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1
ASSESSING THE
PERIPHERAL-
VASCULAR AND
LYMPHATIC
SYSTEMS
2
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)
3
Outcomes
Document peripheral-vascular
and lymphatic assessment
findings.
Identify actual/potential health
problems stated as nursing
diagnosis.
Differentiate between normal
and abnormal findings.
4
Structures
Peripheral vascular:
arteries
veins
Lymphatic system:
lymph nodes
tonsils
thymus
spleen
Peyer’s Patches
5
Functions
What are the functions of…
Peripheral-vascular structures:
Arteries: carry blood away from
heart
Veins: carry blood to heart
(Continued)
6
Functions
What are the functions of…
Lymphatic structures:
Lymph nodes: filter microorganisms
and foreign substances from lymph
Tonsils: lymphatic tissue in
oropharynx destroys
microorganisms and foreign
substances (Continued)
7
Functions
What 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
8
Relationship to
Other Systems
What is the relationship of the
lymphatic system to other systems?
9
10
Developmental
Variations
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
11
Cultural
Variations
What cultural variations of the P-V
and lymphatic system might you see
with:
African Americans
HTN; AIDS
Native Americans
SCIDS
12
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
13
History
What 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
14
15
Symptoms
What symptoms would signal a P-V or
lymphatic system problem?
Swelling
Limb pain
Changes in sensation
Fatigue
16
Pertinent
History Findings
+ smoker (22 pack-years)
+ family history of CV disease
Husband supportive; baby to be
discharged soon
(Continued)
17
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
18
Physical
Assessment
Anatomical landmarks: pulse sites and
lymph nodes
Approach: inspection, palpation, and
auscultation
Position: Supine and sitting
19
Physical
Assessment
Tools: stethoscope with bell and
diaphragm, B/P cuff, thermometer,
watch, ruler, tape measure, light
General survey and head-to-toe scan
20
Pulse Sites
Pulse sites:
Temporal Ulnar
Carotid Femoral
Brachial Popliteal
Radial Dorsalis pedis
Posterior tibialis
21
Lymph Nodes
Lymph node sites:
Cervical
Axillary
Epitrochlear
Inguinal
22
Inspection
Upper extremities: color, edema,
erythema, lesions, capillary refill
Abdomen: ascites
Lower extremities: color, edema,
lesions, hair distribution, varicosities
23
Palpation
Pulses
Pulses:
Rate
Rhythm
Equality
Amplitude (0 - 4, with 2 as normal)
24
Palpation of
Lymph Nodes
Nodes:
size shape
mobility tenderness
consistency warmth
delineation erythema
location
increased vascularity
25
Auscultation
Arteries for bruits
Blood pressure
26
Pertinent
Physical
FindingsTemperature 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
27
Nursing
Diagnosis
What actual or
potential
problems can
you identify for
Mrs. Jordan?
28
Insufficiencies
Arterial
Intermittent claudication
Pulses decreased/absent
Pale elevated
Dusky red dependent
Temp is cool
Skin is thin/shiny/hair loss
Nails thick and ridged
If ulcers—around toes
Severe pain—unless
neuropathy masks it
Gangrene may develop
Venous
Prominent leg veins
(rope-like, spider-like)
Lower leg edema
Leg is hard and leathery
Pulses normal
Normal temp
Brownish pigmentation
Ulcers—occur at ankles
Pain not severe
Eczema or stasis
dermatitis
No gangrene

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