Chapter 20Peripheral Vascular and Lymphatic Assessment
Structure and Function Overview Peripheral vascular system Vascular network Lymphatic system Arterial system Walls of the arteries and arterioles have three layers Arterioles Aorta Smooth endothelial cells
Structure and Function Overview (cont.) Venous system Veins, venules, and connecting veins called perforators Thin-walled, low-pressure system Capacitance vessels Superior vena cava and then the right atrium Inferior vena cava and right atrium Superficial system Deep system
Structure and Function Overview (cont.) Venous return: Pressure gradient Inspiration Expiration Calf muscle pump Bicuspid valves
Structure and Function Overview (con’t) Capillaries Exchange of nutrients, gases, and metabolites Venules Lymphatic system Lymph nodes and lymphatic vessels, spleen, tonsils, and thymus Maintains fluid and protein balance Functions with the immune system to fight infection
Structure and Function Overview (cont.) Lymphatic system (cont.) Lymphatic vessels Thoracic ducts Contain valves Superficial lymph nodes are accessible for palpation Lymphedema
Lifespan Considerations Pregnant women—increased venous pressure and circulating volume Newborns, infants, and children—larger lymphoid tissue. Arterial plaque evident in children and adolescents. Smoking and obesity increases risk factors for vessel changes. Older adults—arteriosclerosis, increased SBP. Risk of peripheral vascular disease increases dramatically. Varicosities are more common, esp in women Cultural considerations—darker races are highest risk for PVD, HTN, DM, and hyperlipidemia and usually have more modifiable risk factors
Acute Assessment Complete arterial occlusion by clot is limb-threatening situation Deep vein thrombosis (DVT) Immediate intervention to start anticoagulants is necessary Pulmonary embolism Life-threatening emergency
Subjective Data Collection Areas for health promotion/Healthy People Health history includes key information for the development of health-promotion measures Identifying cardiovascular risk factors Evaluating the patient’s understanding of risk factors Basis for the development of a plan to eliminate modifiable risk factors and to control as much as possible the severity of those that cannot be changed
Subjective Data Collection (cont.) Assessment of risk factors Risk factors for the development of atherosclerosis Modifiable (eg, smoking) and nonmodifiable (eg, hereditary factors) Essential to identify these risk factors the patient’s understanding of them resources available to the patient his or her support network
Subjective Data Collection (cont.) Risk assessment and health-related patient teaching Essential for the health care provider to determine areas for focused teaching Atherosclerosis Patients with PAD (peripheral arterial disease) Most modifiable risk factors are smoking, high-fat diet, and limited activity level Diet modification; increase fluids Daily assessment of the feet Hypertension, diabetes, and heredity
Subjective Data Collection (cont.) Risk assessment and health-related patient teaching (cont.) Patients with venous disease Education on methods of decreasing venous pressure Compression stockings Patients at risk for or with a history of DVT
Subjective Data Collection (cont.) Lymphatic disorders: Focused health history related to common symptoms Common peripheral vascular and lymphatic symptoms Lifespan considerations Cultural considerations
Question When learning about peripheral vascular disease, the nursing student would learn that signs and symptoms of a DVT need the immediate what? A. Start of anticoagulants B. Preparation for surgery C. Transfer to the ICU as it is life threatening D. Education of signs/symptoms of arterial occlusion
Answer A. Start of anticoagulants Rationale: Complete arterial occlusion is limb-threatening situation. If a patient is experiencing symptoms of deep vein thrombosis (DVT), immediate intervention to start anticoagulants is necessary; pulmonary embolism is a life-threatening emergency.
Objective Data Collection Diagnostics: labs, Duplex Doppler ultrasound Comprehensive physical examination Arms and legs Blood pressure Special techniques Color change Manual compression test Trendelenburg test Documenting normal and abnormal findings
Evidence-Based Critical Thinking Organizing and prioritizing Labs: Cholesterol and triglyceride levels Blood glucose level and hemoglobin A1C (3 month look at glucose levels) D-dimer (assists in determining presence of clot) Blood clotting factors Diagnostic ultrasonography (determines blood flow through vessels) MRI and CT Lymphangiography vs lymphoscintography (examines lymph vessels for flow or blockage)
Evidence-Based Critical Thinking (cont.) Diagnostic reasoning Nursing diagnoses, outcomes, and interventions Outcomes that are related to vascular problems Evidence-based interventions Analyzing findings Collaborating with other health care providers Pulling it all together: reflection and critical thinking
Question Tell whether the following statement is true or false. The manual compression test evaluates the saphenous vein valves and retrograde filling of the superficial veins.
Answer False Rationale: The manual compression test evaluates the competence of the valves in the patient with varicose veins.
Assessing Femoral and Popliteal Pulses
Assessing Pedal Pulse and Edema
Allen Test for Arterial Circulation
Assessing Color Change and Manual Compression Test to Test for Arterial Perfusion and Varicosities