Peripheral vascular-lymphatic

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ASSESSING THE PERIPHERAL-VASCULAR AND LYMPHATIC SYSTEMS

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Outcomes Identify pertinent peripheral-

vascular and lymphatic history questions.

Obtain a peripheral-vascular and lymphatic history.

Perform a peripheral-vascular and lymphatic physical assessment. (Continued)

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Outcomes Document peripheral-vascular and lymphatic assessment findings.

Identify actual/potential health problems stated as nursing diagnosis.

Differentiate between normal and abnormal findings.

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StructuresPeripheral vascular: arteries

veins

Lymphatic system: lymph nodes tonsils thymus spleen Peyer’s Patches

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FunctionsWhat are the functions of…

Peripheral-vascular structures:

Arteries: carry blood away from heart

Veins: carry blood to heart

(Continued)

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FunctionsWhat are the functions of…

Lymphatic structures:

Lymph nodes: filter microorganisms and foreign substances from lymphTonsils: lymphatic tissue in oropharynx destroys microorganisms and foreign substances (Continued)

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FunctionsWhat are the functions of…

Thymus: secretes thymosin, helps with T-cell differentiation

Spleen: filters blood and produces lymphocytes and monocytes

Peyer’s patch: clusters of lymphoid tissue found in small intestines

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Relationship to Other SystemsWhat is the relationship of the

lymphatic system to other systems?

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DevelopmentalVariations

What developmental variations of the lymphatic system might you see with:

Children Increased

Lymphoid tissue Interatrial

Foramen Ovale closes

Pregnant clients Delay in initial

maternal responses to infection

Peripheral vasodilation (Palmer Erythema & Telangiectasis)

Older adults Decreased lymph

nodes (size & #) Decreased venous

elasticity & Increased arterial plaques

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Cultural VariationsWhat cultural variations of the P-V

and lymphatic system might you see with:

African AmericansHTN; AIDS

Native AmericansSCIDS

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Case Study Tasha Jordan, 38- year-

old African American, married, secretary

c/o increasing pain and tenderness in left leg since she delivered premature baby 1 week ago.

Pain: dull, throbbing, swelling of leg

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HistoryWhat can the history tell you about the P-V and lymphatic system? Biographical data Current health status Past health history Family history Review of systems Psychosocial history

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SymptomsWhat symptoms would signal a P-V or lymphatic system problem?

Swelling Limb pain Changes in sensation Fatigue

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Pertinent History Findings + smoker (22 pack-years) + family history of CV disease Husband supportive; baby to be

discharged soon

(Continued)

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Pertinent History Findings Dull, throbbing pain; swelling left

leg; increases with standing and walking

Prolonged bed rest before delivery and 50 # weight gain during pregnancy

More tired than usual

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Physical AssessmentAnatomical landmarks: pulse sites and

lymph nodes

Approach: inspection, palpation, and auscultation

Position: Supine and sitting

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Physical AssessmentTools: stethoscope with bell and

diaphragm, B/P cuff, thermometer, watch, ruler, tape measure, light

General survey and head-to-toe scan

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Pulse Sites

Pulse sites: Temporal Ulnar Carotid Femoral Brachial Popliteal Radial Dorsalis pedis Posterior tibialis

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Lymph Nodes

Lymph node sites:CervicalAxillaryEpitrochlearInguinal

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Inspection

Upper extremities: color, edema, erythema, lesions, capillary refill

Abdomen: ascites

Lower extremities: color, edema, lesions, hair distribution, varicosities

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Palpation Pulses

Pulses: Rate Rhythm Equality Amplitude (0 - 4, with 2 as normal)

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Palpation of Lymph NodesNodes: size shape mobility tenderness consistency warmth delineation erythema location increased vascularity

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AuscultationArteries for bruits

Blood pressure

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Pertinent Physical Findings Temperature 99.8 Left leg warm, tender, edematous from

popliteal to ankle Left pedal pulses difficult to locate Calf circumference left > right + Homan sign No palpable lymph nodes

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Nursing Diagnosis

What actual or potential problems can you identify for Mrs. Jordan?

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InsufficienciesArterial

Intermittent claudicationPulses decreased/absent

Pale elevatedDusky red dependent

Temp is coolSkin is thin/shiny/hair loss

Nails thick and ridgedIf ulcers—around toesSevere pain—unless

neuropathy masks itGangrene may develop

VenousProminent leg veins (rope-like, spider-like)

Lower leg edemaLeg is hard and leathery

Pulses normalNormal temp

Brownish pigmentationUlcers—occur at ankles

Pain not severeEczema or stasis

dermatitisNo gangrene