NURS 347 TOWSON UNIVERSITY Lymphatic Assessment
Dec 26, 2015
NURS 347TOWSON UNIVERSITY
Lymphatic Assessment
LYMPHATIC SYSTEM
Structure & Function
The Lymphatic System: Drainage & Absorption
• The lymphatic system is comprised extensively of vessels. This vascular system is separate from that which carries blood.
Vessels allow fluid to flow from tissue into circulation Conserves fluid and plasma that leak from capillaries
• Lymphatic Fluid: Consistency of plasma; contains white blood cells, lymphocytes. Carries bacteria and pathogens to lymph nodes for destruction
• Absorbs lipids from intestinal tract; lymphatic fluid in the digestive system is milky white from lipids.
Lymphatic System: Immune Function
• Location of infection often indicated by affected, abnormal lymph nodes
• Functions by detecting and elimination foreign substances from the body• Environmental: from outside
the body• From within the body:
Abnormal or mutant cells
• Phagocytosis: Neutrophils and monocytes & macrophages digest foreign substances
Lymphatic System: Immune Function
Lymphocytes produce antibodies and immune responses B Lymphocytes: Creates antibodies against antigens T Lymphocytes
Helper Cytotoxic Memory Regulatory
T Cells originate in bone marrow, mature in the thymus. Does not serve a function after childhood and the development of the immune system.
Lymphatic System & Immune Function
The SpleenLocated in left upper quadrant of abdomenFunctions:
Destroys old red blood cells Produces antibodies Stores red blood cells Filters microorganisms
from the blood
Lymphatic System: Immune Function
Gastrointestinal Surveillance Tonsils: Respond to local inflammation, first line of
defense in the GI tract Palatine Adenoid Lingual
Peyer’s Patches: Lymphoid tissue in the GI tract, often in the small intestines. Can produce an immune response when in contact with organisms from the external environment Ex. Microorganisms found in food
Location of Cervical Lymph Nodes
Lymph Nodes
Multiple Locations
CervicalAxillaryInguinal
Cervical Lymph Nodes
Nodes are small, oval clusters Filter lymph House lymphocytes Prevent harmful
substances from entering circulation
Greatest supply is in the head and neck
Arranged in groups
Lymph nodes follow a drainage pattern and direction
Cervical Lymph Nodes & Landmarks
Preauricular: in front of ear
Posterior auricular (mastoid): superficial to mastoid process
Occipital: Base of skull
Submental: Midline, behind tip of mandible
Submandibular: Halfway between angle and tip of the mandible
Jugulodigastric: Under angle of mandible
Superficial cervical: Overlying sternomastoid muscle
Deep cervical: Beneath sternomastoid muscle
Posterior cervical: In posterior triangle along edge of trapezius muscle
Supraclavicular: Just above and behind clavicle
Axillary Lymph Nodes
The breast has extensive lymphatic drainage
75% of lymph drains into ipsilateral axillary nodes Central axillary nodes Pectoral Subscapular Lateral
Lymphatic Drainage
Without lymphatic drainage, fluid would build up in interstitial spaces and produce edema.
Vessels drain into two main trunks: Right lymphatic duct and thoracic duct
Right Lymphatic Duct Empties into
right subclavian drain, collects from:
Right side of head
Right side of neck
Right arm
Right side of thorax
Right lung and pleura,
Right side of heart
Right upper section of liver
Thoracic Duct• Empties into the left subclavian
vein• Drains the rest of the body
Lymphatic & Immune Systems
LYMPHATIC SYSTEM
Assessment
Subjective Assessment
Leg pain or cramps?Skin changes on arms or legs?Swelling?Lymph node enlargement?Tenderness, lump, or swelling in breasts?Neck pain, decreased range of motion?Sore throat?Medications?
Objective Assessment
Begin head to toe
Inspect head and neck for symmetry, swelling, changes in skin color or pigmentation
Inspect movement of head and neck when asked to look both ways
Palpate neck for symmetry, cervical lymph nodes
Lymph Node Palpation
Palpation: Use a gentle, circular motion of fingerpads
Normal findings: movable, discrete, soft, and non-tender
Note location, size, shape, delimitation, mobility, consistency, borders, tenderness, and if fixed to underlying tissue.
If nodes are enlarged or tender, assess for drainage complications
Order of Palpation: Cervical Lymph Nodes
Tonsils
Using a penlight:Inspect tonsils behind
anterior tonsillar pillar
Should appear pink with indentations, occasional whitish cellular debris are visible; free from exudate
Visualize the posterior wall for color, exudate, or lesions
Tonsil Grading:
+1 Visible
+2 Halfway between
tonsillar pillars and uvula
+3 Touching the uvula
+4 Touching each other
Most often visualize +1 and +2 in health people and
children
Axillary and Inguinal Nodes
Axillary Nodes: Generally not visible or palpable Expect tenderness while palpating high into the axillia Note any enlarged or tender lymph nodes
Inguinal Nodes: Generally small (1 cm or less) Moveable Non-tender
Variations & Considerations
Palpable lymph nodes often occur in infants and children, may be sequelae of past infection
Age related variablesVaccinations and local lymphadenopathyImmunosuppressionMastectomy: Removal or damage to lymph
nodes imped drainage, lymph builds up in interstitial spaces and may lead to infection and delayed wound healing. Chronic lymphedema is unilateral, non-pitting swelling