Lecture Notes: Peripheral Vascular and Lymphatic Systems

Anatomy and Physiology Overview

• Arterial Pulses in the Arm
  • Brachial Artery: Runs medial down the arm.
  • Radial Artery: Easily palpable at the wrist along the thumb.
  • Ulnar Artery: Branches with the radial.
• Arterial Pulses in the Leg
  • Femoral Artery
  • Popliteal Artery: Behind the knee.
  • Pedal Pulses
  • Dorsalis Pedis Pulse: Along the dorsal part of the foot.
  • Posterior Tibial Pulse: Under the medial malleolus.

Indicators of Circulation

• Pulse is indicative of blood flow.
• Other indicators include normal temperature, sensation, and color.
• Check capillary refill on the toes and compare bilaterally.

Lymphatic System Overview

• Lymph nodes in the head, neck, and other locations.
• Functions: Vascular and immune.
• Palpability depends on depth and other factors.
• Lymph Node Characteristics:
  • Normal: Slightly tender, movable.
  • Malignant: Fixed, non-tender.

Assessment Findings

• Differentiate between subjective and objective findings.
• Report findings to a provider; avoid making medical diagnoses without confirmation.

Edema in Lower Extremities

• Common in adult and geriatric populations.
• Causes include:
  • Increased plasma volume: Sodium retention.
  • Capillary membrane permeability: Burns, snake bites, allergic reactions.
  • Renal disorders: Chronic kidney disease.
  • Nutritional deficiencies: Low albumin levels.
  • Medications: Imlodipine (Norvasc).
  • Heart failure, lymphedema, DVTs.

DVTs and Risk Factors

• Unilateral or bilateral swelling, possible warmth/tenderness.
• Risk factors:
  • Pregnancy, sedentary lifestyle, post-surgical, inflammatory conditions.
  • Less likely in patients on anticoagulants.

Peripheral Vascular Disease (PVD) and Peripheral Artery Disease (PAD) Indicators

• Symptoms: Pain, intermittent claudication, cold/numbness, unintended hair loss, edema, tenderness, redness.
• Follow-up required for varicose veins, non-healing wounds, color changes in extremities, and swollen lymph nodes.

Edema Classification

• Pitting Edema: Indentation visible.
• Venous Insufficiency: Brown/red staining, possible ulcers.
• Lymphedema: Non-pitting edema.

Clotting Risk Factors

• Increased risk with oral contraceptives, hormone therapy, pregnancy, inflammation.
• Conditions: Cancer, coronary artery disease, history of heart attack/stroke, surgery, fractures.
• Family history: Peripheral vascular/artery disease, varicose veins, aortic aneurysm.

Equipment for Assessment

• Tape measure: For measuring extremity circumference.
• Doppler ultrasound: For locating non-palpable pulses.

Attributes to Assess

• Size, symmetry, swelling, lesions, pigmentation, tenderness, skin color, texture, temperature, nail beds, capillary refill, edema.

Pulse Grading Chart

• 0: Absent/Unable to palpate
• 1+: Diminished/Weaker than expected
• 2+: Brisk/Normal
• 3+: Bounding

Health Promotion and Counseling

• Preventative measures: Smoking cessation, healthy BMI, exercise, hypertension and lipid control, dietary changes, diabetes management, alcohol use reduction, proper foot care.