Chapter 20ConceptsReview: Major Arteries in the ArmVessels in the LegReview: Major VeinsVascular System and LymphaticsThe Lymphatic SystemFunctions of the Lymphatic SystemReview: Lymphatic Ducts and Drainage PatternsSlide 10Review: Other Organs in the Immune SystemDevelopmental ConsiderationsDevelopmental Considerations cont’dDevelopmental ConsiderationsSubjective DataObjective Data: PreparationHead and Arms: Inspect and PalpatePalpating Pulses: Carotid PulseArms: Palpation *Palpate simultaneously, bilaterally when possiblePalpation of Epitrochlear NodeInspect and Palpation of Peripheral Perfusion:Slide 22Legs: Inspect and PalpateLegs: Palpate ArteriesCheck for BruitsAbnormal Findings Peripheral Vascular DiseaseArterial vs. Venous InsufficiencyArterial InsufficiencyArterial Insufficiency: S/SVenous Insufficiency: S/SComparison of Arterial & Venous InsufficiencyChronic Pain with Arterial vs. Venous InsufficiencyAcute Pain of Arterial vs. Venous InsufficiencyLeg UlcersVenous vs. Arterial UlcersVenous ThromboembolismSlide 37DVT in Upper ExtremityS/S of a DVTS/S of PESlide 41LymphedemaOther Abnormalities (venous)Peripheral Vascular: Normal v. AbnormalDocumentation: NormalChapter 20Chapter 20Peripheral Vascular System Peripheral Vascular System and Lymphatic Systemand Lymphatic SystemConceptsConceptsReview of Review of vascular/lymphatic vascular/lymphatic systemssystems BruitsBruitsClubbingClubbingPeripheral pulsesPeripheral pulsesPathologyPathology–EdemaEdemaIncluding lymphedemaIncluding lymphedema–Vascular diseaseVascular diseaseArterial Arterial VenousVenousReview: Major Arteries in the ArmReview: Major Arteries in the ArmVessels in the LegVessels in the LegSlide 20-Slide 20-44Review: Major VeinsReview: Major VeinsVascular System and LymphaticsVascular System and LymphaticsVascular system consists of vessels of Vascular system consists of vessels of bodybody–Vessels are tubes for transporting fluid, such as Vessels are tubes for transporting fluid, such as blood or lymphblood or lymph–Any disease in vascular system creates problems Any disease in vascular system creates problems with delivery of oxygen and nutrients to tissues or with delivery of oxygen and nutrients to tissues or elimination of waste products from cellular elimination of waste products from cellular metabolismmetabolism–The lymphatics form completely separate vessel The lymphatics form completely separate vessel system, which retrieves excess fluid from tissue system, which retrieves excess fluid from tissue spaces and returns it to the bloodstreamspaces and returns it to the bloodstreamSlide 20-Slide 20-66The Lymphatic SystemThe Lymphatic SystemA complete circulatory networkA complete circulatory network–Linked to vasculature systemLinked to vasculature systemConsists of:Consists of:–Collecting ducts, lymph nodes spleen, Collecting ducts, lymph nodes spleen, thymus, tonsils, adenoids and small amounts thymus, tonsils, adenoids and small amounts of lymph tissueof lymph tissuePurpose: to protect from infectionPurpose: to protect from infectionFunctions of the Lymphatic SystemFunctions of the Lymphatic SystemDefensive immunityDefensive immunityReturn fluid, proteins and electrolytes from Return fluid, proteins and electrolytes from tissue space to the bloodtissue space to the bloodAbsorb fat and fat-soluble substances Absorb fat and fat-soluble substances from the intestinal tractfrom the intestinal tractProduce lymphocytesProduce lymphocytesProduce antibodiesProduce antibodiesReview: Lymphatic Ducts and Review: Lymphatic Ducts and Drainage PatternsDrainage PatternsLymphaticsLymphaticsRight Lymphatic ductRight Lymphatic duct Thoracic ductThoracic duct Lymph nodesLymph nodes Related organs to lymphatic Related organs to lymphatic systemsystemReview: Lymphatic Ducts and Review: Lymphatic Ducts and Drainage PatternsDrainage PatternsReview: Other Organs in the Review: Other Organs in the Immune SystemImmune SystemDevelopmental ConsiderationsDevelopmental ConsiderationsInfants and ChildrenInfants and Children–Infants’ BP: usually not done unless child is lethargic and Infants’ BP: usually not done unless child is lethargic and tires easily during feeding or the skin is cyanotic when tires easily during feeding or the skin is cyanotic when cryingcrying–Children > 18 months: BP checkedChildren > 18 months: BP checked–BP at birth: 70/50 and this increases to 120/80 by BP at birth: 70/50 and this increases to 120/80 by adolescenceadolescence–Pulse is Pulse is ’d with fever’d with fever–Lymphoid tissueLymphoid tissueReaches adult size by 6Reaches adult size by 6Surpasses adult size by pubertySurpasses adult size by pubertyAtrophies after pubertyAtrophies after puberty–Large lymph nodes Large lymph nodes –Palpable superficial nodesPalpable superficial nodesDevelopmental Considerations Developmental Considerations cont’dcont’dPregnancyPregnancy–BP monitored throughout pregnancyBP monitored throughout pregnancyIncrease of 33 mm systolic or 15 mm diastolic may Increase of 33 mm systolic or 15 mm diastolic may indicate preeclampsiaindicate preeclampsia–Blood volume doublesBlood volume doubles–Second trimester: Second trimester: ↓ BP↓ BP–Edema in legs, hemorrhoids or varicose Edema in legs, hemorrhoids or varicose veinsveinsD/t pressure of uterus on LE’sD/t pressure of uterus on LE’sDevelopmental Considerations Developmental Considerations Aging adultAging adult–Arteriosclerosis or calcification of the blood vessel wallsArteriosclerosis or calcification of the blood vessel walls–Arterial walls lose elasticity Arterial walls lose elasticity  BP BP (d/t increased peripheral vascular resistance)(d/t increased peripheral vascular resistance)–HR may slowHR may slow–Irregular pulsesIrregular pulses–Dorsalis pedis and posterior tibial pulses may become Dorsalis pedis and posterior tibial pulses may become more difficult to findmore difficult to find–Ability to resist infection decreasesAbility to resist infection decreasesSubjective DataSubjective DataLeg pain or crampsLeg pain or crampsSkin changes on arms or legsSkin changes on arms or legsSwelling in the arms or legsSwelling in the arms or legsLymph node enlargementLymph node enlargementMedicationsMedicationsObjective Data: PreparationObjective Data: PreparationTechniquesTechniques::Inspection Inspection PalpationPalpationEquipmentEquipment::StethoscopeStethoscopePaper