Lymphatic and Peripheral Vascular Exam Flashcards
Thrill
turbulent flow through an artery consistent with significant obstruction
Pulse Scale : 0
Unable to palpate
Pulse Scale : 1
Diminished
Pulse Scale : 2
Normal Briskness (expected)
Pulse Scale : 3
Bounding
Ankle Brachial Index Values
Ratio of the doornails pedis and brachial arterial pressures
.9-1.3 : Normal
.41 - .9 : Moderate Peripheral Artery Disease
Allen Test
tests atrial circulation to the hands
Postural Color Change Test
Tests for chronic peripheral artery disease
Acute Arterial Disease Symptoms (7)
Pain Coldness Numbness Hair loss (Chronic) Color change (Chronic) Loss of pulse 3 P’s-Pain, Pallor, Pulselessness
Acute Arterial Occlusion
Sudden onset of extreme pain
unilateral
cold, weak, numb distal to site
extremity is pallid, cold, and pulseless
Peripheral Arterial Disease
Chronic, Inadequate arterial flow
claudication upon exertion w/ muscle fatigue, numbness, and cold feet
Decreases distal pulses, pallor, ulcers
Venous Valve Competency Test
rapid filling or sudden distension indicates incompetency
Homan’s Sign
calf pain upon dorsiflexion of a flexed and elevated extremity is a positive Homan’s sign.
May indicate a DVT
Virchow’s Triad
Causation of DVT’s
Stasis
Hypercoaguability
Endothelial Injury
DVT Symptoms
Painless, unilateral, with swelling, pitting edema distal to the site.
Discoloration may be present due to venous congestion.
Superficial Thrombophlebitis
Clot in one of the smaller veins of the leg
Is often Painful with redness and tenderness over the affected vein but without as much swelling as a DVT
Varicose Veins
Valves in veins of lower extremities become incompetent so that blood begins to pool in veins
Initially is cosmetic- then can progress to chronic venous insufficiency
Greater Saphenous Vein often involved
Mapping Varicose Veins
Place your fingers on any two visible veins
Tap on the vein with one hand rapidly and feel with the other hand for a transmitted pressure wave
Chronic Venous Insufficiency
Higher than normal venous pressure in legs → damage to the valves→ higher venous pressures → further damage to valves
Chronic Venous Insufficiency : Risk Factors
Deep vein thrombosis (DVT) Varicose veins or a family history of varicose veins Obesity Pregnancy Extended periods of standing or sitting Age over 50
Chronic Venous Insufficiency : Signs and Symptoms
Symptoms Diffuse ache in legs Gradual onset over months Aggravated by prolonged standing Alleviated by elevation of the legs
Signs Pitting edema Rust colored skin with chronic disease Thickened skin hair Moist reddened ulcers
Lymphedema
Lymph channel obstruction or damage
Gradual onset
Unilateral or bilateral depending on cause
Aggravated by pressure on lymphatics
Alleviated by elevation and pressure release
Examination: non-pitting edema, thickened skin, often no pigmentation change
Lymphadenopathy : Signs of benign disease
Less than 1 cm Tender May be firm but not hard Freely movable Discreet borders
Lymphadenopathy : Signs of malignant disease
Greater than 1 cm Non tender Rock-hard Fixed to surrounding tissue Difficult to palpate borders
Lymphangitis
Localized bacterial infection of lymphatics
Acute onset
Usually secondary to skin injury
Associated symptoms: pain and fever
Physical findings: Tender red streaks in the skin, tender and enlarged lymph nodes.
Non-Pitting Edema
Usually a lymphatic problem
Pitting Edema
Fluid Overload
DVT
Cardiac Problem
Grading Edema
To grade pitting edema apply gentle, firm pressure with the thumb for 5 seconds in a swollen area, (often the pretibial area). Upon release if an indentation remains, grade:
Grade 1 = 2 mm pit and resolves quickly
Grade 2 = 4 mm pit and resolves in less than 1 minute
Grade 3 = 6 mm pit lasts from 1-2 minutes
Grade 4 = 8 mm pit and lasts from 2- 5 minutes
Grade 1
2 mm pit and resolves quickly
Grade 2
4 mm pit and resolves in less than 1 minute
Grade 3
6 mm pit lasts from 1-2 minutes
Grade 4
8 mm pit and lasts from 2- 5 minutes
Erythema Nodosum
Inflammation of the skin of the shins,
Gradual onset over weeks and often associated various systemic infections or immune reactions, not a vascular disease
Recurrent and bilateral
No aggravating or alleviating factors
Associated symptoms: fatigue, joint pain, fever
Examination: Raised red inflammatory nodules commonly found in crops
Cellulitis
Inflammation of the skin and/or subcutaneous tissues
Almost always a bacterial infection usually strep or staph
Acute onset
Usual presenting symptoms: pain, redness and warmth (dolor, rubor and calor)
Physical findings: well demarcated area that is exquisitely tender to palpation
Frequently accompanied by localized lymphadenopathy
