Partial preview of the text
Download Health Assessment 2 Exam 1 Study Guide (Peripheral Vascular & Lymphatic System) Aneurysms, and more Exams Advanced Education in PDF only on Docsity!
{, aneurysm: defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect 1, Arrythmia: Abnormal heart rhythm 3, thrombophlebitis: inflammation of the vein associated with thrombus formation 4, Risk factors for venous stasis: Prolonged standing, sitting, or bed rest (because these situations do not allow a person to benefit from the milking action that walking accomplishes) Presence of varicose veins, especially in the presence of obesity and pregnancy 5, What are the three mechanisms returning venous blood to the heart: (1) The contracting skeletal muscles milk the blood proximally, back toward the heart. (2) The pressure gradient caused by breathing, in which inspiration makes the thoracic pressure decrease and the abdominal pressure increase. (3) The intraluminal valves ensure unidirectional flow toward the heart. 6. They ability for veins to stretch is a compensatory mechanism that...: Reduces stress on the heart 1. varicosity occur in what veins?: Saphenous veins 8 produces loss of vasomotor tone and pooling of blood in the veins.: Chronic hypoxia 9, Venous stasis: the temporary cessation or slowing of the venous blood flow 10. Name the related organs in the lymphatic system: spleen, tonsils, thymus (bone marrow and lymph nodes) {1. 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. + Medications. 12. List the skin characteristics expected with arterial insufficiency to the lower legs.: Skin is trophic, thin, shiny, with absence of hair, atrophy of muscles, and thick-ridged nails 13. Brown discoloration in the leg: occurs with chronic venous stasis due to hemosiderin deposits from red blood cell degradation 14, venous stasis ulcer: Venous stasis causes increased venous pressure, which then causes red blood cells (RBCs) to leak out of veins and into skin. RBCs break down to hemosiderin (iron deposits), which are brown pigment * Blue color, due to slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of Hb. + Red (rubor), due to return of blood into the dilated capillary bed or reactive hyperemia. 14. With a patient who has raynaud phenomenon what associated symptoms may they experience during the pallor or cyanosis stage?: May have cold, numbness, or pain 3, With a patient who has raynaud phenomenon what associated symptoms may they experience during the rubor stage?: burning, throbbing pain, swelling 1. Raynaud's Phenomenon treatment: Avoidance of cold Rewarm hands by donning gloves, rubbing in warm water, or using chemical rewarmers. After rewarming, a typical attack lasts 15 to 20 minutes 77. Venous ulcers occur usually: at medial malleolus because of bacterial invasion of poorly drained tissues 18. Function of veins: drain deoxygenated blood and its waste products from tissues and return it to the heart 2), With arterial deficit ulcers occur on: tips of toes, metatarsal heads, and lateral malleoli 30. Why is auscultation of bowel and vascular sounds done first?: percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds. i. What could cause a bruit when auscultating the femoral pulse?: Turbulent blood flow indicating partial occlusion 32. True or false: the popliteal pulse is very easy to palpate: FALSE: often a normal popliteal pulse is impossible to palpate 33. Palpation of lower leg popliteal pulse: With leg extended but relaxed, ancho knee, and curl your fingers around into popliteal fossa. 34. You want to palpate a patients brachial pulse when you suspect...: Arterial insuflciency 3. Grading scale for an arterial pulse: 0 = absent 1+ = weak 2+ = normal 3+ = increased 3. If you are to not get a pedal pulse, what should you do?: Move up the leg to the next pulse point 3. In adults older than 45 years, occasionally either the dorsalis pedis or the posterior tibial pulse may be hard to find, but should both on the same foot be hard to find?: No, not both on the same foot should be hard to find 38. Pulsus alternans: regular rhythm, but force of pulse varies with alternating beats of large and small amplitude 39. Pulsus bigeminus: irregular rhythm; every other beat is premature; premature beats have weakened amplitude 40. pulsus paradoxus: beats have weaker amplitude with respiratory inspiration, stronger with expiration 4. If you are having difficulty locating the posterior tibial pulse, what could you have the patient do?: Have them try passice dorsiflexion of the foot to make the pulse more accessible 4. Palpation of lower leg posterior tibial pulse: Curve your fingers around m feel the tapping right behind it in groove between malleolus and Achilles tendon. 43. Palpation of lower leg dorsalis pedis pulse: Normally it is just lateral to a extensor tendon of big toe. 44, Palpation of lower leg femoral artery pulse: Locate femoral arteries just ligament halfway between pubis and anterior superior iliac spines. 4, You would use a to assess neuromuscular status: Monofilament 4, Although using pitting edema is the classic method often used, what is a more reliable method?: Ankle circumference using non stretchable tape at a point of 7cm proximal to the midpoint of the medial malleolus 4, When you ask a patient to stand so you can assess the venous system, what should you be looking for?: Note any visible, dilated, and tortuous veins 44. If you suspect an arterial deficit and perform the elevated leg test, where might you see the results in both light and dark skinned patients?: Light skinned- the feet should look pale but still pink Dark skinned- the soles of their feet should reveal extreme color change 4. When you have a patient sit up with legs over the side of table how long should it normally take for color to return?: 10 seconds or less LP) 60. In a patient with PAD what questions should you ask about medications?: What medications are you taking? OTC therapies? 61. In a patient with PAD what questions should you ask about lymph node enlargement?: Location Size Hard or soft Associated symptoms 62. In a patient with PAD what questions should you ask about smoking histo- ry?: Do you smoke cigarettes? PPD (packs per day) history What age did you start? Cessation therapy 63. Compression stocking are indicated to prevent leg swelling in or prevent : Standing workers or prevent thrombus formation 64. In a patient with PAD what type of questions should you ask to assess skin changes?: On arms or legs ask about: a@ny skin changes in arms or legs r/t color or temperature. afny changes in appearance. se of support hose and/or treatment. a@ny leg sores or ulcers? Where on leg? Any pain with leg ulcer. Presence of swelling and/or associated symptoms Aleviating factors versus worsening factors 65. peripheral arterial disease (PAD): attects non-coronary vessels and refers to arteries attecting the limbs 6t. What is the difference between arteries and veins location?: Body has more veins, and they lie closer to skin surface 67. Arteries contain muscle fibers (vascular smooth muscle) which controls..: the amount of blood delivered to the tissues by changing the diameter of the arteries to control the rate of blood flow. 68. What name is given to veins because of their ability to stretch?: Capacitance vessels . True or false: vessels harden with age: TRUE 1. When assessing the jugular veins how do you want the patient sitting?: At a 45 degree angle 1. What are the deep veins of the leg and what do they do?: femoral and popliteal deep arteries and conduct most of the venous return from the legs. nt. What are the superficial veins of the leg and what do they do?: great saphenous and small saphenous Blood flows from the superficial veins into the deep leg veins 13, What are the perforator veins and what do they do?: Connecting veins that join two sets have one-way valves that route blood from the superficial into the deep veins and prevent reflux to the superficial veins. 14, What type of pressure is in the veins?: low pressure 1, What 3 mechanisms help venous flow?: Skeletal muscle Breathing Valves 76. varicose veins: abnormally swollen and twisted veins, usually occurring in the legs Tl, What do varicose veins create?: Incompetent valves leading to increased venous pressure, which further dilates the vein 78. What is a SCD and what is it used for?: sequential compression device Device used to pump air to allow the flow back to the heart to help prevent DVT 1, The cervical nodes drain the:: head and neck 80. Axillary nodes drain the: breast and upper arm 8. Epitrochlear nodes drain the: Hand and lower arm 82. If someone were to cut their finger and it gets infected, which lymph nodes would you expect to check?: Epitrochlear nodes 83. Inguinal nodes drain the: Lymph from lower extremity, genitalia, and abdomen 84. What happens to peripheral blood vessels with aging?: Vessels grow more rigid with age 8. Peripheral blood vessels grow more rigid with age resulting in what?: Arte- riosclerosis with increased prevalence of PAD 8. When assessing a patient for PAD what should be looking for?: For presence of intermittent claudication 87. arteriosclerosis: hardening of the arteries 17. Smoking is the strongest risk factor for PAD because it does what to the arteries?: Tobacco constricts arteries 18. During a complete physical examination, what order should you take when assessing the peripheral vascular system?: Examine the arms at the very beginning when you are checking the vital signs and the person is sitting. Examine the legs directly after the abdominal examination while the person is still supine. Then have the person stand to evaluate the leg veins. 19. Examination of the arms and legs includes what when assessing the periph- eral vascular system?: Peripheral vascular characteristics Musculoskeletal findings Neurologic findings {10. When preparing for a complete physcial exam what equipment will you need to assess the peripheral vascular system?: Paper tape measure Tourniquet or blood pressure cutt Stethoscope Doppler ultrasonic stethoscope {{1. When inspecting a persons hand how should you go about it and what do you want to note?: Inspect, then turn the persons hands over, noting color of skin and nail beds; temperature, texture, and turgor of skin; and the presence of any lesions, edema, or clubbing 11. When detecting for early clubbing in a patient with PAD how will you do it?: Use profile sign, viewing finger from side 13. What all should you assess about the hands when inspecting a patient with PAD: Color of skin and nail beds Temperature, texture and turgor of skin Clubbing Capillary refill Radial pulse Modified Allen test 114. Modified Allen test: used to evaluate the adequacy of collateral circulation before cannulating the radial artery 115. How do you perform the Modified Allen test?: Have patient pump hand while occluding both the radial and ulnar arteries; slowly release one artery to check for circulation when blood flows back into the hand OB 116. Results of the modified Allen test: < 7 sec adequate circulation 8-14 sec equivocal result 45 sec negative result 117. Allen test: test that determines the patency of the radial and ulnar arteries by com-pressing one artery site and observing return of skin color as evidence of patency of the other artery 118, What should you do if you are inspecting a patients legs who has PAD and they look asymmetric?: Measure leg at widest point, taking care to measure other leg in exactly same place, same number of centimeters down from patella or other landmark 119. When palpating a patients leg who has PAD, you should note size and exact location of what?: Skin discoloration, skin ulcers, gangrene 120. pretibial edema: Firmly depress skin over tibia or medial malleolus for 5 seconds and release {21. Grading scale for pitting edema: 1+ Mild pitting, slight indentation, no perceptible swelling 2+ Moderate pitting, indentation subsides rapidly 3+ Deep pitting, indentation remains, leg looks swollen 4+ Very deep pitting, indentation lasts long time, leg grossly swollen and distorted {2 Bilateral pitting edema occurs with?: heart failure, diabetic neuropathy, and hepatic cirrhosis 123, When palpating the leg what does a unilateral cool foot or leg, or a sudden temperature drop as you move down the leg represent?: Arterial ischemia 14. An enlarged epitrochlear node occurs with: infection of the hand or forearm 15, Epitrochlear nodes occur in conditions of generalized: Lymphadenopathy Lymphoma Chronic leukemia Infectious mononucleosis HIV infection 126, A capillary refill lasting more than 1-2 seconds signifies...: Vasoconstriction or decreased cardiac output 121, Edema of the upper extremities occurs when: lymphatic drainage is obstructed after breast surgery or radiation 128, With a patient who has arterial insufficiency what signs can you look for when inspecting the legs?: Malnutrition: thin, shiny, atrophic skin; thick-ridged nails; loss of hair; ulcers; gangrene. Malnutrition, pallor, and coolness 14. When looking at pain profiles of peripheral vascular disease you want to note: Note: Wocation, character, onset, and duration Hggravating factors and relieving factors Risk factors 141, Lymphedema: swelling due to an abnormal accumulation of protein rich fluid within the t ! ' tl } 14, Example of chronic arterial insufficiency ulcer: 14, Example of chronic venous insufficiency ulcer: 14, Example of chronic venous disease: 14. Example of acute venous disease: 14. What is the names of the 3 quadrants in the middle of the stomach region from superior to inferior: Epigastric Umbilical Hypogastric or suprapubic 147. True or false: aging alters the appearance of the abdominal wall: TRUE 148. Changes of the GI system occur with aging, but most do not significantly affect function as long as no disease is present, what changes occur?: Salivation decreases, leading to a dry mouth and decreased sense of taste Esophageal emptying and gastric acid secretion are delayed 14, True or false: the incidence of gallstones increases with age, occurring in 10% to 20% of middle-age and older adults, being more common in females: - TRUE 150, What changes take place to the liver between the gates of 20 to 70: Liver size decreases by 25% Liver function remains normal Drug metabolism is impaired 151, What is the Rome Ill: Standardizes symptom criteria for functional constipation because many adults are confused as to what defines constipation 152, Common causes of constipation found in the older adult: Decreased physical activity Inadequate intake of water Low-fiber diet Side ettects of medications Irritable bowel syndrome Bowel obstruction Hypothyroidism Inadequate toilet facilities, that is, diflculty ambulating to toilet may cause person to deliberately retain stool until it becomes hard and diflcult to pass 153, is the digestive enzyme necessary for absorption of the carbohy- drate lactose (milk, sugar): lactase 154, What happens when lactase levels are low?: The person becomes lactose intolerant and has abdominal pain, bloating and flatulence when milk products are consumed {4. During an interview what should you ask about the patients medications?: Rx and OTC. dcohol—type, amount, and frequency. smoking history. 15. During an interview what should you ask about the patients food nutritional assessment?: @ietary history. 16. When interviewing an aging adult about their abdominal region, what ad- ditional history should you ask about?: afccess to groceries and food preparation. shared meals or eats alone. # hour dietary recall. swallowing or feeding diflculties. activities done following mealtimes. Kowel health—frequency, constipation, fiber in your diet, use of laxatives. ghedications—Rx and OTC. {t7, In preparation for an abdominal examination, how should you prepare the room and the patient?: A¢dequate lighting Expose abdomen so that it is fully visible; drape genitalia and female breasts. Rosition for comfort to enhance abdominal wall relaxation. «Empty bladder prior to examination with specimen saved if needed. «Warm stethoscope and examine areas identified as painful last so as to prevent guarding. 18, Abnormal findings associated with peripheral vascular disease in the arms- : Arms Raynaud phenomenon kymphedema 19, When examining a patient, which should you do first? Palpate, percussion, or auscultate?: Auscultate prior to palpation and percussion 17, True or false: when inspecting a patient you may need to use distraction to keep patient relaxed and facilitate muscle relaxation: TRUE {. What equipment is needed for abdominal inspection?: ¥tethoscope, small centimeter ruler, and skin-marking pen cohol wipe to clean endpiece {2. What do you want to note when inspecting the abdomen?: Contour Symmetry Umbilicus Skin Pulsation or movement Hair distribution Demeanor 173, Inspection of the abdomen: CONTOUR: Stand on person's right side and look down on abdomen Then stoop or sit to gaze across abdomen Your head should be slightly higher than abdomen Determine profile from rib margin to pubic bone; contour describes nutritional state and normally ranges from flat to rounded 14, scaphoid abdomen: caves in 1%, Protuberant abdomen: abdomen is distended {76. Inspection of the abdomen: SYMMETRY: Shine light across abdomen toward you or length- wise across the person Abdomen should be symmetric bilaterally Note any localized bulging, visible mass, or asymmetric shape (Even small bulges are highlighted by shadow) Step to the foot of the examination table to recheck symmetry. You can have the patient Take a deep breath (abdomen should stay smooth and symmetric) Perform a sit-up without pushing up with hands {71. hernia: protrusion of abdominal viscera through abnormal opening in muscle wall 178. Sister Mary Joseph nodule: hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary, or pancreas 179. Inspection of the abdomen: UMBILICUS: Normally midline and inverted, with no sign of discoloration, inflammation, or hernia. Becomes everted and pushed upward with pregnancy. Common site for piercings. The site should not be red or crusted. 1. A common pigment change is...: Striae 718 100. Costovertebral Angle Tenderness: Tenderness to percussion over the costovertebral angle; a common finding in pyelonephritis and other infections of the kidney and adjacent structures; Acronym: CVAT. 11. Positive finding of costovertebral angle tenderness indicates: Inflammation of the kidney 102. How should you palpate surface and deep areas?: J¢idge size, location, and consistency of certain organs and screen for an abnormal mass or tenderness. Because most people are naturally inclined to protect abdomen, you need to use additional measures to enhance complete muscle relaxation. Begin with light palpation then proceed to deep palpation. 103. With either light or deep palpation, what do you want to note?: size, consistency, and mobility of any palpable organs and presence of any abnormal enlargement, tenderness, or masses 14, True or false: mild tenderness normally presents when palpating the sig- moid colon: TRUE 105, If you identify a mass, what should you note?: lgocation ize Yhape Gonsistency: soft, firm, hard ffurface: smooth, nodular HMobility, including movement with respirations Pulsatility Fenderness 106. Blumberg's sign: assessment technique elicited during abdominal assessment to check for peritonitis rebound tenderness 207. Murphy's sign: Pain with palplation of gall bladder (seen with cholecystitis) Inspiration arrest 208. McBurney's point tenderness: tenderness to palpation in the mid-point of the right lower quadrant (RLQ) which can indicate appendicitis 205. llipsoas muscle test: With the person supine, lift the right leg straight up, flexing at the hip then push down over the lower part of the right thigh as the person tries to hold the leg up. When the test is negative, the person feels no change. 210. When should you perform the llipsoas muscle test?: when the acute abdominal pain of appendicitis is suspected. i. With an aging adult inspecting the abdomen you may note increased de- posits of on the and because it is redistributed away from extremities: Subcutaneous fat on the abdomen and hips 12. In an aging adult Abdominal musculature is and has less tone than that of a younger adult, so in absence of obesity you may note persistalsis: Thin- ner 13. Abnormal findings associated with abdominal distention: Obesity Air or gas Ascites Feces 114, Common sites of referred abdominal pain: eLiver—RUQ +Esophagus—behind lower sternum + Ulcer—shoulder +Gallbladder—RUQ +Appendix—RLQ +Pancreas—Midscapular +Kidney—flank pain *Small intestine—dittuse +Colon—colicky pain and bloating 215. Friction rubs: Grating sound heard throughout the respiratory cycle as inflamed pleural spaces rubs together 116, Gl disorders: Bowel obstruction Ratient history and symptoms Physical exam findings Biagnostic test Choleystitis Bilary colic Positive Murphy sign 17. When measuring the ankle brachial index who might give a falsely high (or negative) ankle pressure?: People with diabetes mellitus or chronic kidney disease bc may have calcified arteries that occasionally are non-compressible 
