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.