Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 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: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—The Physical Exam  Abnormal Findings

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-3 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-4 Structure and Function (cont.) Veins  Jugular veins (Chapter 19)  Veins in the arm  Veins in the leg  Deep veins Femoral Femoral Popliteal Popliteal  Superficial veins Great saphenous Great saphenous Small saphenous Small saphenous  Perforators (connecting veins)

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-5 Arteries in the Arm

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-6 Vessels in the Leg

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-7 Venous Flow

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-8 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 20-9 Lymphatic Ducts and Drainage Patterns

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Immune-Related Organs

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Objective Data—The 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Radial Pulse

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Ulnar Pulse

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Brachial Pulse

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Femoral Pulse

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Popliteal Pulse

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Posterial Tibial Pulse

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Dorsalis Pedis Pulse © Pat Thomas, 2006.

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Pitting Edema © Pat Thomas, 2006.

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Objective Data—The 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Sample Charting

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Sample Charting (cont.)

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide Sample Charting (cont.)

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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. Chapter 20: Chapter 20: Peripheral Vascular System and Lymphatic System Slide 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