1. Chapter 20Peripheral Vascular and Lymphatic Assessment

2. 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

3. 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

4. Structure and Function Overview (cont.)
Venous return:
Pressure gradient
Inspiration
Expiration
Calf muscle pump
Bicuspid valves

5. 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

6. Structure and Function Overview (cont.)
Lymphatic system (cont.)
Lymphatic vessels
Thoracic ducts
Contain valves
Superficial lymph nodes are accessible for palpation
Lymphedema

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Subjective Data Collection (cont.)
Lymphatic disorders:
Focused health history related to common symptoms
Common peripheral vascular and lymphatic symptoms
Lifespan considerations
Cultural considerations

14. 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

15. 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.

16. 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

17. 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)

18. 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

19. 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.

20. Answer
False
Rationale: The manual compression test evaluates the competence of the valves in the patient with varicose veins.

21. Assessing Femoral and Popliteal Pulses

22. Assessing Pedal Pulse and Edema

23. Allen Test for Arterial Circulation

24. Assessing Color Change and Manual Compression Test to Test for Arterial Perfusion and Varicosities