1. NURS 347 TOWSON UNIVERSITY Lymphatic Assessment

2. LYMPHATIC SYSTEM Structure & Function

3. The Lymphatic System: Drainage & Absorption The lymphatic system is comprised extensively of vessels. This vascular system is separate from that which carries blood.  Vessels allow fluid to flow from tissue into circulation  Conserves fluid and plasma that leak from capillaries Lymphatic Fluid: Consistency of plasma; contains white blood cells, lymphocytes. Carries bacteria and pathogens to lymph nodes for destruction Absorbs lipids from intestinal tract; lymphatic fluid in the digestive system is milky white from lipids.

4. Lymphatic System: Immune Function Location of infection often indicated by affected, abnormal lymph nodes Functions by detecting and elimination foreign substances from the body Environmental: from outside the body From within the body: Abnormal or mutant cells Phagocytosis: Neutrophils and monocytes & macrophages digest foreign substances

5. Lymphatic System: Immune Function Lymphocytes produce antibodies and immune responses  B Lymphocytes: Creates antibodies against antigens  T Lymphocytes  Helper  Cytotoxic  Memory  Regulatory T Cells originate in bone marrow, mature in the thymus. Does not serve a function after childhood and the development of the immune system.

6. Lymphatic System & Immune Function The Spleen Located in left upper quadrant of abdomen Functions:  Destroys old red blood cells  Produces antibodies  Stores red blood cells  Filters microorganisms from the blood

7. Lymphatic System: Immune Function Gastrointestinal Surveillance  Tonsils: Respond to local inflammation, first line of defense in the GI tract  Palatine  Adenoid  Lingual  Peyer’s Patches: Lymphoid tissue in the GI tract, often in the small intestines. Can produce an immune response when in contact with organisms from the external environment  Ex. Microorganisms found in food

8. Location of Cervical Lymph Nodes

9. Lymph Nodes Multiple Locations Cervical Axillary Inguinal

10. Cervical Lymph Nodes  Nodes are small, oval clusters  Filter lymph  House lymphocytes  Prevent harmful substances from entering circulation  Greatest supply is in the head and neck  Arranged in groups  Lymph nodes follow a drainage pattern and direction

11. Cervical Lymph Nodes & Landmarks Preauricular: in front of ear Posterior auricular (mastoid): superficial to mastoid process Occipital: Base of skull Submental: Midline, behind tip of mandible Submandibular: Halfway between angle and tip of the mandible Jugulodigastric: Under angle of mandible Superficial cervical: Overlying sternomastoid muscle Deep cervical: Beneath sternomastoid muscle Posterior cervical: In posterior triangle along edge of trapezius muscle Supraclavicular: Just above and behind clavicle

12. Axillary Lymph Nodes The breast has extensive lymphatic drainage 75% of lymph drains into ipsilateral axillary nodes  Central axillary nodes  Pectoral  Subscapular  Lateral

13. Lymphatic Drainage Without lymphatic drainage, fluid would build up in interstitial spaces and produce edema. Vessels drain into two main trunks: Right lymphatic duct and thoracic duct

14. Right Lymphatic Duct  Empties into right subclavian drain, collects from:  Right side of head  Right side of neck  Right arm  Right side of thorax  Right lung and pleura,  Right side of heart  Right upper section of liver Thoracic Duct Empties into the left subclavian vein Drains the rest of the body Thoracic Duct Empties into the left subclavian vein Drains the rest of the body

15. Lymphatic & Immune Systems

16. LYMPHATIC SYSTEM Assessment

17. Subjective Assessment Leg pain or cramps? Skin changes on arms or legs? Swelling? Lymph node enlargement? Tenderness, lump, or swelling in breasts? Neck pain, decreased range of motion? Sore throat? Medications?

18. Objective Assessment Begin head to toe Inspect head and neck for symmetry, swelling, changes in skin color or pigmentation Inspect movement of head and neck when asked to look both ways Palpate neck for symmetry, cervical lymph nodes

19. Lymph Node Palpation  Palpation: Use a gentle, circular motion of fingerpads  Normal findings: movable, discrete, soft, and non- tender  Note location, size, shape, delimitation, mobility, consistency, borders, tenderness, and if fixed to underlying tissue.  If nodes are enlarged or tender, assess for drainage complications

20. Order of Palpation: Cervical Lymph Nodes

21. Tonsils Using a penlight: Inspect tonsils behind anterior tonsillar pillar Should appear pink with indentations, occasional whitish cellular debris are visible; free from exudate Visualize the posterior wall for color, exudate, or lesions Tonsil Grading: +1 Visible +2 Halfway between tonsillar pillars and uvula +3 Touching the uvula +4 Touching each other Most often visualize +1 and +2 in health people and children

22. Axillary and Inguinal Nodes Axillary Nodes:  Generally not visible or palpable  Expect tenderness while palpating high into the axillia  Note any enlarged or tender lymph nodes Inguinal Nodes:  Generally small (1 cm or less)  Moveable  Non-tender

23. Variations & Considerations Palpable lymph nodes often occur in infants and children, may be sequelae of past infection Age related variables Vaccinations and local lymphadenopathy Immunosuppression Mastectomy: Removal or damage to lymph nodes imped drainage, lymph builds up in interstitial spaces and may lead to infection and delayed wound healing. Chronic lymphedema is unilateral, non-pitting swelling