Lymphatic System Assessment
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Questions and Answers

What is the purpose of saying 'let me know if you have any pain or tenderness when I touch you' before palpation?

  • To inform the client of the procedure
  • To assess the client's pain tolerance
  • To alert the client of potential discomfort during palpation (correct)
  • To ensure the client's comfort during the assessment
  • What is the recommended touch and pressure when palpating the lymph nodes?

  • Light touch with gentle pressure (correct)
  • Firm touch with heavy pressure
  • Rapid touch with varying pressure
  • Deep touch with moderate pressure
  • What is the purpose of palpating bilaterally?

  • To assess the lymph nodes on one side only
  • To palpate the lymph nodes in a circular motion
  • To assess the lymph nodes in a single area
  • To compare the right side to the left side (correct)
  • What is an example of a question a nurse may ask a client when assessing their lymphatic and immune system?

    <p>When did the swelling start?</p> Signup and view all the answers

    What is a characteristic of healthy hair?

    <p>Shiny, clean, and untangled</p> Signup and view all the answers

    What is a possible cause of very thin and brittle hair?

    <p>Hypothyroidism</p> Signup and view all the answers

    What is an example of a characteristic to note when inspecting the hair?

    <p>Distribution</p> Signup and view all the answers

    What is a possible cause of faded, reddish, or bleached hair?

    <p>Severe protein deficiency</p> Signup and view all the answers

    Study Notes

    Lymphatic System Assessment

    • Palpation is used to assess the lymphatic system, and the nurse should inform the client to report any pain or tenderness during the process.
    • Use the finger pads of two to three fingers, moving in a circular motion with light touch and gentle pressure, to avoid forcefully pushing the lymph node inwards.
    • Palpate in one spot, then shift fingers to a new spot within the same area, as lymph nodes are present in strands throughout the area.
    • Palpate bilaterally, comparing both sides, and ask the client about any pain or tenderness.
    • Assess the body's ability to regulate fluid and waste, noting any swelling, lymphoedema, or cellulitis.

    Client Assessment Questions

    • When did the swelling start?
    • Have you noticed any lymph nodes or lumps on your head, neck, underarms, or groin area?
    • Have you noticed any changes in your skin?
    • Do you have any chronic conditions or diseases that affect your lymphatic system?
    • If yes, ask about other symptoms, particularly if noticeable lymph node changes or skin changes are present.

    Hair Inspection Characteristics

    Hair Characteristics

    • Should be shiny, clean, and untangled
    • Hypothyroidism can cause brittle, thin hair
    • Distribution: Facial and body hair
    • Color: Varies, with severe protein deficiency (Kwashiorkor) causing faded, reddish, or bleached hair

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    Description

    Learn how to assess the lymphatic system using palpation technique. Understand the importance of gentle touch and communication with the client during the process.

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