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Course: Medical Surgical Nursing

Topic: Anatomic/Physiology Overview and Assessment of Peripheral Vascular System

The Nurses International Community

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Module Goals

Learners will be able to

Describe the anatomy and physiology of the vascular system.
Discuss the pathophysiology of the vascular system.
Discuss gerontological considerations.
Describe the assessment of the vascular system.

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Peripheral Vascular System Function

The peripheral vascular system transports blood to and from the body’s tissues and organs.

The peripheral vascular system:

Maintains proper circulation
Delivers oxygen and nutrients to the cells
Removes waste products

Toronto Metropolitan University, 2021

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Peripheral Vascular System

Refers to the network of blood vessels located outside of the heart and lungs and includes:

Arteries
Veins
Capillaries

Toronto Metropolitan University, 2021

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Artery Physiology

Inner Layer: endothelial cells → form a smooth surface to reduce friction and facilitate the smooth flow of blood.
Middle Layer: smooth muscle cells, elastic fibers, and collagen → allow the arteries to constrict or dilate, provide flexibility, and maintain the shape of artery.
Outer Layer: connective tissue, including collagen fibers → structural support and anchors artery to surround tissues.

Toronto Metropolitan University, 2021

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Artery Physiology

Arteries branch out into smaller blood vessels called arterioles.

Arterioles further divide into capillaries.

Capillaries are the smallest and thinnest blood vessels. After exchanging oxygen and nutrients and collecting waste products, rejoin to form venules, which merge with veins.

Toronto Metropolitan University, 2021

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Arterial Functions

Oxygen and nutrient delivery
Waste product removal
Blood pressure regulation
Distribution of hormones and signaling molecules

Toronto Metropolitan University, 2021

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Oxygen and Nutrient Delivery: Arteries transport oxygenated blood rich in nutrients, including glucose and amino acids, to the tissues and organs. Oxygen is essential for cellular respiration, which produces energy for cell function.

Waste Product Removal: Arteries also carry away waste products, such as carbon dioxide and metabolic byproducts, from the tissues. These waste products are transported back to the heart and eventually eliminated from the body through the lungs or kidneys.

Blood Pressure Regulation: Arteries help regulate blood pressure. As the heart pumps blood into the arteries, the elastic walls of the arteries expand and then recoil, creating pressure that helps propel blood forward and maintain blood flow throughout the body.

Distribution of Hormones and Signaling Molecules: Arteries distribute hormones, enzymes, and signaling molecules to various tissues and organs, enabling communication and coordination between different parts of the body.

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Circulation Diagram

Toronto Metropolitan University, 2021

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Question

What is the primary function of arteries in the circulatory system?

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Vein Physiology

Vein walls have the same 3 layers as arteries, except there is less smooth muscle and connective tissue

Innermost Layer (tunica intima)
Middle Layer (tunica media)
Outermost Layer (tunica Externa)

Contains valves to prevent backflow of deoxygenated blood
Have higher capacity to stretch (capacitance)

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Venous Function

Return deoxygenated blood and waste products from the capillaries back to the right atrium of the heart.
Low-pressure system allows the vein to accommodate variations in blood volume and facilitates venous return.
Venous return is facilitated by contracting muscle around veins, valves and the action of the respiratory pump.
Blood distribution throughout the body acts as a conduit between the capillary networks and the heart.

Toronto Metropolitan University, 2021

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Mechanisms of Venous Flow

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Question

What is the primary function of veins in the circulatory system?

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Subjective Assessment Data

Leg pain or cramps
Skin changes on arms or legs
Swelling
Lymph node enlargement
Medications
Smoking history

Wisconsin Technical College System, 2023

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Objective Assessment Data: Inspection

Skin color uniform and appropriate for race bilaterally
Equal hair distribution on upper and lower extremities
Absence of jugular vein distension (JVD)
Absence of edema
Sensation and movement of fingers and toes intact

Wisconsin Technical College System, 2023

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Objective Assessment Data: Palpation

Skin warm and dry
Pulses present and equal bilaterally
Absence of edema
Capillary refill less than 2 seconds

Wisconsin Technical College System, 2023

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Objective Assessment Data: Auscultation

Carotid Pulse

Wisconsin Technical College System, 2023

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Critical Conditions to Report Immediately

Cyanosis
Absent pulse (and not heard using Doppler device)
Capillary refill time greater than 3 seconds
Unilateral redness, warmth, and edema, indicating a possible deep vein thrombosis (DVT)

Wisconsin Technical College System, 2023

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Abnormal Assessment Findings

of the Peripheral Vascular System

Arms

Raynaud phenomenon (see picture to right)
Lymphedema

Legs Ulcers: Arterial, Venous, or Diabetic

Arterial (ischemic) ulcer
Venous (stasis) ulcer
Neuropathic ulcer

Peripheral Venous Disease

Superficial Varicose Veins (see picture to the right)
Deep Vein Thrombophlebitis

Peripheral Arterial Disease

Aneurysms
Occlusions

Wisconsin Technical College System, 2023

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Symptoms of Venous Insufficiency

Varicose veins
Darkened, hard, or leathery skin
Swelling
Pain and heaviness of lower extremities
Restless leg syndrome
Leg cramps or spasms
Itchy skin

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Pain Profiles of Peripheral Vascular Disease

Arterial

Dangling the legs down (dependent position) helps with pain.
Elevation makes it worse.

Venous

Elevation of the legs decreases swelling and helps with blood flow.
Dangling legs or standing/sitting for long periods makes the pain and edema worse.

Wisconsin Technical College System, 2023

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Red Flags with the Aging Adult

Peripheral blood vessels grow more rigid and less elastic with age.
Build up of fatty deposits inside arteries will narrow the arterial lumen and reduce blood flow.
Pedal pulses may become more difficult to find.
Trophic changes may occur due to arterial insufficiency.
Progressive enlargement of intramuscular calf veins can cause deep vein thrombosis.

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Cultural Considerations

Diet and Nutrition can influence cardiovascular health.
Traditional Medicine and Belief Practices may need to be integrated into treatments in order to prevent potential risks or interactions.
Religious and Spiritual Beliefs may influence individual perceptions of illness and treatment decisions.
Language and Health Literacy Levels could be barriers to health care provision.

Surikova et al., 2020; WHO, n.d.

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Diet and Nutrition: Cultural dietary practices can influence cardiovascular health and, subsequently, the peripheral vascular system. For instance, certain cultures may have diets that are high in salt, saturated fats, or carbohydrates, which can contribute to conditions like hypertension or atherosclerosis. Understanding cultural dietary patterns and working collaboratively with patients to identify culturally appropriate and healthier food choices can be beneficial.

Traditional Medicine and Beliefs: Many cultures have traditional healing practices and beliefs that may be intertwined with their understanding of health and illness. Some individuals may seek traditional remedies or consult traditional healers for managing vascular conditions. It is important for healthcare providers to inquire about and respect these practices, integrate them with evidence-based care when appropriate, and educate patients about potential risks or interactions.

Religious and Spiritual Beliefs: Religious and spiritual beliefs can influence an individual's perception of illness, treatment decisions, and acceptance of certain medical interventions. Some cultural or religious practices may involve dietary restrictions, fasting, or specific rituals that may impact the management of the peripheral vascular system. Healthcare providers should be sensitive to these beliefs and work with patients to develop care plans that align with their religious or spiritual values.

Language and Health Literacy: Language barriers and varying levels of health literacy can impact communication, understanding, and adherence to treatment plans. Healthcare providers should ensure the availability of language interpretation services and use culturally appropriate communication methods, such as using plain language, visual aids, or involving family members as interpreters when necessary.

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Cultural Considerations: Examples

Examples:

In some South Asian cultures, a diet high in saturated fats and carbohydrates, including fried foods and sweets, is common.
Traditional Chinese Medicine (TCM) incorporates various practices, such as herbal remedies, acupuncture, and dietary therapies.
During Ramadan, observed by Muslims worldwide, fasting from sunrise to sunset is practiced.
In some Middle Eastern cultures, patients may prefer to have healthcare providers of the same gender perform examinations or interventions related to the peripheral vascular system.

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Cultural Consideration: Diet and Nutrition Example: In some South Asian cultures, a diet high in saturated fats and carbohydrates, including fried foods and sweets, is common. Healthcare providers should be aware of these dietary patterns and work with patients to find culturally appropriate healthier alternatives. They can provide education on portion control, the inclusion of more fruits, vegetables, and whole grains, and adapting traditional recipes to be more heart-healthy.

Cultural Consideration: Traditional Medicine and Beliefs Example: Traditional Chinese Medicine (TCM) incorporates various practices, such as herbal remedies, acupuncture, and dietary therapies. In the assessment and management of peripheral vascular conditions, healthcare providers should inquire about any TCM treatments patients are using and communicate openly to ensure an integrated approach to care. They can collaborate with TCM practitioners, if available, to develop a comprehensive treatment plan that incorporates both conventional and traditional approaches.

Cultural Consideration: Religious and Spiritual Beliefs Example: During Ramadan, observed by Muslims worldwide, fasting from sunrise to sunset is practiced. Healthcare providers should be aware of the potential impact of fasting on the management of peripheral vascular conditions, such as medication schedules or fluid intake, and work with patients to develop modified fasting plans that ensure adequate hydration and medication adherence while respecting religious obligations.

Cultural Consideration: Language and Health Literacy Example: In a diverse community with limited English proficiency, healthcare providers should ensure the availability of professional medical interpreters or bilingual staff to facilitate communication during the assessment and management of peripheral vascular conditions. Educational materials should be provided in patients' preferred languages, and explanations should be delivered in clear and simple language to improve health literacy.

Cultural Consideration: Body Image and Modesty Example: In some Middle Eastern cultures, patients may prefer to have healthcare providers of the same gender perform examinations or interventions related to the peripheral vascular system. Healthcare providers should respect these preferences and accommodate them whenever possible to ensure patient comfort and compliance with necessary assessments and procedures.

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References

Agency for Healthcare Research and Quality (AHRQ). (2020). Health Literacy Universal Precautions Toolkit, 2nd Edition. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Surikova, J., Payne, A., Miller, K.-L., Ravaei, A., & Nolan, R. P. (2020). A Cultural and Gender-Based Approach to Understanding Patient Adjustment to Chronic Heart Failure. Health and Quality of Life Outcomes, 18, 238. https://doi.org/10.1186/s12955-020-01458-2

Toronto Metropolitan University. (2021). Introduction to the Peripheral Vascular System. Pressbooks. https://pressbooks.library.torontomu.ca/assessmentnursing2/chapter/introduction-to-the-peripheral-vascular-system/#:~:text=The%20peripheral%20vascular%20system%20

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References

World Health Organization (WHO). (n.d.) Traditional, Complementary and Integrative Medicine. https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1

Wisconsin Technical College System. (2023). 9.3 Cardiovascular Assessment. Pressbooks. https://wtcs.pressbooks.pub/nursingskills/chapter/9-3-cardiovascular-assessment/

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