Peripheral Vascular System and Lymphatic System Chapter 20

Peripheral Vascular System and Lymphatic System Chapter 20

Objective Data—The Physical Exam (cont. ) Arms—Inspect and palpate Skin Profile sign Capillary refill Symmetry Radial pulse Ulnar pulse Brachial pulse Epitrochlear lymph node Modified Allen test Sli de 20 -2

Radial Pulse Sli de 20 -3

Ulnar Pulse Sli de 20 -4

Brachial Pulse Sli de 20 -5

Objective Data—The Physical Exam (cont. ) Legs—Inspect and palpate Skin and hair Symmetry Temperature Calf muscle Inguinal lymph nodes Femoral pulse Popliteal pulse Posterior tibial pulse Dorsalis pedis pulse Pretibial edema Leg veins ◦ Assess while patient stands ◦ Manual compression test Sli de 20 -6

Femoral Pulse Sli de 20 -7

Popliteal Pulse Sli de 20 -8

Posterial Tibial Pulse Sli de 20 -9

Dorsalis Pedis Pulse © Pat Thomas, 2006. Sli de 20 10

Manual Compression Test From Bloom A, Watkins PH, Ireland J: Color atlas of diabetes, ed 2, St. Louis, 1992, Mosby. Sli de 20 11

Pitting Edema © Pat Thomas, 2006. Sli de 20 12

Objective Data—The Physical Exam (cont. ) � Additional techniques ◦ Color changes ◦ Doppler ultrasonic stethoscope ◦ Ankle-brachial index (ABI) Sli de 20 13

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 Sli de 20 14

Abnormal Findings Peripheral Vascular Disease � Arms ◦ Raynaud’s syndrome ◦ Lymphedema � Legs ◦ ◦ Arteriosclerosis—ischemic ulcer Venous (stasis) ulcer Superficial varicose veins Deep vein thrombophlebitis � Occlusions � Aneurysms Sli de 20 15