1. Peripheral Vascular System and Lymphatic System
Chapter 20

2. 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

3. Radial Pulse

4. Ulnar Pulse

5. Brachial Pulse

6. 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

7. Femoral Pulse

8. Popliteal Pulse

9. Posterial Tibial Pulse

10. Dorsalis Pedis Pulse
© Pat Thomas, 2006.

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

12. Pitting Edema
© Pat Thomas, 2006.

13. 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

14. 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

15. 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