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Peripheral vascular-lymphatic

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  • 1. 1 ASSESSING THE PERIPHERAL- VASCULAR AND LYMPHATIC SYSTEMS
  • 2. 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. 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. 4 Structures Peripheral vascular: arteries veins Lymphatic system: lymph nodes tonsils thymus spleen Peyer’s Patches
  • 5. 5 Functions What are the functions of… Peripheral-vascular structures: Arteries: carry blood away from heart Veins: carry blood to heart (Continued)
  • 6. 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. 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. 8 Relationship to Other Systems What is the relationship of the lymphatic system to other systems?
  • 9. 9
  • 10. 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. 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. 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. 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. 14
  • 15. 15 Symptoms What symptoms would signal a P-V or lymphatic system problem? Swelling Limb pain Changes in sensation Fatigue
  • 16. 16 Pertinent History Findings + smoker (22 pack-years) + family history of CV disease Husband supportive; baby to be discharged soon (Continued)
  • 17. 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. 18 Physical Assessment Anatomical landmarks: pulse sites and lymph nodes Approach: inspection, palpation, and auscultation Position: Supine and sitting
  • 19. 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. 20 Pulse Sites Pulse sites: Temporal Ulnar Carotid Femoral Brachial Popliteal Radial Dorsalis pedis Posterior tibialis
  • 21. 21 Lymph Nodes Lymph node sites: Cervical Axillary Epitrochlear Inguinal
  • 22. 22 Inspection Upper extremities: color, edema, erythema, lesions, capillary refill Abdomen: ascites Lower extremities: color, edema, lesions, hair distribution, varicosities
  • 23. 23 Palpation Pulses Pulses: Rate Rhythm Equality Amplitude (0 - 4, with 2 as normal)
  • 24. 24 Palpation of Lymph Nodes Nodes: size shape mobility tenderness consistency warmth delineation erythema location increased vascularity
  • 25. 25 Auscultation Arteries for bruits Blood pressure
  • 26. 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. 27 Nursing Diagnosis What actual or potential problems can you identify for Mrs. Jordan?
  • 28. 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