1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Peripheral Vascular System and Lymphatic System Chapter 20

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—The Physical Exam  Abnormal Findings

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-3 Structure and Function Arteries  Temporal artery  Carotid artery  Arteries in the arm  Brachial  Ulnar  Radial  Arteries in the leg  Femoral  Popliteal  Dorsalis pedis  Posterior tibial

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-4 Structure and Function (cont.) Veins  Jugular veins (Chapter 19)  Veins in the arm  Veins in the leg  Deep veins Femoral Femoral Popliteal Popliteal  Superficial veins Great saphenous Great saphenous Small saphenous Small saphenous  Perforators (connecting veins)

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-5 Arteries in the Arm

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-6 Vessels in the Leg

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-7 Venous Flow

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-8 Structure and Function (cont.) Lymphatics  Right lymphatic duct  Thoracic duct  Functions of the lymphatic system  Lymph nodes  Related organs to lymphatic system

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-9 Lymphatic Ducts and Drainage Patterns

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-10 Immune-Related Organs

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-11 Subjective Data— Health History Questions  Leg pain or cramps  Skin changes on arm or legs  Swelling  Lymph node enlargement  Medications

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-12 Objective Data—The Physical Exam  Preparation  Equipment needed (occasionally)  Paper tape measure  Tourniquet or blood pressure cuff  Stethoscope  Doppler ultrasonic stethoscope

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-13 Objective Data—The Physical Exam (cont.) Arms—Inspect and palpate  Skin  Profile sign  Capillary refill  Symmetry  Radial pulse  Ulnar pulse  Brachial pulse  Epitrochlear lymph node  Modified Allen test

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-14 Radial Pulse

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-15 Ulnar Pulse

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-16 Brachial Pulse

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-17 Objective Data—The Physical Exam (cont.) Legs—Inspect and palpate  Skin and hair  Symmetry  Temperature  Calf muscle  Inguinal lymph nodes  Femoral pulse  Popliteal pulse  Posterior tibial pulse  Dorsalis pedis pulse  Pretibial edema  Leg veins  Assess while patient stands  Manual compression test

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-18 Femoral Pulse

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-19 Popliteal Pulse

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-20 Posterial Tibial Pulse

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-21 Dorsalis Pedis Pulse © Pat Thomas, 2006.

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-22 Manual Compression Test From Bloom A, Watkins PH, Ireland J: Color atlas of diabetes, ed 2, St. Louis, 1992, Mosby.

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-23 Pitting Edema © Pat Thomas, 2006.

24. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-24 Objective Data—The Physical Exam (cont.)  Additional techniques  Color changes  Doppler ultrasonic stethoscope  Ankle-brachial index (ABI)

25. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-25 Abnormal Findings Variations in Arterial Pulse  Weak, “thready” pulse – 1+  Full, bounding pulse – 3+  Water-Hammer (Corrigan’s) pulse – 3+ (collapses suddenly)  Pulsus bigeminus  Pulsus alternans  Pulsus paradoxus  Pulsus bisferiens

26. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-26 Sample Charting

27. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-27 Sample Charting (cont.)

28. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-28 Sample Charting (cont.)

29. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-29 Abnormal Findings Peripheral Vascular Disease  Arms  Raynaud’s syndrome  Lymphedema  Legs  Arteriosclerosis—ischemic ulcer  Venous (stasis) ulcer  Superficial varicose veins  Deep vein thrombophlebitis  Occlusions  Aneurysms

30. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-30 The relevant variable when discussing claudication with a patient is A.Related foods B.Distance C.Blood glucose D.Emotional state

31. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-31 The ABI (ankle-brachial index) should normally be A.Slightly greater than 1 B.Slightly less than 1 C.A negative number D.Less than 0.5