lOMoAR cPSD| 61371432
NR304: WEEK 1 PERIPHERAL VASCULAR SYSTEM OVERVIEW | VERIFIED
STUDY | 2026 UPDATES | GUARANTEED PASS
NR 304: Week 1 Notes
Arteries (high-pressure system)
• Role: Deliver oxygen & nutrients to tissues; create palpable pulses with each
LV contraction.
• Wall structure: Thick, strong, elastic (maintain & buffer high pressure).
• Major accessible pulses o Head/neck: temporal, carotid (⚠ palpate one at
a time).
o Upper limb: brachial → bifurcates to radial (thumb side) & ulnar (pinky
side).
o Lower limb: femoral → popliteal → posterior tibial (behind medial
malleolus) & dorsalis pedis (dorsum of foot, lateral to extensor tendon
of great toe).
• Carotid bruit o Auscultate with bell at 3 spots (angle of jaw, mid-neck, base).
o Cause: turbulent flow from narrowing/atherosclerosis.
o Partial obstruction → bruit; total obstruction → no bruit (no flow). o
Often associated pulse force ↓ (weak) distal to narrowing. o Bruit-
is a partial blockage +1 is weak
• Ischemia o Inadequate O₂ from arterial obstruction → tissue injury/death.
o PAD = atherosclerotic narrowing of non-coronary limb arteries.
• Patient education (arterial disease) o No compression stockings for
arterial insufficiency.
o Do not cross legs; avoid tight garments.
o Encourage graded walking (walk–rest–walk) for intermittent
claudication; inspect feet daily (mirror), protective footwear.
Veins (low-pressure system)
, lOMoAR cPSD| 61371432
• Role: Return deoxygenated blood & waste to heart (CO₂, metabolites).
• Why low pressure works: 1) Skeletal muscle contraction (“calf pump =
peripheral heart), 2) Respiratory pressure gradient (↓ intrathoracic, ↑ intra-
abdominal on inspiration), 3) Intraluminal valves (one-way).
• Anatomy o More veins than arteries; more superficial overall. o
Legs: Deep (femoral, popliteal), superficial (great & small saphenous),
perforators connect systems.
• Varicose veins= Incompetent valves → venous stasis → distension o
Valve failure → reflux, venous hypertension, dilated tortuous veins.
o Risks: prolonged standing/sitting, obesity, pregnancy, prior vein
trauma; occupations (nurses, servers, etc.).
• Jugular venous assessment o Position supine 30–45°.
o Visible distention at 45° → consider right-sided HF (if
bilateral/symmetric).
• Venous insu\iciency = blood pooling → heaviness, edema, and relief with leg
elevation.
Lymphatics (fluid balance & immunity)
• Functions: 1) Return excess interstitial fluid & proteins to venous blood, 2)
Immune defense (nodes filter; T/B cell activation), 3) Lipid absorption
(intestinal lacteals).
• Flow: One-way from lymphatic capillaries → vessels → nodes → ducts (right
lymphatic duct & thoracic duct) → subclavian veins.
• Organs:
o Spleen: destroys old RBCs, produces antibodies, stores RBCs, filters
microbes.
o Tonsils: respond to local inflammation at aerodigestive entry. o
Thymus: T-cell maturation (childhood).
• Lymphedema: Non-pitting, “brawny” edema from impaired drainage (e.g.,
post-mastectomy node removal). Long-term limb precautions.
Developmental & physiologic changes
• Infants/children: Lymphoid tissue large/active; palpable “shotty” nodes
can be normal.
NR304: WEEK 1 PERIPHERAL VASCULAR SYSTEM OVERVIEW | VERIFIED
STUDY | 2026 UPDATES | GUARANTEED PASS
NR 304: Week 1 Notes
Arteries (high-pressure system)
• Role: Deliver oxygen & nutrients to tissues; create palpable pulses with each
LV contraction.
• Wall structure: Thick, strong, elastic (maintain & buffer high pressure).
• Major accessible pulses o Head/neck: temporal, carotid (⚠ palpate one at
a time).
o Upper limb: brachial → bifurcates to radial (thumb side) & ulnar (pinky
side).
o Lower limb: femoral → popliteal → posterior tibial (behind medial
malleolus) & dorsalis pedis (dorsum of foot, lateral to extensor tendon
of great toe).
• Carotid bruit o Auscultate with bell at 3 spots (angle of jaw, mid-neck, base).
o Cause: turbulent flow from narrowing/atherosclerosis.
o Partial obstruction → bruit; total obstruction → no bruit (no flow). o
Often associated pulse force ↓ (weak) distal to narrowing. o Bruit-
is a partial blockage +1 is weak
• Ischemia o Inadequate O₂ from arterial obstruction → tissue injury/death.
o PAD = atherosclerotic narrowing of non-coronary limb arteries.
• Patient education (arterial disease) o No compression stockings for
arterial insufficiency.
o Do not cross legs; avoid tight garments.
o Encourage graded walking (walk–rest–walk) for intermittent
claudication; inspect feet daily (mirror), protective footwear.
Veins (low-pressure system)
, lOMoAR cPSD| 61371432
• Role: Return deoxygenated blood & waste to heart (CO₂, metabolites).
• Why low pressure works: 1) Skeletal muscle contraction (“calf pump =
peripheral heart), 2) Respiratory pressure gradient (↓ intrathoracic, ↑ intra-
abdominal on inspiration), 3) Intraluminal valves (one-way).
• Anatomy o More veins than arteries; more superficial overall. o
Legs: Deep (femoral, popliteal), superficial (great & small saphenous),
perforators connect systems.
• Varicose veins= Incompetent valves → venous stasis → distension o
Valve failure → reflux, venous hypertension, dilated tortuous veins.
o Risks: prolonged standing/sitting, obesity, pregnancy, prior vein
trauma; occupations (nurses, servers, etc.).
• Jugular venous assessment o Position supine 30–45°.
o Visible distention at 45° → consider right-sided HF (if
bilateral/symmetric).
• Venous insu\iciency = blood pooling → heaviness, edema, and relief with leg
elevation.
Lymphatics (fluid balance & immunity)
• Functions: 1) Return excess interstitial fluid & proteins to venous blood, 2)
Immune defense (nodes filter; T/B cell activation), 3) Lipid absorption
(intestinal lacteals).
• Flow: One-way from lymphatic capillaries → vessels → nodes → ducts (right
lymphatic duct & thoracic duct) → subclavian veins.
• Organs:
o Spleen: destroys old RBCs, produces antibodies, stores RBCs, filters
microbes.
o Tonsils: respond to local inflammation at aerodigestive entry. o
Thymus: T-cell maturation (childhood).
• Lymphedema: Non-pitting, “brawny” edema from impaired drainage (e.g.,
post-mastectomy node removal). Long-term limb precautions.
Developmental & physiologic changes
• Infants/children: Lymphoid tissue large/active; palpable “shotty” nodes
can be normal.
