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ASSESSING THE
PERIPHERAL-
VASCULAR AND
LYMPHATIC
SYSTEMS
2
Outcomes
Identify pertinent peripheral-
vascular and lymphatic history
questions.
Obtain a peripheral-vascular and
lymph...
3
Outcomes
Document peripheral-vascular
and lymphatic assessment
findings.
Identify actual/potential health
problems state...
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 ...
6
Functions
What are the functions of…
Lymphatic structures:
Lymph nodes: filter microorganisms
and foreign substances fro...
7
Functions
What are the functions of…
Thymus: secretes thymosin, helps
with T-cell differentiation
Spleen: filters blood ...
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
L...
11
Cultural
Variations
What cultural variations of the P-V
and lymphatic system might you see
with:
African Americans
HTN;...
12
Case Study
Tasha Jordan, 38- year-
old African American,
married, secretary
c/o increasing pain and
tenderness in left ...
13
History
What can the history tell you about
the P-V and lymphatic system?
Biographical data
Current health status
Past ...
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
disch...
17
Pertinent
History Findings
Dull, throbbing pain; swelling left
leg; increases with standing and
walking
Prolonged bed r...
18
Physical
Assessment
Anatomical landmarks: pulse sites and
lymph nodes
Approach: inspection, palpation, and
auscultation...
19
Physical
Assessment
Tools: stethoscope with bell and
diaphragm, B/P cuff, thermometer,
watch, ruler, tape measure, ligh...
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: col...
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
increas...
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 ...
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 co...
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Peripheral vascular-lymphatic

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Transcript of "Peripheral vascular-lymphatic"

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