Jarvis: Physical Examination & Health Assessment Chapter 21 (PDF)

Jarvis: Physical Examination & Health Assessment, 4th Canadian Edition **Chapter 21: Peripheral Vascular System and Lymphatic System** **Key Points** **This section discusses key points about the structure and function of the peripheral vascular and lymphatic systems.** The **vascular system**...

Jarvis: Physical Examination & Health Assessment, 4th Canadian Edition **Chapter 21: Peripheral Vascular System and Lymphatic System** **Key Points** **This section discusses key points about the structure and function of the peripheral vascular and lymphatic systems.** The **vascular system** consists of the **vessels** of the body, which transport fluid, such as **blood or lymph**. Three **mechanisms keep blood moving toward the heart** in the venous system. Veins are called **capacitance vessels** because they can stretch and hold more blood when blood volume increases. This compensatory mechanism reduces stress on the heart. **Risk factors for venous stasis** include standing, sitting, or bed rest because of the absence of the milking action of walking. Other risk factors are hypercoagulation, vein wall trauma, varicose veins, obesity, pregnancy, and genetic predisposition. The **lymphatic system** is a separate system that retrieves fluid from tissue spaces and returns it to the bloodstream. The **right lymphatic duct** empties into the right subclavian vein. The **thoracic duct** drains the rest of the body. The lymphatic system has **three major functions**: **Lymph nodes** are small oval clumps of lymphatic tissue located at intervals along the vessels. They **filter fluid** before it is returned to the bloodstream and remove harmful organisms. In lymph nodes, pathogens are exposed to **lymphocytes**, which mount an antigen-specific response to eliminate the pathogens. With local inflammation, the nodes in the affected area become swollen and tender. **Four major groups of lymph nodes** are accessible to inspection and palpation: The **spleen**, **tonsils**, **and thymus** aid the lymphatic system. - Developmental considerations: - Infants and children: Lymph nodes are relatively large in children, and the superficial ones are often more easily palpable. - Pregnant women: Hormonal changes cause vasodilation and a decrease in blood pressure. The vascular related changes can cause edema, varicosities, and hemorrhoids. - Older adults: Rigid Vessels result in arteriosclerosis, and they have an increased risk for peripheral artery disease. **This section presents critical points about subjective and objective assessments of the peripheral vascular system and lymphatic system.** To obtain **subjective data**, ask questions that investigate these topics: To obtain **objective data**, first assess the **arms**. Next, assess the **legs**. Expect findings to vary among patients in different **developmental stages**. For example, in healthy **infants and children**, lymph nodes commonly are easily palpable. In **pregnant women**, diffuse bilateral pitting edema and varicose veins may appear in the legs. In **older adults**, the dorsalis pedis and posterior tibial pulses may be difficult to find, and trophic changes are likely to be present. Incorporate **health promotion** when assessing the peripheral vascular system. For instance, discuss ways to prevent foot problems and more serious disorders. Teach the patient the principles of **good foot care**, such as checking the feet every day, keeping blood flowing to the feet, wearing shoes that fit comfortably, and keeping the skin soft and smooth.