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L7 Peripheral Vascular System.docx

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NURS 2200
Cynthia Barkhouse Mckeen

Peripheral Vascular System, Lymphatic System & Breast Assessment Objectives  After completing assigned readings, attending class, viewing video, & demo/practice in lab:  Describe the structure & function of arteries, veins, lymphatic tissue/nodes & breasts.  Demonstrate knowledge of symptoms related to peripheral vascular system, lymphatic system and breasts by obtaining a regional/focused health history from a peer or patient.  Explain the term: capacitance vessels  Palpate peripheral arterial pulses (brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis) by assessing amplitude & symmetry, assess for signs of arterial insufficiency.  Demonstrate inspection & palpation of peripheral veins, assess for venous insufficiency.  Practice using a Doppler to auscultate pulse, discuss indications for use.  Document history & physical examination findings accurately.  Differentiate normal from abnormal findings in history & physical assessment of PV system.  Identify ways to decrease venous stasis  Describe variations in arterial pulses  Discusses appropriate response to “irregular pulse” – ie apical pulse rate & pulse deficit  Describe developmental & cultural variations in assessment techniques & findings of PV system.  Describe techniques for assessment of the breasts & axillae.  Discuss abnormal findings & appropriate action to take in physical assessment of the breasts & axillae. Peripheral Vascular & Lymphatic System Peripheral Vascular (PV) System  Transports oxygenated blood to organs & tissues- returns it to heart for reoxygenation in lungs  Disruption in PV system can cause pain, edema, loss of limb, death Lymphatic System  Helps heart & peripheral vasculature maintain circulation - retrieves excess fluid  Disruption in lymphatic system may result in edema, reduced range of motion, susceptibility to infection VEINS - Capacitance Vessels  veins are distensible & can therefore stretch & hold more blood when blood volume increases  compensatory mechanism: reduces stress on heart Capillaries Exchange Gases & Nutrients Between Arterial & Venous Systems Main Functions of Lymphatic System 1. Movement of lymph fluid in a closed circuit with CV system 2. Development & maintenance of immune system 3. Reabsorption of fat & fat-soluble substance from small intestine Interactions With Other Systems Peripheral vascular blood flow control:  Local blood flow to tissues as needed  Nervous system involved with shifting blood flow during exercise, injury, temperature changes  Endocrine system through hormones, ions & other chemicals  Cardiovascular System  Lymphatic system has no pumping mechanism Assessing the Peripheral Vascular & Lymphatic Systems Focused PV History  Any pain, pallor, pulselessness, poikilothermia (polar or cold sensation), paresthesia or paralysis  Any aching, throbbing or burning, cramping or itching in the legs  Any swelling in the ankles - symmetry or assymmetrical  Leg pain with ambulation or rest – symmetrical or assymmetrical  Sores/ulcers on legs, feet Leg Pain or Cramps  Describe the type of pain- gradual/sudden  burning, aching, cramping, stabbing, throbbing  Is it aggravated by activity, walking?  Does the pain wake you up at night?  What relieves the pain? (dangling, rest)  Any Hx of vascular problems/varicosities?  Hx of heart problems, diabetes, obesity, pregnancy, smoking, trauma, prolonged standing? Skin Changes on Arms or Legs  What colour are the changes?  Erythema (redness), pallor, cyanosis (blueness), brown discolourations, dusky, mottled  Do your leg veins look bulging and/or crooked?  Leg or foot “sores or open areas”?  Location on legs/feet, ankles/toes? Swelling in the Arms or Legs  Is the swelling in one or both legs?  What time of day is the swelling worst?  Does the swelling come and go or is it constant?  Is the swelling associated with pain, heat, redness? Sudden or gradual onset?  Bilateral edema usually caused by a systemic problem such as heart failure;  unilateral edema often caused by a local obstruction or inflammation Focused Lymphatic History  Swelling in neck, axillae or groin  Unusually tired  Recent fever  Joint pain Many of these questions can be combined with other assessments. Physical assessment of the lymphatic system is usually incorporated with other system assessments. PV & Lymphatic Assessment  Techniques for PV & lymphatic assessment  Inspection, palpation, vital signs  Positions: Examine upper body /vitals - sitting  Abdomen/ legs - supine  Legs - standing  BP may be taken in both arms (sitting, lying & standing to rule out orthostatic hypotension or occlusion)  Tools used  Stethoscope, tape measure, VS equipment, Doppler if indicated Inspection & Palpation  hands, fingers & finger nails for colour, skin condition, temperature, moisture, turgor, clubbing - circulation (capillary refill)  abdomen for visible veins or pulsations  legs & feet for colour, hair distribution, varicosities, temperature & edema Inspect & Palpate Hands/ Arms  Hand inspection  Capillary refill  Inspect & palpate for colour of skin & nail beds, temperature, texture & skin turgor, lesions, edema & clubbing, symmetry of arms/hands Inspect & Palpate the Abdomen  Abdominal veins should barely be visible.  Visible, large diffuse pulsations may indicate aneurysm. Inspecting & Palpating Lower Extremities  Inspect both legs together  Note skin colour, temperature, hair distribution, venous pattern, size, skin lesions or ulcers  Leg hair should be evenly distributed, hair loss may indicate arterial insufficiency, should be no varicosities or edema  Legs should be symmetric in size without swelling or atrophy. If asymmetric or if DVT suspected, measure the calf circumferences  Should be <1 cm difference between calf circumferences Inspecting for Varicosities  Have client stand when assessing varicosities so that veins are more prominent  Varicose veins create incompetent valves that increase venous pressure. Obesity, pregnancy, & genetic predisposition are additional risk factors. Inspecting for Arterial & Venous Insufficiency Assessing Edema  To assess edema, press index finger over bony prominent area: severity of edema graded on scale 1+(2mm), 2+ (4mm), 3+ (6mm) to 4+(8mm) VERY IMPORTANT  Unilateral edema - suspect occlusion of a major vein  Edema without pitting - suspect arterial disease & occlusion Palpating Pulses Temporal artery Carotid artery Temporal & carotid arteries: regular, elastic, smooth, 2+ bilaterally Palpating Cervical Lymph Nodes  Nodes should not be palpable or if palpable should be less that 1 cm in size, easily moveable & non-tender.  Tender, palpable nodes may indicate recent infection.  Large well defined nodes may indicate acute infection or tumour in or near the node Palpating radial pulses  Radial pulses should be equally palpable, symmetrical in strength & amplitude bilaterally Palpating brachial pulses  Note pulse rate, rhythm- absent pulses may indicate arterial occlusion; need immediate response! Palpating the Epitrochlear Nodes  Generally not palpable, if palpable then suspect infection of hand or forearm Allen Test Palpating Femoral Pulse Place client supine, feel below inguinal ligament, palpate for groin crease, use palmar surface of 3 fingers Palpating Popliteal Pulse If client cannot lie prone: have client supine, flex knee, place one hand on each side of knee with thumbs near front of patella. Curl fingers around knee, rest fingers in popliteal fossa Palpating Posterior Tibialis (pedal) Pulse Palpating Dorsalis Pedis (Pedal) Pulse Focused assessment!!  Alterations in pulse rate/rhythm may indicate a cardiac arrhythmia  If documented in past and asymptomatic, monitor for changes If new &/or symptoms of concern, notify dr., ECG needed STAT  Absent pulses may = arterial occlusion  Most often af
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