P.V, breasts, lymphatic system

Peripheral vascular system

small and large vessels that circulate oxygenated and deoxygenated blood throughout the body

Lymphatic system

complementary component of the circulatory system; carries lymph fluid (proteins, water, impurities, and waste products) throughout our circulation

Primary function of lymphatic system

drain excess fluid and plasma proteins from body tissues and return them to venous system

Secondary function of lymphatic system

defends body against microorganisms 

Third function of lymphatic system

absorb fats (lipids) from SI to blood stream

Lymph nodes

round/oval, around 1 to 2 cm normally; soft, nontender, and nonpalpable

Lymphadenopathy

lymph nodes are greater than 2 cm with/without tenderness

Hard and fixed lymph nodes may indicate

malignancy

The thinnest and most fragile parts of the arterial system are the

Capillaries

Diagnostics

CT scan, duplex ultrasound, MRA, angiogram, angioplasty, lymph node biopsy

angiogram

imaging x-ray that uses a special dye to visualize blood flow through arteries or veins, ordered if obstruction/blockage in coronary or pvs

angioplasty

a balloon is placed in the blocked area and inflated to break up the plaque, widen the diameter of the artery, and increase blood flow

CT, duplex ultrasound, MRA

noninvasive tests that can help the medical specialist map the blood flow in the affected areas

Health History 

pain, cramping, edema, lumps, skin changes, PH, FH - atherosclerosis, varicose veins, diabetes, DVT, hypertension, coronary disease, PMH - heart disease, high blood pressure, high cholesterol, overweight, DVT, blood vessel surgery, psychosocial history - work, travel, mobility, prolonged sitting, smoking, meds - blood thinners, cholesterol, oral contraceptives, neuropathy, aching, heaviness, burning in feet, ED, lymph node enlargement, skin color change, blood clots, loss of hair, temp change, ulcers, varicose veins

most severe clinical manifestation of PAD

limb ischemia

CAD vs PAD

same causes, different s/s and treatments

CAD - plaque buildup in coronary arteries

PAD - affects arteries of limbs or peripheral areas, mostly in legs

Peripheral vascular disease (PVD) aka PAD

a slow and progressive circulation disorder. Narrowing, blockage, or spasms in a blood vessel can cause, legs and feet most commonly caused

Peripheral artery disease (PAD)

plaque buildup in the leg arteries

plaque that narrows arteries

atherosclerosis

What occurs if blood can’t get through to nourish organs and other tissues?

damage and death (gangrene), happens most in toes and feet

Coronary artery disease (CAD)

limits blood flow in the coronary arteries, which deliver blood to the heart muscle

Plaque can arise from

high cholesterol or other substances

Most common CAD symptom

chest pain

CAD can lead to

heart attack, arrhythmia, heart failure

Arterial insufficiency and chronic venous insufficiency both affect the

lower extremities 

s/s of arterial insufficiency

decreased/absent pulse, cool, pale, shiny skin, loss of hair, pain in legs/feet, toe ulcerations, deep red color of foot, thick, rigid nails

s/s of chronic venous insufficiency

ankle ulcerations, difficulty palpating pulse, edema, cyanotic foot, hyperpigmentation, warmth

Sequence of assessment

IP

Preliminary steps

comfortable room, temp, help change positions if needed, remove clothing, footwear, socks, jewelry

Purpose of assessing lymph nodes

assess for signs of inflammation or disease

Organs containing lymphatic tissue

spleen (largest), thymus, tonsils and adenoids, appendix, lymph nodes, peyer patches, bone marrow

Functions of lymphatic system

WBC production, fluid and protein balance, immune functions of body; first line of defense against disease

Lymph node sites in head and neck

Preauricular

Postauricular

Suboccipital

Tonsillar

Submandibular

Submental

Superficial cervical

Posterior cervical

Deep cervical chain

Supraclavicular

Normal Lymph node findings

not palpated, less than 2 cm, discrete/soft, moveable, nontender

Abnormal lymph node findings

enlarged (2 cm <), matted/fixed, rubbery/hard, tender

What lymph nodes located in back of the neck and head?

Suboccipital 

I/P upper extremities purpose

assess for peripheral circulation

Inspect each arm for

size/symmetry, color, edema, texture

Inspect nail beds for

color, thickness, clubbing, temperature, radial/ulnar/brachial pulses, capillary refill

Why is palpating lymph nodes in axillary region done in breast exam?

breast cancer can metastasize to lymphatic regions, causing swelling/enlargement

Breast function

reproductive organ, production + storage of milk, sexual stimulation

HH of breast

lumps, nodules, swelling, redness, warmth, dimpling, rashes, change in size/firmness, nipple retraction/discharge, pain/tenderness, disease, trauma, surgery, biopsy, implants, breast cancer, hormone therapy/oral contraceptives, alcohol, tobacco use, high-fat diet, caffeine use, self exam

Breast health promotion/prevention

self exam monthly, physician exam yearly, mammogram (age/risk dependent), education of risk factors

Normal findings of I/P upper extremities

symmetrical arms, uniform color, no edema/ulcerations, normal venous pattern, warm temp, 2+, pink fingernail beds, even thickness, 160-degree, capillary refill <2 s

I/P upper extremities abnormal findings

altered peripheral circulation, discoloration, change in skin texture, cool extremities, bilateral/unilateral edema, enlarged epitrochlear nodes, cellulitis, edema, ulcerations, capillary refill > 2 s

What do you use when you cannot find pulse

Doppler

Edema

localized or generalized condition in which body tissues contain an excessive amount of tissue fluid in the interstitial spaces, d/t cardiac, p.v., renal/liver disease, lymphedema/thrombosis

Lymphedema

accumulation of lymph fluid in the tissues, most common cause is obstruction of lymphatic vessels

Unilateral edema

if in upper/lower extremity, can indicate DVT

Thrombosis

blood clot

2 types of edema

pitting, nonpitting 

Peripheral edema

accumulation of fluid in feet / legs

Pitting edema

1-4 scale,

Assessing capillary refill purpose

assess tissue perfusion

What do you note in capillary refill

amount of time it takes nail to return to pink color

Normal cap refill

less than 2 s

Abnormal cap refill

more than 2 s

I/P lower extremities purpose

assess arterial or venous circulation

Inspect each leg for

size/symmetry, color, texture, edema, venous pattern, hair distribution, ulcerations

Inspect toe nails for

color, thickness, capillary refill,

Pulses assessed in lower extremities

femoral, popliteal, dorsal pedis, posterior tibial

Pulse strength

0-4

Normal lower extremity findings

symmetrical, uniform color, no edema/ulcerations, pink, evenly thick toenails, warm temp, even hair distribution, regular femoral venous pattern, nondistended veins, capillary refill <2 s

How to remember pitting edema

x2 - +1 = 2 × 1 = 2 mm, +2 = 2 × 2 = 4 mm …

Abnormal findings of lower extremities

discoloration, decreased texture, loss of hair, cool temp, thick toenails, raynaud disease, cellulitis, arterial/venous insufficiency wounds, bilateral/unilateral edema, varicose veins, lymphedema, PVD, varicosities, thrombophlebitis

You are performing the Blanch Test on an 85-year-old patient. Your assessment finding is 4 seconds. What is a normal finding?

less than 3 secs

What is this

Raynaud’s Syndrome

What is this

Enlarged epitrochlear nodes

What is this

What is this

DVT