HA - PVS

• Peripheral Vascular System


  Arteries and veins of the arms and legs, lymphatic system, capillaries, fluid exchange
• Structure and Function

  • Arteries
  • Veins
  • Capillaries
  • Fluid exchange
• Arteries


  • Carry oxygenated, nutrient-rich blood from the heart to the capillaries
  • High-pressure system
  • Thick-walled; strong
  • Stretchable – contain elastic fibers
• Arterial Pulse


  Surge of blood created as each heartbeat forces blood through the arterial vessels under high pressure
• Assessing Pulse Strength

  1. Palpation

  2. Pulse Amplitude graded 0-4+ scale
• Veins


  • Carry deoxygenated, nutrient-depleted, waste-laden blood from the tissues back to the heart
  • Walls are much thinner because blood is carried in much lower pressure than in the arteries
  • Contains 70% of the body's blood volume
  • Larger in diameter and expands when blood volume increases, helping the workload of the heart
• Mechanisms of Venous Function

  1. Structure of the vein – all veins of the legs contain one-way valves

  2. Muscular contraction – skeletal muscles contract and squeeze blood towards the heart through the one-way valves

  3. Pressure gradient – through the act of breathing; inspiration decreases intrathoracic pressure while increasing abdominal pressure thus producing a pressure gradient
• Pressure Gradient


  A physical quantity that describes in which direction and at what rate the pressure increases the most
• Venous return is impeded if there is a problem with the 3 mechanisms, resulting in venous stasis
• Pulse Sites

  • Radial artery (wrist)
  • Carotid artery (neck)
  • Brachial artery (medial border of the humerus)
  • Femoral artery (at the groin)
  • Popliteal artery (behind the knee)
  • Dorsalis pedis (top of the foot)
  • Posterior tibial arteries (below ankle bone)
  • Abdominal aorta (abdomen)
  • Apical (chest)
• Risk factors for Venous Stasis

  • Long periods of standing still, sitting or lying down
  • Varicose veins – tortuous and dilated – increases venous pressure
  • Damage to the vein wall
• Capillaries and Fluid Exchange

  • Small blood vessels that form connection between arterioles and venules
  • Allow circulatory system to maintain vital equilibrium between the vascular and interstitial spaces
• Normal capillary circulation


  Ensures removal of excess fluid (edema) from the interstitial spaces as well as delivery of oxygen and removal of carbon dioxide
• Hydrostatic Force/Pressure


  The primary mechanism by which the interstitial fluid diffuses out of the capillaries and enters the tissue space
• Perfusion


  1. The interstitial fluid releases the oxygen, water and nutrients and picks up waste products (carbon dioxide, etc) - process of PERFUSION

  2. Fluid then re-enters the capillaries by OSMOTIC PRESSURE and is transported away from the tissues and interstitial spaces by venous circulation
• Lymphatic System


  • An integral and complementary component of the circulatory system
  • Lymphatic capillaries, lymphatic vessels, and lymph nodes
  • To drain excess fluid and plasma proteins from bodily tissues and return them to the venous system (to prevent edema)
• During circulation, more fluid leaves the capillaries than the veins can absorb, resulting in edema
• Biological and Cultural Behavior Variations

  • Cases of venous insufficiency is highest in white women (US)
  • Increasing incidence with increasing age (US)
  • Decreases with age (African Americans and Hispanics)
  • African Americans have more lower leg veins than do whites
• Health Assessment

  1. Collecting Subjective Data: The Nursing Health History

  2. Collecting Objective Data: Physical Examination
• Diseases develops gradually, with symptoms only developing with extensive damage
• Nurse Must Consider

  • Personal and family history of vascular diseases
  • Lifestyle and health factors
• History of Present Concern - Questions with Rationale

  • Color, temp. or texture changes in the skin
  • Pain
  • Lack of Pain Sensation
  • Heaviness; aching sensation in the legs aggravated with standing by standing/sitting for long periods, edema, or varicosities
  • Varicosities
  • Sores or Open Wounds on the Legs
• Arterial Ulcer Characteristics

  • Pain: intermittent claudication to sharp, unrelenting constant
  • Pulses: diminished or absent
  • Skin characteristic: dependent rubor
  • Ulcer characteristics: very painful, deep, often involving joint space, circular, pale black to dry, gangrene
• Venous Ulcer Characteristics

  • Painless and occur on the lower leg; aching or cramping
  • Difficult to palpate pulses
  • Skin characteristics: pigmentation in gaiter area, skin thickened and tough, reddish-blue in color, frequently associated with dermatitis
  • Ulcer Characteristics: Medial malleolus or anterior tibial area, Pain: superficial – minimal; may be very painful, Irregular shape, Ulcer base – granulation tissue: beefy red to yellow fibrinous, Moderate to severe leg edema
• PVD Symptoms

  • Painful cramping in hips, calf/s, thighs after activity
  • Numbness or weakness
  • Sore on toes, feet or legs that will not heal
  • Change in color of legs
  • Slower hair growth or hair loss on feet or legs
  • Absent or weak pulses in on feet or legs
  • Slower growth of toenails
  • Shiny skin on legs
  • ED
• Previous Surgeries

  • May alter appearance of the skin and underlying tissues surrounding the blood vessels; graft for bypass are often taken from veins in the legs (CABG)
  • Repair of aneurysm
  • Vein stripping
• Risk Factors

  • Family History – cholesterol and triglycerides level
  • Tobacco Smoking
  • Regular Exercise
  • Use of Oral/Transdermal Patch Contraceptive
  • Stress
  • Use of Support Hose to Manage Varicose Veins
• Objective Data: Physical Examination

  • Arms: Lymphedema
  • Color: Raynaud's Disease
  • Palpation: Cool skin, Capillary refill time, Obliteration of ulnar pulse, Buerger Disease
  • Legs: Pallor when elevated and rubor when dependent, Dark colored toes and blisters, Gangrene, Ulcers of the Feet, Bilateral Edema, Pitting Edema, Cool Skin, Weak or absent femoral pulse, Bruits, Pallor, Manual Compression Test (Varicose Veins), Trendelenburg Test, Doppler Ultrasound Device
• Nursing Diagnoses: Actual Problem

  • Poor skin integrity associated with arterial/venous insufficiency
  • Pain associated with arterial/venous insufficiency
  • Fear of loss of extremities associated with arterial insufficiency
  • Poor body image associated with edema, ulcerations or varicosities of legs
• Nursing Diagnoses: Potential Problems

  • Risk for poor health maintenance associated with insufficient knowledge of health-related resources
  • Risk for infection associated with poor circulation to and impaired skin integrity of lower extremity
  • Risk for injury associated with altered sensation in lower extremities secondary to edema and/or neuropathy
  • Risk for poor skin integrity associated with poor circulation to extremities due to arterial or venous insufficiency
  • Risk for poor skin integrity associated with arterial or venous insufficiency
  • Risk for inability to ambulate or exercise associated with leg pain when walking
  • Risk for poor circulation to extremities associated with arterial or venous insufficiency
• Potential Collaborative Problems

  • RC: Pulmonary Embolus
  • RC: Cellulitis
  • RC: Deep Vein Thrombosis
• Types of Veins Deep (femoral, popliteal)

  • Superficial (great and small saphenous veins)
  • Great saphenous – longest; from the medial dorsal aspect of the foot, crossing over the medial malleolus, continuing across the thigh to the medial aspect of the groin, where it joins the femoral vein
  • Small saphenous vein – begins at the lateral dorsal aspect of the foot, travels up behind the lateral malleolus on the back of the leg and joins the popliteal vein
  • Perforator - connects the superficial veins with the deep veins
• Erectile dysfunction (ED)


  May occur with decreased blood flow or an occlusion of the blood vessels in one type of PAD known as aortoiliac occlusion (Leriche syndrome)
• Men may be reluctant to report or discuss difficulties achieving or maintaining an erection
• Nursing concepts


  • Assessment
  • Clotting
  • Perfusion
• Major arteries of the arm

  • Brachial artery
  • Radial artery
  • Ulnar artery
• Major arteries of the leg

  • Femoral artery
  • Popliteal artery
  • Anterior branch (dorsalis pedis artery)
  • Posterior branch (posterior tibial artery)
• Deep veins account for about 90% of venous return from the lower extremities
• Lymph nodes are somewhat circular or oval, normally varying from very small and nonpalpable to 1 to 2 cm in diameter
• Superficial lymph nodes assessed

  • Epitrochlear nodes
  • Superficial inguinal nodes