Assessment
best way to palpate lymph nodes in head and neck
pads of digits 1-3, only one hand for submental. drag fingers across the skin as moving from set to set to avoid missing anything
normal peripheral pulse grade
2+
Cause of unilateral lower extremity redness, swelling, pain
DVT. this is a 911 and requires urgent ultrasound and anticoagulation
sedentariness is a risk factor for this
DVT
How to grade pulses
0-3+
normal cap refill finding
brisk < 2 seconds
lymphedema, from resection of axillary lymph nodes 2/2 breast cancer
DVT
How to grade pitting edema
1+ - 4+ based upon depth or time to rebound
normal lymph node description
soft (if palpable at all), discrete, moveable, non tender. Malignant: enlarged, cool, hard, non tender, matted/fixed.
Infected: enlarged, warm, tender, discrete
Cause of pain with walking, remits with rest
arterial disease. this condition is called claudication
DVT is a risk factor for
pulmonary embolus
Good practice when one limb is larger than the other
measure its circumference
direction of lymph drainage in the head
downward, assess upstream for an infection
Cause of dark, ulcerated, weeping ulcers in the lower extremities
venous insufficiency/valve disease
mastectomy is a common cause of this
lymphedema
The other PV variables to assess other than grading pulses
color, temp, cap refill, hair distribution
piece of equipment to use when difficult to palpate pulses
doppler ultrasound. pulses may be difficult to palpate in cases of obesity or edema, and when found with the doppler, draw an X with a marker on the spot
The name of tortuous lower extremity veins common in pregnancy and the geriatric populations
varicosed veins. risk factor for DVT
this is a normal finding in lower extremity pulses in the geriatric patient
1+. Vessels stiffen, cardiac output usually goes down. 1+ should be bilateral, and the remainder of the exam should be wnl as well- nl color, skin temp, hair distribution, and cap refill, although cap refill may be hard to elicit with dystrophic toenails