1. Peripheral Vascular Perfusion
Lewis, ch 32

2. Arteries High pressure system Heart is pump for system
Elastic, tough, thick, strong
Recoil allows stretching
Made of vascular smooth muscle so meds that affect VSM will affect arteries

3. Veins Low pressure system More veins than arteries
Large diameter allows expansion of holding of large amounts of blood (capacitance vessels)
Do not have pump, but valves
Valves, calf muscles, and respiratory cycle facilitate venous return

4. Lymphatics Completely separate system of microscopic, open-ended tubes
Prevents edema by siphoning excess fluid from tissue spaces that is not reabsorbed by veins
Absorbs lipids from intestinal tract
Conserves fluid and plasma proteins that leak out of capillaries
Nodes are the filters
Flow is propelled by valves, respiratory cycle, muscles and lymph vessel contractions
Forms major part of immune system

5. Lymphatics cont’d Two main trunks:
Right lymphatic that drains right side of head and neck, right arm, right thorax and lung, right heart, RUQ of liver. Empties into right subclavian vein
Thoracic duct drains rest of body and empties into left subclavian

6. Related Organs
Spleen—destroys old RBCs and stores new ones, produces antibodies, filters blood
Tonsils—palatine, adenoid, lingual—respond to inflammation
Thymus—develops T lymphocytes in children

7. Developmental Considerations
Lymph tissue adult size by age 6
Twice adult size by puberty
Back to adult size by age 18
Large and palpable in children (shoddy) even when not inflamed, but should not be hard, tender, or immovable
Vessels and nodes atrophy and vessels grow rigid in adults

8. Risk Factors Arterial—same as those for CAD
Venous—bedrest, prolonged sitting and standing, hypercoagulation, vein wall trauma, genetics, obesity, pregnancy, BCPs

9. History Leg pain Color changes (red, white, blue, brown) Ulcerations
Edema
Swollen glands
Sx of hypertension (if any)
Meds (esp hormones, antihypertensives, anticoagulants)

10. Physical Assessment: Arterial System
Diminished or absent pulses
Smooth, shiny, dry, hairless
No edema
Round, regularly shaped painful ulcers on distal foot, toes or webs of toes
Dependent rubor
Pallor and pain with legs up

11. Arterial cont’d Intermittent claudication Brittle, thick nails
Clubbing
Elevated BP
Slow capillary refill
Bruits

12. Physical Assessment: Venous, Lymph Systems
Normal pulses
Brown patches lower legs
Dependent edema; pitting, nonpitting
Irregularly shaped, usually painless ulcers on lower legs and ankles
Dependent cyanosis & pain

13. Venous cont’d Pain relief when legs are up
No intermittent claudication
Normal nails
Swollen lymph nodes
+Homan’s sign
Inflammation

14. Diagnostics (some on 911) Blood pressure Allen test Doppler ultrasound
Duplex scanning
Ankle-Brachial Index
Arteriography, Venography
Exercise testing
D-dimer
PT, PTT, INR