1145 Peripheral vascular system & lymphatic system

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• Temporal artery
• Carotid artery
• Arteries in the arm
- Brachial - Ulnar - Radial
• Arteries in the leg
- Femoral
- Popliteal
- Dorsalis pedis


• Jugular veins
• Veins in the arm
• Veins in the leg
- Deep veins
• Femoral • Popliteal (normal not to feel)
- Superficial veins
• Great saphenous • Small saphenous
- Perforators (connecting veins)

venous flow

- muscles pump valves
- inactivity = won't close properly & you get back flow
- IV drug user = incompetent veins

structure & function: Lymphatics

• Right lymphatic duct
• Thoracic duct
• Functions of the lymphatic system
• Lymph nodes
• Related organs to lymphatic system

lymph functions

1. fluid drainage
2. help with infections

Aging Adult

- Arteriosclerosis = hardening of the arteries
- Atherosclerosis = plaque
- Calf vein enlargement = can be caused by inactivity
• Increased risk of DVT & PE
- Skin & hair changes
- Atrophy of lymphatic tissue = ↑ risk for infection
- Loss of valvular competence = aortic valve loss is common


- unilateral swelling, pain, heat
- can break off & travel to lungs (PE)
People at risk = pregnancy, abdominal & gyn. surgery

PE: symptoms

shortness of breath, pain with respiration
severe = death

arterial insufficiency

- dependent = low → flushed
- when elevated pain is worse

arterial disease 0-1+ symptoms

1. thickened toenails
2. no hair
3. elevated pain (caudication =pain)
4. dependent rubor

valve competence

incompetent = blood flow is going backward and forward (ex. varicose veins)

health history

• Leg pain or cramps (caudication if arterial)
• Skin changes on arm or legs
• Swelling = when does this occur
• Lymph node enlargement
• Medications = cholesterol reducing meds, birth control pills

Inspection & palpation: arms

• Skin
• Edema
• Capillary refill
• Clubbing
• Symmetry

pitting edema

= excessive fluid in the interstitial spaces that will leave an indentation in the skin when palpating
- easiest to palpate over hard bones.
- swelling, pitting, ↑ rebound time, warmth, redness, hair loss, shiny skin
- prolonged edema may lead to infection
- best to monitor is by weight
1+ : slight indentation (2mm), normal contours, interstitial fluid 30% above normal
2+ : deeper pit after pressing (4mm), lasts longer than 1+, fairly normal contour
3+ : Deep pit (6mm), remains several seconds after pressing, skin swelling is obvious by observation
4+ : deep pit (8mm), pit remains a long time after pressing, frank swelling

pitting edema: causes

- unilateral edema = thrombosis
- bilateral edema = renal failure, liver disease, cirrhosis, lack of movement, standing for too long, Na+ imbalance, varicose veins, valves in vein deteriorating

pulse assessment

• Radial pulse - access for quality
• Ulnar pulse
• Brachial pulse
• Grade force
• 4 + increased • 3 + bounding • 2+ normal
• 1+ weak • 0 absent

legs: inspect & palpate

• Skin and hair
• Symmetry
• Temperature
• Calf muscle
• Pretibial edema

inguinal lymph nodes: Normal & Abnormal

• Normal
- May be palpable
- 1cm or less, moveable & nontender
• Abnormal
- Enlarged, tender or fixed

leg veins

1. assess while patient stands
2. manual compression test

manual compression test

= test for competent values on varicose veins
1. firmly compress the lower portion of the varicose vein & place your other hand 6-8 above the first hand
2. feel for a pulsation at your second hand
Normal = no pulsation palpated the valves are competent
Abnormal = pulsations are felt with upper hand = the valves are incompetent

homan's sign

• Supine with knee flexed
• Sharply flex foot toward tibia
• Pain (felt in calf)
- Deep vein thrombosis - Tendinitis
- Muscle injury - Lumbosacral problems

Abnormal findings: Variation in arterial pulse

• Weak, "thready" pulse - 1+
• Full, bounding pulse - 3+
• Pulsus bigeminus = irregular pulse

pulsus bigeminus

irregular pulse


swelling caused by obstruction of the lymphatic system and accumulation of interstitial fluid

Raynaud's syndrome

causes vasoconstriction = intermittent loss of blood flow

what is #1 cause of preventable death in hospitalized patients


Abnormal: Arterial ****test

• Claudication (pain)
• Pain with exercise or at rest
• ↓ or absent pulses (hard to feel)
• Thin, shiny, hairless skin
• Cool skin temperature
• Ulcers on pressure points of feet
• pale

Abnormal: Venous ****test

• Pain increases when legs dependent (ex. dangling on long flight)
• Lower extremity edema
• Brown discoloration of skin
• Ankle ulcerations
• Skin temperature normal
• Pulses present, but difficult to palpate due to edema

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