Peripheral Vascular System and Lymphatic System Chapter 20

Objective Data—The Physical Exam (cont.) Arms—Inspect and palpate Skin Profile sign Capillary refill Symmetry Radial pulse Ulnar pulse Brachial pulse Epitrochlear lymph node Modified Allen test

Radial Pulse

Ulnar Pulse

Brachial Pulse

Objective Data—The Physical Exam (cont.) Legs—Inspect and palpate Skin and hair Symmetry Temperature Calf muscle Inguinal lymph nodes Femoral pulse Popliteal pulse Posterior tibial pulse Dorsalis pedis pulse Pretibial edema Leg veins Assess while patient stands Manual compression test

Femoral Pulse

Popliteal Pulse

Posterial Tibial Pulse

Dorsalis Pedis Pulse © Pat Thomas, 2006.

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

Pitting Edema © Pat Thomas, 2006.

Objective Data—The Physical Exam (cont.) Additional techniques Color changes Doppler ultrasonic stethoscope Ankle-brachial index (ABI) ABI: Ankle systolic pressure divided by arm systolic pressure. Normally 1.06 or 106%. Less reliable in patients with DM. • 0.90 to 0.70—mild claudication • 0.70 to 0.40—moderate to severe claudication • 0.40 to 0.30—severe claudication, usually with rest pain except in the presence of diabetic neuropathy • <0.30—ischemia, with impending loss of tissue

Abnormal Findings Variations in Arterial Pulse Weak, “thready” pulse – 1+ Full, bounding pulse – 3+ Water-Hammer (Corrigan’s) pulse – 3+ (collapses suddenly) Pulsus bigeminus Pulsus alternans Pulsus paradoxus Pulsus bisferiens

Abnormal Findings Peripheral Vascular Disease Arms Raynaud’s syndrome Lymphedema Legs Arteriosclerosis—ischemic ulcer Venous (stasis) ulcer Superficial varicose veins Deep vein thrombophlebitis Occlusions Aneurysms