Ch. 15: Peripheral Vascular & Lymphatic System

What is the main function of the peripheral vascular system?

Circulates blood through arteries and veins

What is the lymphatic system responsible for?

One-way upward flow that moves lymph and supports immunity

Name 3 noninvasive vascular diagnostics

CT scan, Duplex ultrasound, MRA

X-ray with specialized dye to visualize blood flow in vessels

Angiogram

Balloon inflation to break plaque and widen blocked arteries

Angioplasty

What is the gold standard for enlarged lymph node diagnosis?

Lymph node biopsy

What is intermittent claudication?

Peripheral arterial disease (PAD) symptom: cramping leg pain during exercise

Accumulation of lymph fluid causing swelling

lymphedema

Skin changes in the extremities:

• Rubor

• Elevational pallor

• Changes in texture of skin

• Loss of hair on the extremities

• Raynaud's phenomenon

• Wound or skin ulcers

Poor perfusion; reddish-blue-purple color when feet are dependent

Rubor

Pale skin when affected limb is raised

Elevational pallor

Cold-induced vasospasm in fingers/toes causing color changes

Raynaud’s phenomenon

What does warmth and redness in an extremity suggest?

infection

How do you palpate a carotid artery?

Between trachea and sternocleidomastoid; one side at a time

What is a normal carotid pulse amplitude?

2+ Rate: 60–100 bpm, athletes 40–60 bpm

What are signs of abnormal carotid findings?

• No pulse

• Bounding/weak pulse

• Irregular rhythm

What do you inspect in upper extremities?

Symmetry, color, texture, edema, nailbeds, pulse

Normal upper extremity findings:

Pink nails, 160° angle, warm temp, 2+ radial/brachial pulse

What is cellulitis?

Bacterial skin infection: red, warm, swollen, tender

Pitting edema grading scale?

1+ = 2 mm (rapid return)
2+ = 4 mm (10–15 sec)
3+ = 6 mm (>1 min)
4+ = 8 mm (2–3 min)

Depression is about 2 mm

1+ pitting edema

Depression is about 4 mm

2+ pitting edema

Depression is about 6 mm

3+ pitting edema

Depression is about 8 mm

4+ pitting edema

What does unilateral edema suggest?

Possible blood clot

What is normal capillary refill time?

Less than 2 seconds

Which fingers should be used to palpate the inguinal area for lymph nodes and femoral pulses?

Second, third, and fourth finger pads of the dominant hand

How is the popliteal pulse best assessed?

Ask the patient to flex the knee at approximately 120 degrees

Where is the dorsalis pedis pulse located?

On the dorsum of the foot between the first and second toes

Where is the posterior tibial pulse located?

Between the medial malleolus and Achilles tendon

What should the nurse do after the patient sits on the side of the exam table for 1 minute?

Inspect the veins of the legs in the dependent position for distention

Palpating Lower Extremities Normal Findings

• Legs are symmetrical

• Uniform color

• No edema

• 2+ symmetrical pulses

• Warm temperature

• Pink toenails

• Even leg hair

• Non-distended veins

• Nonpalpable lymph nodes

Palpating Lower Extremities Abnormal Findings

• Color discoloration

• Erythema

• Decreased texture

• Cool skin temperature

• loss of hair

• Thick toenails

How do you check capillary refill?

Press nailbed until white, release, watch for pink return

What do you inspect in lower extremities?

Color, symmetry, hair, texture, edema, venous pattern, nails

What pulses are assessed in lower extremities?

Femoral, popliteal, dorsalis pedis, posterior tibial

What does poor leg hair distribution indicate?

Poor circulation (arterial insufficiency)

Punched-out, round, smooth, well-defined borders

Arterial ulcers

Irregular, uneven edges, shallow wound

Venous Ulcers

Dilated veins from valve incompetence and blood pooling

Varicose veins

Swelling from lymph fluid buildup in tissues

Lymphedema

What are modifiable vascular risk factors?

Exercise, occupation, weight

What are nonmodifiable vascular risk factors?

Age, family history, genetics