Daniela Gonzalez

Health Assessment II

07/12/2022

Peripheral Vascular System and Lymphatic System Workbook

Glossary:

Allen test- test that determines the patency of the radial and ulnar arteries by compressing one

artery site and observing return of skin color as evidence of patency of the other artery

Aneurysm- defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or

congenital defect

Arrythmia- variation from the heart’s regular rhythm

Arteriosclerosis- thickening and loss of elasticity of the arterial walls

Atherosclerosis- plaques of fatty deposits formed in the inner layer (intima) of the arteries

Bradycardia- slow heart rate, less than 50 beats per minute in the adult

Bruit- blowing, swooshing sound heard through a stethoscope when an artery is partially

occluded

Cyanosis- dusky blue mottling of the skin and mucous membranes due to excessive amount of

reduced hemoglobin in the blood

Diastole- the heart’s filling phase

Ischemia- deficiency of arterial blood to a body part due to constriction or obstruction of a blood

vessel

Lymph nodes- small oval clumps of lymphatic tissue located at grouped intervals along

lymphatic vessels

Lymphedema- swelling of extremity due to obstructed lymph channel, nonpitting

Pitting edema- indentation left after examiner depresses the skin over swollen edematous tissue

Profile sign- viewing the finger from the side to detect early clubbing

Pulse- pressure wave created by each heartbeat, palpable at body sites where the artery lies close

to the skin and over a bone

Pulsus alternans- regular rhythm, but force of pulse varies with alternating beats of large and

small amplitude

Pulsus paradoxus- beats have weaker amplitude with respiratory inspiration, stronger with

expiration

Systole- the heart’s pumping phase

Tachycardia- rapid heat rate, more than 95 beats per minute in the adult

Thrombophlebitis- inflammation of the vein associated with thrombus formation

Ulcer- open skin lesion extending into dermis, with sloughing of necrotic inflammatory tissue

Varicose veins- dilated tortuous veins with incompetent valves

Study guide:

Answers will be in red

1. Describe the structure and function of arteries and veins.

Arteries provide the body with oxygenated blood after it has left the heart. They contain

elastic fibers that allow the walls to withstand the pressure of systole and recoil during

diastole.

Veins return deoxygenated blood to the heart once it has traveled through the body. They

are more superficial than arteries and contain valves.

2. List the pulse sites accessible to examination.

 Temporal artery, carotid artery, brachial artery, femoral artery, popliteal artery, dorsalis

pedis, posterior tibial

3. Describe 3 mechanisms that help return venous blood to the heart.

1. Contraction of skeletal muscles

2. Pressure gradient caused by breathing

3. Intraluminal valves. Ensure blood flows in one direction

4. Define the term capacitance vessels, and explain its significance.

Veins that have the ability to stretch. It is a compensatory mechanism to reduce stress on

the heart

5. List the risk factors for venous stasis.

The elderly, diabetes, obesity, peripheral vascular disease, pregnancy, smoking, varicose

veins, inactivity

6. Describe the function of the lymphatic system.

Retrieves excess fluid from the tissue spaces and returns it to the bloodstream. Without

lymphatic drainage, fluid would build up in the interstitial spaces and cause edema

7. Describe the function of the lymph nodes.

Filter the fluid before it is returned to the bloodstream. Aids the immune system by

filtering harmful microorganism

8. Name the related organs in the lymphatic system.

Spleen, tonsils, thymus

9. List the symptom areas to address during history taking of the peripheral vascular system.

Leg pain or cramps, skin changes on arms or legs, swelling in the arms or legs, lymph

node enlargement, medication

10. Fill in the grading scale for assessing the force of an arterial pulse: 0 absent; 1+ weak; 2+

normal; 3+ increased

11. List the skin characteristics expected with arterial insufficiency to the lower legs.

Malnutrition, pallor and coolness, thin and shiny atrophic skin, thick ridged nails, loss of

hair, ulcers, gangrene

12. Compare the characteristics of leg ulcers associated with arterial insufficiency with ulcers

with venous insufficiency.

Ulcers occur on the tip of the toes, metatarsal heads, and lateral malleoli with arterial

insufficiency. Ulcers occur at medial malleolus and tibia with venous insufficiency.

13. Fill in the description of the grading scale for pitting edema:

1+ mild pitting, slight indentation, no perceptible swelling of the leg

2+ moderate pitting, indentations, subsides rapidly

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

4+ very deep pitting, indentation lasts a long time, leg is very swollen

14. Describe the technique for using the Doppler ultrasonic probe to detect peripheral pulses.

Lay patient supine, with legs externally rotated, place coupling gel on the end of the

probe, place probe over a pulse site at a 45-degree angle, apply light pressure, pulse is

located when a swishing, whooshing sound is heard

15. Raynaud phenomenon has associated progressive tricolor changes of the skin from white

to blue and then to red. State the mechanism for each of these color changes.

- White: pallor resulting from deficit in blood supply

- Blue: cyanosis

- Red: caused by return of blood flow to the area

Label:

Review questions:

Answers will be in red

1. A function of the venous system includes:

a. Holding more blood when blood volume increases

b. Conserving fluid and plasma proteins that leak out of the capillaries
 c. Forming a major part of the immune system that defends the body against disease

d. Absorbing lipids from the intestinal tract

2. Which of the following organs aid the lymphatic system?

a. Liver, lymph nodes, and stomach

b. Pancreas, small intestine, and thymus

c. Spleen, tonsils, and thymus

d. Pancreas, spleen, and tonsils

3. Ms. T. has come for a prenatal visit. She reports dependent edema, varicosities in the

legs, and hemorrhoids. What is the best response?

a. “If these symptoms persist, we will perform and amniocentesis”

b. “If these symptoms persist, we will discuss having you hospitalized”

c. “The symptoms are caused by the pressure of the growing uterus on the veins. They

are usual conditions of pregnany”

d. “At this time, the symptoms are minor inconveniences. You should learn to accept

them”

4. A patient’s pulse with an amplitude of 3+ indicates:

a. Irregular, with 3 premature beats

b. Increased, full

c. Normal

d. Weak

5. Inspection of a person’s right hand reveals a red swollen area. To further assess for

infection, you would palpate the:

a. Cervical node
 b. Axillary node

c. Epitrochlear node

d. Inguinal node

6. To screen for deep vein thrombosis, you would:

a. Measure the circumference of the ankle

b. Check the temperature with the palm of the hand

c. Compress the dorsalis pedis pulse, looking for blood return

d. Measure the widest point with tape measure

7. During the examination of the lower extremities, you are unable to palpate the popliteal

pulse. You should:

a. Proceed with the examination. It is often impossible to palpate this pulse

b. Refer the patient to a vascular surgeon for further evaluation

c. Schedule the patient for a venogram

d. Schedule the patient for an arteriogram

8. You assess a patient who has 4+ edema of the right leg. What is the best way to

document this finding?

a. Mild pitting, no perceptible swelling of the leg

b. Moderate pitting, indentation subsides rapidly

c. Deep pitting, leg looks swollen

d. Very deep pitting, indentation lasts a long time

9. You assess a patient for arterial deficit in the lower extremities. After rising the legs 12

inches off the table and then having the person sit up and dangle the leg, the color should

return in:
 a. 5 seconds or less

b. 10 seconds or less

c. 15 seconds

d. 30 seconds

10. A 54-year-old woman with 5 children has varicose veins of the lower extremities. Her

most characteristic sign is:

a. Reduced arterial circulation

b. Blanching, deathlike appearance of the extremities on elevation

c. Loss of hair on feet and toes

d. Dilated, tortuous superficial bluish vessels

11. Atrophic skin changes that occur with peripheral arterial insufficiency include:

a. Thin, shiny skin with loss of hair

b. Brown discoloration

c. Thick, leathery skin

d. Slow-healing blisters on the skin

12. Intermittent claudication includes:

a. Muscular pain relieved by exercise

b. Neurologic pain relieved by exercise

c. Muscular pain brought on by exercise

d. Neurologic pain brought on by exercise

13. A known risk factor for venous ulcer development is:

a. Obesity

b. Male gender
 c. History of hypertension

d. Daily aspirin therapy

14. Arteriosclerosis is caused by:

a. Deposition of fatty plaques on the intima of the arteries

b. Loss of elasticity of the walls of blood vessels

c. Loss of lymphatic tissue that occurs in the aging process

d. Progressive enlargement of the intramuscular calf veins

15. Raynaud phenomenon occurs:

a. When the patient’s extremities are exposed to heat and compression

b. In hands and feet as a result of exposure to cold, vibration, and stress

c. After removal of lymph nodes or damage to lymph nodes and channels

d. As a result of leg cramps due to excessive walking or climbing stairs