1. Peripheral Vascular and Lymphatic Systems
Health History
Inspection
Palpation
Auscultation

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

3. Pulse assessment
9 sites:

4. Inspection – Upper Extremities
Color
Nailbeds (capillary refill and clubbing)
Temperature
Texture
Skin turgor
Lesions or scars
Edema
Symmetrical

5. 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

6. Palpation – Upper Extremities
Epitrochlear lymph nodes
In the antecubital fossa, drains the hand and lower arm

7. 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

8. 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

9. Non-pitting edema

11. 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

12. Brawny Edema Nonpitting, hard to touch. Seen with
lymphatic obstruction
and deep vein
occlusion.

13. 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

14. Assessment for arterial occlusion or insufficiency
Parethesia
and Paralysis
occur with
acute occlusion
of a major
artery.