Pulmonary

• Peripheral-Vascular System


  Branching network of vessels that transports oxygenated blood to all body organs and tissues and then returns it to the heart for reoxygenation in the lungs
• Peripheral-Vascular System


  • Delivers blood to all areas of the body
  • Blood flows through arteries, veins, and capillaries
  • Measured by pulse and pressure
  • Adequate perfusion to vital organs and extremities is essential to life
• Disruption in the Peripheral-Vascular System

  Can cause significant pain, loss of limb, or even death
• Lymphatic System


  • Complements the function of the vascular system
  • Collects and drains excess tissue fluid that accumulates from the cardiovascular system and returns this fluid to the heart
• Lymphatic System


  • Helps the heart and peripheral vasculature maintain adequate circulation
  • Lymphatic dysfunction may result in reduced range of motion, permanent disfigurement, and susceptibility to infection
  • Responsible for movement of lymph fluid, development and maintenance of the immune system, and reabsorption of fat and fat-soluble substances from the small intestine
• Structures of the Lymphatic System

  • Lymph
  • Lymphatic Capillaries
  • Lymphatic Vessels
  • Lymph Nodes
  • Tonsils
  • Thymus
  • Spleen
  • Peyer's Patches
• Functions of the Lymphatic System Structures

  • Lymph - Excessive fluid from body tissue that has drained into lymphatic capillaries
  • Lymphatic Capillaries - Collects fluid from interstitial space and surrounding tissue
  • Lymphatic Vessels - Drain lymph back to right lymphatic duct and thoracic duct
  • Lymph Nodes - Filter microorganisms and foreign substances from lymph
  • Tonsils - Destroy microorganisms and foreign substances at beginning of digestive and respiratory tracts
  • Thymus - Forms antibodies in newborn and developing immune system, secretes thymosin to help T-cell differentiation
  • Spleen - Filters blood and produces lymphocytes and monocytes
  • Peyer's Patches - Respond to antigens by producing antibody
• Lymphatic System


  Depends on the cardiovascular system, contraction of smooth muscles within lymphatic vessels, and skeletal muscle contraction to pump lymph throughout the body
• Obstruction of lymphatic system flow


  Lymph may diffuse into the vascular system or collateral channels (to provide alternate routes) may develop
• Infection in the lymphatic system can occur at any age
• When assessing the peripheral-vascular and lymphatic systems

  • Begin by asking for the person's chief complaint
  • You may need to ask which symptom is the most bothersome
• Major vascular symptoms to watch for

  • Swelling
  • Limb pain
  • Changes in sensation of an extremity
• Always ask about fever, fatigue, and lumps when evaluating the lymphatic system
• The past health history can provide direct links to the patient's present health status
• The family history identifies any causative factors that may lead to problems with the peripheral-vascular or lymphatic system
• The cause of lymphomas, lymphosarcoma, and cancer of the lymph glands is unknown
• A complete review of systems is an essential component of the assessment
• The psychosocial profile reveals patterns in the patient's life that may affect the health of their peripheral-vascular and lymphatic systems
• Before examining the peripheral-vascular and lymphatic systems, review the location of pulse sites, and remember that the lymphatic system drains toward the center of the body
• Keep key history findings, especially the chief complaint, in mind as you assess
• Tools for examination of the peripheral-vascular and lymphatic systems

  • Stethoscope
  • Sphygmo-manometer
  • Flashlight
  • Ruler
  • Non-stretchable tape measure
• You may be able to combine the peripheral-vascular and cardiovascular physical assessments
• Physical assessment of the lymphatic system is usually integrated into the assessment of other body systems
• A head-to-toe approach is suggested to incorporate the peripheral-vascular and lymphatic systems
• Be alert for signs of an acute illness or chronic problem when performing a general survey
• Observe for edema, which is associated with peripheral-vascular or lymphatic disease
• Abnormal posture, gait, and movements may signal an autoimmune disease
• Elevated temperature may indicate an infection; changes in blood pressure and pulse may indicate a cardiovascular problem
• Assessment techniques for upper extremities


  • Inspect color, lesions, edema
  • Test capillary refill
• Normal variations for upper extremities

  • Skin color uniform
  • Fingernails of equal thickness
  • Positive brisk capillary refill less than 2 to 3 seconds
  • No edema, erythema, red streaks, or skin lesions
• Abnormal findings for upper extremities

  • Delayed capillary refill time
  • Edema
  • Lymphedema secondary to mastectomy
  • Intermittent pallor and cyanosis of hands and fingers
  • Ischemic changes and gangrene of hands and fingers
  • Streaky redness, tenderness, warmth along course of a vein
• Assessment techniques for abdomen

  • Inspect arterial pulsations over the abdominal aorta
  • Note abdominal venous pattern and flow
• Normal variations for abdomen

  • Abdominal contour flat, concave, or round
  • Abdominal veins barely visible. Veins flowing upward above and downward below umbilicus
  • Arterial pulsations at midline over aorta in thin adults
• Abnormal findings for abdomen

  • Tense, shiny abdominal skin
  • Upward or centrifugal venous flow
  • Visible, large, diffuse pulsations
• Assessment techniques for lower extremities


  • Inspect color, lesions, edema, hair distribution, and condition of nails
• Normal variations for lower extremities


  • Leg hair distributed evenly
  • No varicosities or only superficial ones
  • No swelling or edema
  • No lesions or ulcers
• Abnormal findings for lower extremities

  • Hair loss, thin shiny skin, and thick nails
  • Eczema, stasis dermatitis
  • Prominent leg veins, possibly with ropelike, dilated appearance or purplish spider-like appearance
  • Edema
  • Skin ulcers
• When evaluating pulses, use the distal pads of your second and third fingers
• To palpate lymph nodes, use the pads of your second, third, and fourth fingers, and gently palpate for superficial nodes
• Assessment techniques for head and neck pulses

  • Note rate, rhythm, amplitude, contour, symmetry, thrills
  • Carotid pulse: Gently palpate along sternocleidomastoid muscle
  • Temporal pulse: Gently palpate next to eyes over temporal area