Peripheral Vascular and Lymphatic Systems

• The peripheral vascular and lymphatic systems are being discussed
• A clinical judgment case involving Mr. Fred Rossi is presented

Arteries vs Veins vs Lymphatics

• Arteries expand and recoil, creating a pressure wave or pulse
• Arteries supply oxygen and essential nutrients to cells and include the brachial, femoral, dorsalis pedis, posterior tibial, radial, and ABG's
• Veins absorb CO2 and waste products, carrying them back to the heart
• The body has more veins and they lie closer to the skin and are capacitance vessels, and include VBG's
• Lymphatics retrieve excess fluid and plasma proteins from interstitial spaces, returning it to the bloodstream
• Lymphatics form a major part of the immune system and absorb lipids from the small intestine

Peripheral Vascular Disease (PVD) & Peripheral Arterial Disease (PAD)

• Peripheral Vascular Insufficiency (PVI) refers to a narrow vein
• Peripheral Arterial Disease (PAD) refers to a narrow artery

Signs and Symptoms of PVD and PAD

• The 6 P's of assessment: pain, paresthesia, pulses, pallor, polar, and paralysis
• Pain is unrelieved and present even at rest
• Paresthesia involves tingling and numbness
• Pulses may be weak or absent
• Pallor presents as pale skin
• Polar signifies coldness
• Paralysis means weakness or inability to move

Cardiovascular Risk Factors

• Risk factors: smoking, hypercholesterolemia, diet high in saturated fats, sedentary lifestyle, hypertension, diabetes, obesity, and genetics
• Cardiovascular disease (CVD) is the leading cause of death worldwide
• Peripheral arterial disease (PAD) is a form of CVD
• People with PAD have a higher risk of morbidity and mortality from CVD

Older Adults and Vascular Issues

• Arterial vessels stiffen with age, and hypertension increases with age
• PAD along with atherosclerosis is often overlooked in older populations
• Thickening of arterial walls decreases nourishment to tissue, resulting in trophic nail changes, shiny skin, and hair loss in the lower extremities

Pulse Sites

• Pulse sites include temporal, carotid, brachial, radial, ulnar, femoral, popliteal, posterior tibial, and dorsalis pedis

Edema

• Pitting edema involves indentation in the affected areas
• Pitting edema means excess fluid is mainly composed of water
• Non-pitting edema is associated with conditions affecting the thyroid or lymphatic system
• Non-pitting edema is indicated by a build-up composed of proteins, salts, and water
• Common risk factors are medications, obesity, low protein levels, sitting/standing in the same position too long, and pregnancy
• Mild cases resolve on their own, facilitated by elevating the affected limb
• Severe cases require a diuretic to eliminate excess fluid through urine
• Chronic cases require compression socks to promote circulation

Varicose Veins

• Varicose veins are dilated leg veins resulting from chronic increased venous pressure
• Incontinent valves permit blood to reflux back towards the leg instead of toward the heart
• Pregnancy makes you three times more likely to get varicose veins:
• Risk increases with age
• Symptoms: aching, heaviness in calf, easy fatigability, restless legs, burning, throbbing, and cramping
• Signs: Dilated, tortuous veins; new varicosities on the surface of muscle or bone feel spongy if deep

Arterial vs Venous Ulcers

• Arterial ulcers are located on toes, metatarsals, malleoli, and heels
• Venous ulcers are located on the ankle, medial malleolus, or distal third of the leg, in the "gaiter area."
• Arterial ulcers have regular borders
• Venous ulcers have irregular borders
• Arterial ulcers have a pale, yellow base
• Venous ulcers have a red, pink base
• Arterial ulcers have minimal drainage
• Venous ulcers have a moderate to large amount of drainage
• Gangrene may be present in arterial ulcers, but not in venous ulcers
• Arterial ulcers are painful and decrease with dependency
• Venous ulcers demonstrate an aching pain or feeling of heaviness that decreases with elevation
• Arterial ulcers have pale, inflamed, or necrotic skin
• Venous ulcers are marked by stasis dermatitis and pigmentation changes
• Pulses are decreased or absent in arterial ulcers, and normal but difficult to palpate due to edema in venous ulcers

Clinical Scenario: S.R.

• S.R. is a 65-year-old woman presenting to the emergency department with pain in her left leg and a lesion near her left ankle bone
• The lesion is deep with a pale base, and the client does not exhibit any signs of acute distress

Assessment Questions

• Subjective information a nurse should obtain
• Objective information a nurse should obtain
• Pulse locations a nurse should check is assessing their patients
• What a nurse should do if unable to locate lower extremity pulse