Assessment of the Peripheral Vascular and Lymphatic System

Assessment of the Peripheral Vascular and Lymphatic System Health Assessment Across the Lifespan NRS 102 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 20: Peripheral Vascular System and Lymphatic System Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -2

Chapter 20: Peripheral Vascular System and Lymphatic System Structure and Function Arteries Temporal artery Carotid artery Arteries in the arm Brachial Ø Ulnar Ø Radial Ø Arteries in the leg Femoral Ø Popliteal Ø Dorsalis pedis Ø Posterior tibial Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -3

Chapter 20: Peripheral Vascular System and Lymphatic System Structure and Function (cont. ) Veins Jugular veins (Chapter 19) Veins in the arm Veins in the leg Ø Deep veins • Femoral • Popliteal Ø Superficial veins • Great saphenous • Small saphenous Ø Perforators (connecting veins) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -4

Chapter 20: Peripheral Vascular System and Lymphatic System Arteries in the Arm Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -5

Chapter 20: Peripheral Vascular System and Lymphatic System Vessels in the Leg Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -6

Chapter 20: Peripheral Vascular System and Lymphatic System Venous Flow Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -7

Chapter 20: Peripheral Vascular System and Lymphatic System Structure and Function (cont. ) Lymphatics Right lymphatic duct Thoracic duct Functions of the lymphatic system Lymph nodes Related organs to lymphatic system Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -8

Chapter 20: Peripheral Vascular System and Lymphatic System Lymphatic Ducts and Drainage Patterns Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -9

Chapter 20: Peripheral Vascular System and Lymphatic System Immune-Related Organs Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -10

Chapter 20: Peripheral Vascular System and Lymphatic System Subjective Data— Health History Questions Leg pain or cramps Skin changes on arm or legs Swelling Lymph node enlargement Medications Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -11

Chapter 20: Peripheral Vascular System and Lymphatic System Objective Data—The Physical Exam Preparation Equipment needed (occasionally) Ø Paper tape measure Ø Tourniquet or blood pressure cuff Ø Stethoscope Ø Doppler ultrasonic stethoscope Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -12

Chapter 20: Peripheral Vascular System and Lymphatic System Objective Data—The Physical Exam (cont. ) Arms—Inspect and palpate Skin Ulnar pulse Profile sign Brachial pulse Capillary refill Symmetry Radial pulse Epitrochlear lymph node Modified Allen test Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -13

Chapter 20: Peripheral Vascular System and Lymphatic System Radial Pulse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -14

Chapter 20: Peripheral Vascular System and Lymphatic System Ulnar Pulse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -15

Chapter 20: Peripheral Vascular System and Lymphatic System Brachial Pulse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -16

Chapter 20: Peripheral Vascular System and Lymphatic System Objective Data—The Physical Exam (cont. ) Legs—Inspect and palpate Skin and hair Popliteal pulse Symmetry Posterior tibial pulse Temperature Dorsalis pedis pulse Calf muscle Pretibial edema Inguinal lymph nodes Leg veins Femoral pulse Ø Assess while patient stands Ø Manual compression test Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -17

Chapter 20: Peripheral Vascular System and Lymphatic System Femoral Pulse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -18

Chapter 20: Peripheral Vascular System and Lymphatic System Popliteal Pulse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -19

Chapter 20: Peripheral Vascular System and Lymphatic System Posterial Tibial Pulse Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -20

Chapter 20: Peripheral Vascular System and Lymphatic System Dorsalis Pedis Pulse © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -21

Chapter 20: Peripheral Vascular System and Lymphatic System Manual Compression Test From Bloom A, Watkins PH, Ireland J: Color atlas of diabetes, ed 2, St. Louis, 1992, Mosby. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -22

Chapter 20: Peripheral Vascular System and Lymphatic System Pitting Edema © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -23

Chapter 20: Peripheral Vascular System and Lymphatic System Objective Data—The Physical Exam (cont. ) Additional techniques Ø Color changes Ø Doppler ultrasonic stethoscope Ø Ankle-brachial index (ABI) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -24

Chapter 20: Peripheral Vascular System and Lymphatic System Abnormal Findings Variations in Arterial Pulse Weak, “thready” pulse – 1+ Full, bounding pulse – 3+ Water-Hammer (Corrigan’s) pulse – 3+ (collapses suddenly) Pulsus bigeminus Pulsus alternans Pulsus paradoxus Pulsus bisferiens Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -25

Chapter 20: Peripheral Vascular System and Lymphatic System Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -26

Chapter 20: Peripheral Vascular System and Lymphatic System Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -27

Chapter 20: Peripheral Vascular System and Lymphatic System Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -28

Chapter 20: Peripheral Vascular System and Lymphatic System Abnormal Findings Peripheral Vascular Disease Arms Raynaud’s syndrome Ø Lymphedema Ø Legs Arteriosclerosis—ischemic ulcer Ø Venous (stasis) ulcer Ø Superficial varicose veins Ø Deep vein thrombophlebitis Ø Occlusions Aneurysms Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -29

Chapter 20: Peripheral Vascular System and Lymphatic System The relevant variable when discussing claudication with a patient is A. Related foods B. Distance C. Blood glucose D. Emotional state Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -30

Chapter 20: Peripheral Vascular System and Lymphatic System The ABI (ankle-brachial index) should normally be A. Slightly greater than 1 B. Slightly less than 1 C. A negative number D. Less than 0. 5 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 20 -31