain elastic fibers allowing walls to stretch.
Contain vascular smooth muscle (VSM) that create a wave action to move blood.
Define Capacitance Vessels
those with the ability to stretch (reducing stress on the heart) to accommodate greater volumes of blood.
List the symptoms area to address during history taking of the peripheral vascular system:
Leg pain/cramps
Skin changes in arms and legs
Lymph node enlargement
medications
Smoking history
List the skin characteristics expected with arterial insufficiency to the lower legs:
Skin appears taut and shiny
Lack of leg hair