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NUR 245: CH 20 Peripheral Vascular and Lymphatic Systems Terms in this set (26) Brachial Artery Peripheral arterial disease (PAD affects noncoronary vessels and refers to arteries affecting the limbs Frombosis blood clot Embolus blood clot that m$9.99
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NUR 245: CH 20 Peripheral Vascular and Lymphatic Systems Terms in this set (26) Brachial Artery Peripheral arterial disease (PAD affects noncoronary vessels and refers to arteries affecting the limbs Frombosis blood clot Embolus blood clot that m
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NUR 245: CH 20 Peripheral Vascular and Lymphatic Systems
Terms in this set (26)
Brachial Artery
Peripheral arterial disease (PAD affects noncoronary vessels and refers to arteries affecting the limbs
Frombosis blood clot
Embolus blood clot that moves
The nurse is assessing a pa...
NUR 245: CH 20 Peripheral Vascular and Lymphatic
Systems
Jeremiah
Terms in this set (26)
Brachial Artery
Peripheral arterial disease (PAD affects noncoronary vessels and refers to arteries affecting the limbs
Frombosis blood clot
Embolus blood clot that moves
The nurse is assessing a patient's risk for The correct answer is 1. Bed rest and inactivity increase a patient's risk of DVT.
developing a deep vein thrombosis (DVT). Answer 2 is incorrect because although this patient would be considered at risk, knee
The patient considered at the highest risk is a replacement patients are not the highest risk.
60-year-old patient who: Answer 3 is incorrect because this would be a normal assessment of calf and thigh for
has been on bed rest for 3 days. DVT.
has been receiving physical therapy for left Answer 4 is incorrect because this patient would not be at high risk for DVT.
knee replacement.
has calf and thigh measurements that have
less than an inch of variation on both legs.
was admitted to the hospital with asthma
exacerbation.
Signs and symptoms relative to a thrombophlebitis would include:
The physician asks the nurse if the patient
S: Sudden onset of intense, sharp, deep muscle pain.
has any signs/symptoms related to a
O: Increased warmth; swelling; redness; dependent cyanosis is mild or may be absent;
possible thrombophlebitis. What
tender to palpation
observations would the nurse provide that
would provide the physician with the
As the patient is not experiencing any of these symptoms, the nurse would respond
information requested?
with a negative assessment with regard to these criteria.
1) contraction of skeletal muscles
three mechanisms keep blood moving
2) pressure gradient
toward the heart in the venous system
3) intraluminal valves
1/5
, 8/9/24, 1:39 PM
1. conserves fluid and plasma proteins that leak out of capillaries
the lymphatic system has 3 major functions 2. major part of the immune system that defends against disease
3. absorbs lipids from intestinal tract
filter fluid before it is returned to bloodstream; exposes blood to lymphocytes which
lymph node function
eliminate pathogens
1) Spleen: left upper quadrant of the abdomen, destroys old red blood cells, produces
antibodies, stores red blood cells, and filters organisms from the blood
2) The palatine, adenoid, and lingual tonsils: located at the entrance to the respiratory
3 primary organs of lymphatic system
and gastrointestinal tracts, respond to local inflammation
3) Thymus: behind the sternum, develops T lymphocytes in the immune system in
children but atrophies in adults
an inadequate blood supply to an organ or part of the body, especially the heart
ischemia
muscles (partial blockage)
arteriosclerosis hardening of the arteries (causing rise in systolic pressure)
myocardial infarction heart attack; treatment now includes early mobilization and preemptive anticoagulants
atherosclerosis occurring in the lower extremities, such as in the feet, calves, or legs, or
peripheral artery disease (PAD)
in the arms
arterial pain: leg cramps
arterial pain vs venous pain
venous pain: aching pain, veracose veins or sudden cramping if its a clot
determining the patency of the radial and ulnar arteries by compressing one artery site
Allen test and observing return of skin color as evidence of patency of the other artery (typically
release ulnar)
• 1+ Mild pitting, slight indentation, no perceptible swelling of the leg
• 2+ Moderate pitting, indentation, subsides rapidly
Edema Scale
• 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
compares ankel blood pressure to BP in arm (low number means arterial blockage in
Ankel Brachial Index (ABI)
leg)
combination of assessment findings categorized into Low risk (0) moderate risk (1-2)
Wells Score for Leg DVT
and high risk (3+) of DVT
Raynaud Phenomenon: A condition in which some areas of the body feel numb and
Abnormal findings in arms cool in certain circumstances.
Lymphedema: Swelling in an arm or leg caused by a lymphatic system blockage.
arterial ischemic ulcer: buildup of fatty plaques (atherosclerosis) (no bleeding, well
defined edges)
venous (stasis) ulcer: after acute DVT or chronic incompetent vlaves in deep beings,
Abnormal findings in legs
account for 80% of lower leg ulcers, bleeding and poorly defined edges)
superficial varicose veins
DVT
right lymphatic duct (red) and thoracic duct (green)
lymphatic drainage
2/5
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