Peripheral Vascular and Lymphatic Systems Health History Inspection Palpation Auscultation

Health History Leg pain or cramps Skin changes to extremities Swelling Lymph node enlargement Current medications

Pulse assessment 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 2+ Moderate 3+ Deep Slight indentation, no visible swelling 2+ Moderate Indentation subsides Rapidly,10-15 sec. 3+ Deep Indentation remains for a short time, lasts > 1 min. Legs look swollen 4+ Very deep Indentation lasts a long time, lasts 2-5 min. Legs look very swollen

Brawny Edema Nonpitting, hard to touch. Seen with lymphatic obstruction and 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 Parethesia and Paralysis occur with acute occlusion of a major artery.