MEDICAL SURGICAL NURSING II
VNRS B85
ASSESSING CLIENTS WITH HEMATOLOGIC, PERIPHERAL VASCULAR,
AND LYMPHATIC DISORDERS
INTRODUCTION:
Clients with disorders of the hematologic, peripheral vascular and lymphatic system
experience a wide variety of circulatory deficits. As the heart ejects blood with each
beat, a closed system of blood vessels transports oxygenated blood to all body organs and
tissues and then returns it to the heart for reoxygenation in the lungs. This branching
network of vessels is called the peripheral vascular system. Nursing care should be
planned and implemented to meet the needs of the client and individualized according to
the client’s response to alterations in peripheral and lymphatic blood flow.
LEARNING OUTCOMES:
Upon completion of this unit, the student will be able to:
A.
Theory
1.
Describe the anatomy, physiology, and functions of the hematologic,
peripheral vascular, and lymphatic systems.
2.
Explain the physiologic dynamics of blood flow, peripheral resistance, and
blood pressure.
3.
Compare and contrast the major factors influencing arterial blood
pressure.
4.
Describe normal variations n assessment findings for the older adult.
5.
Identify manifestations of impairment in the function of the hematologic,
peripheral vascular, and lymphatic systems.
ASSIGNMENT:
LeMone-Burke Chapter 33
CHAPTER 33
LECTURE OUTLINE
ASSESSING CLIENTS WITH HEMATOLOGIC, PERIPHERAL VASCULAR
AND LYMPHATIC DISORDERS
•Hematologic System
–Consists of the blood components of the circulation
•Plasma
•Solutes
•Red blood cells
•White blood cells
•Platelets
Hematologic, Peripheral
Vascular, and Lymphatic Systems
•Hematopoietic System
–The blood forming system
•Bone marrow
•Lymphoid tissues
–All blood cells originate from stem cells (hemocytoblasts)
Hematologic, Peripheral
Vascular, and Lymphatic Systems
•Functions of the Blood
–Transporting oxygen, nutrients, hormones, and metabolic wastes
–Protecting against invasion of pathogens
–Maintaining blood coagulation
–Regulating fluids, electrolytes, acids, bases, and body temperature
Hematologic, Peripheral
Vascular, and Lymphatic Systems
•Peripheral Vascular System: Two Main Components
–Arterial network
•Major artery branches from aorta
•Successively small arteries
•Arterioles
•Capillary bed
–Venous system
•Capillary bed
•Venules
•Veins
•Inferior and superior vena cavae
•Right atrium
Hematologic, Peripheral
Vascular, and Lymphatic Systems
•Lymphatic System Components
–Lymphoid organs
•Lymph nodes
•Spleen
•Thymus
•Tonsils
•Peyer’s patches of small intestine
–Lymphatic vessels
Blood Flow, Peripheral
Resistance, and Blood Pressure
•Blood Flow
–The volume of blood transported in a vessel, in an organ, or throughout the circulation
over a given period of time
–Commonly expressed as liters or milliliters per minute or cubic centimeters per second
•Peripheral Vascular Resistance
–The opposing forces or impedance to blood flow as arterial channels become more
distant from the heat
–Determine by blood viscosity, length of vessel, and diameter of vessel
Blood Flow, Peripheral
Resistance, and Blood Pressure
•Blood Pressure
–Force exerted against walls of arteries by blood as it is pumped from the heart
–Mean arterial pressure is regulated by cardiac output and peripheral vascular resistance
•MAP = CO x PVR
•Systolic Blood Pressure
–Highest pressure that occurs at peak of ventricular contraction (systole)
•Diastolic Blood Pressure
–Lowest pressure that occurs during ventricular relaxation (diastole)
Arterial Blood Pressure
•Sympathetic Nervous System
–Causes vasoconstriction of arterioles, increasing BP
•Parasympathetic Nervous System
–Causes vasodilation of arterioles, lowering BP
Arterial Blood Pressure
•Baroreceptors and Chemoreceptors
–Located in the aortic arch, carotid sinus, and other large vessels
–Sensitive to pressure and chemical changes and cause sympathetic stimulation
•Kidneys
–Excrete or conserve sodium and water
–Renin-angiotension mechanism
–Antidiuretic hormone released by pituitary
Arterial Blood Pressure
•Environmental Temperatures
–Cold causes vasoconstriction; heat causes vasodilation
•Chemicals, Hormones, Drugs
–Influence blood pressure by affecting cardiac output and/or peripheral vascular resistance
Arterial Blood Pressure
•Dietary Factors
–Salt, saturated fats, and cholesterol elevate blood pressure by affecting blood volume and
vessel diameter
•Personal Factors
–Arterial blood pressure can be affected by race, gender, age, weight, time of day, position,
exercise and emotional state
–Systemic venous pressure can be influenced by blood volume, venous tone, and right
atrial pressure
Results of Aging
•Decrease bone marrow activity
–Risk for anemia
•Blood vessel changes
–Postural hypotension
–Cold intolerance
–Edema
–Inflammation
–Pressure ulcers
–Changes in effects of medications
Results of Aging
•Immune system
–Increased risk of infection
–Increased risk of cancers
–Altered response to antigens
–Possible reactivation of TB
Hematologic, Peripheral Vascular, and Lymphatic Systems
•Assessment of Blood Pressure may reveal
–Hypotension
–Hypertension
–Orthostatic hypotension
–Narrowing or widening of pulse pressure
•Skin Assessment may reveal
–Pallor or cyanosis from circulatory abnormalities
–Edema, redness, induration, lesions resulting from lymphangitis, lymphedema, infection,
or malignancy
Hematologic, Peripheral Vascular, and Lymphatic Systems
•Artery and Vein Assessment may reveal
–Redness, swelling, nodules, or presence of thrill or bruit
–Pulses may be asymmetrical or have changes in rate, rhythm, or amplitude
•Extremity Assessment may reveal
–Edema, color changes, temperature variations, inadequate capillary refill, arterial
insufficiency, lesions, skin thickening, or varicose veins
Hematologic, Peripheral Vascular, and Lymphatic Systems
•Abdominal Assessment may reveal
–Pulsations, bulging, bruits
–Presence of palpable spleen (splenomegaly)