Peripheral Vascular and Lymphatic System Assessment

Breast, Axilla, and Lymphatics Examination

Skin Color: Should be normal for the patient's ethnicity.
Lesions: Assess for any lesions, which can indicate circulation issues or low perfusion.
Low Perfusion Causes:
- Volume issues.
- Vasoconstriction.
  - Causes of Vasoconstriction:
    - Cold exposure.
    - Smoking.
    - Shock (low output or low volume).

Shake the patient's hand, then palpate the epitrochlear node from underneath the arm.
Infection Indication: Enlargement or tenderness of the epitrochlear node may indicate an infection below it (hand or forearm).
The arm and forearm primarily drain into the epitrochlear node.

Purpose: Evaluates collateral circulation of the hand (not used on CVE).
Collateral Circulation: The hand is supplied by two arteries: the ulnar (pinky side) and the radial (thumb side).
Procedure:
- Occlude both the ulnar and radial arteries simultaneously.
- Have the patient make a fist several times until the hand turns pale (blood flow is restricted).
- Release pressure on one artery (either ulnar or radial).
- Observe the hand for color return.
Normal Result: Color should return to the hand when pressure is released from one artery, indicating intact circulation.
Abnormal Result: If the hand remains pale after releasing pressure on an artery, it indicates a blockage in the released artery, suggesting impaired blood flow.
Relevance: This test is important for patients with conditions like atherosclerosis.

Peripheral Arterial Disease (PAD):
- Arterial system carries oxygenated blood away from the heart to the tissues under its own pressure.
- In PAD, a clot (arteriosclerosis) restricts blood flow.
- Reduced blood flow leads to decreased oxygen and nutrient supply to the tissues (e.g., the foot).
- Skin Appearance: Pale and cold due to inadequate blood flow.
- Pulses: Diminished or weak due to reduced blood volume reaching the periphery.
- Lesions: Lesions appear as perfectly round, punched-out holes.
Peripheral Venous Disease (PVD):
- Venous system relies on smooth muscle contraction and valves to return deoxygenated blood back to the heart and lungs.
- Sedentary lifestyle or bed rest increases the risk of deep vein thrombosis (DVT) due to blood pooling in the legs.
- Skin Appearance: Brownish color due to blood pooling, edema (swelling) because blood is stuck in the lower extremities due to valve insufficiency.
- Pulses: Regular/normal, as the issue is with blood return, not blood delivery.
- Lesions: Wound bed is not uniform, wet, squishy, and weepy due to fluid accumulation.
Skin Integrity: Both PAD and PVD can cause skin lesions.
Prolonged Moisture: Constant moisture can degrade the skin, leading to a wrinkled or