Peripheral Vascular System

and Lymphatic System

Chapter 20

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 20: Peripheral Vascular System and Lymphatic System

Structure and Function

Subjective DataHealth History Questions

Objective DataThe Physical Exam

Abnormal Findings

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-2

Chapter 20: Peripheral Vascular System and Lymphatic System

Structure and Function

Arteries
Temporal artery
Carotid artery

Arteries in the arm

Brachial
Ulnar
Radial

Arteries in the leg

Femoral
Popliteal
Dorsalis pedis
Posterior tibial

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-3

Chapter 20: Peripheral Vascular System and Lymphatic System

Structure and Function

(cont.)

Veins

Jugular veins (Chapter 19)

Veins in the arm
Veins in the leg

Deep veins
Femoral
Popliteal
Superficial veins
Great saphenous
Small saphenous
Perforators (connecting veins)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-4

Chapter 20: Peripheral Vascular System and Lymphatic System

Arteries in the Arm

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-5

Chapter 20: Peripheral Vascular System and Lymphatic System

Vessels in the Leg

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-6

Chapter 20: Peripheral Vascular System and Lymphatic System

Venous Flow

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-7

Chapter 20: Peripheral Vascular System and Lymphatic System

Structure and Function

(cont.)

Lymphatics

Right lymphatic duct

Thoracic duct

Functions of the lymphatic system

Lymph nodes

Related organs to lymphatic system

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-8

Chapter 20: Peripheral Vascular System and Lymphatic System

Lymphatic Ducts and

Drainage Patterns

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-9

Chapter 20: Peripheral Vascular System and Lymphatic System

Immune-Related Organs

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-10

Chapter 20: Peripheral Vascular System and Lymphatic System

Subjective Data
Health History Questions

Leg pain or cramps

Skin changes on arm or legs

Swelling

Lymph node enlargement

Medications

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-11

Chapter 20: Peripheral Vascular System and Lymphatic System

Objective DataThe Physical Exam

Preparation

Equipment needed (occasionally)

Paper tape measure

Tourniquet or blood pressure cuff

Stethoscope

Doppler ultrasonic stethoscope

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-12

Chapter 20: Peripheral Vascular System and Lymphatic System

Objective DataThe Physical Exam

(cont.)

ArmsInspect and palpate

Skin

Ulnar pulse

Profile sign

Brachial pulse

Capillary refill

Symmetry

Epitrochlear lymph
node

Modified Allen test

Radial pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-13

Chapter 20: Peripheral Vascular System and Lymphatic System

Radial Pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-14

Chapter 20: Peripheral Vascular System and Lymphatic System

Ulnar Pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-15

Chapter 20: Peripheral Vascular System and Lymphatic System

Brachial Pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-16

Chapter 20: Peripheral Vascular System and Lymphatic System

Objective DataThe Physical Exam

(cont.)

LegsInspect and palpate

Skin and hair

Popliteal pulse

Symmetry

Posterior tibial pulse

Temperature

Dorsalis pedis pulse

Pretibial edema

Leg veins

Calf muscle
Inguinal lymph nodes
Femoral pulse

Assess while patient stands

Manual compression test

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-17

Chapter 20: Peripheral Vascular System and Lymphatic System

Femoral Pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-18

Chapter 20: Peripheral Vascular System and Lymphatic System

Popliteal Pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-19

Chapter 20: Peripheral Vascular System and Lymphatic System

Posterial Tibial Pulse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-20

Chapter 20: Peripheral Vascular System and Lymphatic System

Dorsalis Pedis Pulse

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-21

Chapter 20: Peripheral Vascular System and Lymphatic System

Manual Compression Test

From Bloom A, Watkins PH, Ireland J: Color atlas of diabetes, ed 2, St. Louis, 1992, Mosby.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-22

Chapter 20: Peripheral Vascular System and Lymphatic System

Pitting Edema

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-23

Chapter 20: Peripheral Vascular System and Lymphatic System

Objective DataThe Physical Exam

(cont.)

Additional techniques

Color changes

Doppler ultrasonic stethoscope

Ankle-brachial index (ABI)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-24

Chapter 20: Peripheral Vascular System and Lymphatic System

Abnormal Findings

Variations in Arterial Pulse

Weak, thready pulse 1+

Full, bounding pulse 3+

Water-Hammer (Corrigans) pulse 3+ (collapses

suddenly)

Pulsus bigeminus

Pulsus alternans

Pulsus paradoxus

Pulsus bisferiens
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-25

Chapter 20: Peripheral Vascular System and Lymphatic System

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-26

Chapter 20: Peripheral Vascular System and Lymphatic System

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-27

Chapter 20: Peripheral Vascular System and Lymphatic System

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-28

Chapter 20: Peripheral Vascular System and Lymphatic System

Abnormal Findings

Peripheral Vascular Disease

Arms

Legs

Raynauds syndrome
Lymphedema
Arteriosclerosisischemic ulcer
Venous (stasis) ulcer
Superficial varicose veins
Deep vein thrombophlebitis

Occlusions
Aneurysms
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-29

Chapter 20: Peripheral Vascular System and Lymphatic System

The relevant variable when discussing

claudication with a patient is
A.

Related foods

B.

Distance

C.

Blood glucose

D.

Emotional state

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-30

Chapter 20: Peripheral Vascular System and Lymphatic System

The ABI (ankle-brachial index)

should normally be
A.

Slightly greater than 1

B.

Slightly less than 1

C.

A negative number

D.

Less than 0.5

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 20-31