P ERIPHERAL V ASCULAR AND L YMPHATIC S YSTEMS Health History Inspection Palpation Auscultation

PERIPHERAL VASCULAR ANDLYMPHATIC SYSTEMS

Health History Inspection Palpation Auscultation

HEALTH HISTORY

Leg pain or cramps Skin changes to extremities Swelling Lymph node enlargement Current medications

PULSEASSESSMENT

9 sites:

INSPECTION – UPPER EXTREMITIES

Color Nailbeds (capillary refill and clubbing) Temperature Texture Skin turgor Lesions or scars Edema Symmetrical

PALPATION – UPPER EXTREMITIES

Pulses – Carotid, Temporal, Brachial, Radial Rate Rhythm

Regular Irregular – Unpredictable pattern

Consider conduction problem Irregular - With repeated pattern

Sinus arrhythmia Pulsus alternans – regular rate, beats alternate weak and strong, seen

with heart failure Bigeminal pulse – 2 rapid beats followed by a long interval Labile pulse – normal at rest, increases with sitting or standing

Elasticity Force

Pulsus differens – unequal pulses in L and R extremities, indicative of impaired circulation

PALPATION – UPPER EXTREMITIES

Epitrochlear lymph nodes In the antecubital fossa, drains the hand and

lower arm

INSPECTION – LOWER EXTREMITIES

Color Hair distribution Venous pattern Size, atrophy Skin lesions or ulcers Edema

Bilateral – with a systemic problem, heart failure

Unilateral – local obstruction or inflammation

PALPATION – LOWER EXTREMITIES

Temperature Pulses Inguinal lymph nodes Homan’s sign

With the pt’s. knee slightly bent, sharply dorsiflex the foot. Ask the pt. if it elicits calf pain. **A (+) Homan’s sign is present is < 20% of all DVTs.

Edema Pitting Brawny

NON-PITTING EDEMA

PITTING EDEMA

Grading Pitting Edema 1+ Mild

Slight indentation, novisible swelling

2+ Moderate Indentation subsidesRapidly,10-15 sec.

3+ Deep Indentation remainsfor a short time, lasts > 1 min.Legs look swollen

4+ Very deep Indentation lasts a longtime, lasts 2-5 min. Legs look very swollen

BRAWNY EDEMA

Nonpitting, hardto touch. Seen withlymphatic obstructionand deep vein occlusion.

AUSCULTATION Bruit – unexpected swooshing or

murmur sound over an artery or organ. Occurs with turbulent blood flow, indicative of partial occlusion. Sites for auscultation: Temporal Carotid Subclavian Abdominal aorta Renal Iliac Femoral

ASSESSMENT FOR ARTERIAL OCCLUSION OR INSUFFICIENCY

Parethesiaand Paralysisoccur with acute occlusionof a majorartery.