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02.09 Lymphatic Assessment

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Overview

  1. Lymphatic system is a transport system for immune cells and waste products/excess fluid
  2. Blockages of lymphatic ducts, vessels, or nodes can cause fluid buildup

Nursing Points

General

  1. Signs of lymphatic drainage problems:
    1. Severe edema in one extremity
    2. Swollen, palpable, or tender lymph nodes
  2. Can assess these lymph nodes during other portions of the head-to-toe assessment to avoid duplication and increase efficiency

Assessment

  1. Inspect
    1. Look for significant edema in extremities
      1. If unilateral and no known trauma or other cause, may be lymphedema
    2. Obvious masses or swelling around lymph nodes
  2. Palpate – nodes should be nonpalpable and nontender
    1. Preauricular
    2. Submandibular
    3. Cervical
    4. Supraclavicular
    5. Axillary
    6. Inguinal/Pelvic

Nursing Concepts

  1. Specifically, swelling of the supraclavicular lymph nodes (to the point of being palpable) is highly indicative of malignancy

Patient Education

  1. Purpose of assessment and what you’re looking/feeling for

Reference Links

Study Tools

Video Transcript

In this video, we’re going to talk about the lymphatic system assessment. Truthfully, these things are usually assessed during other parts of the head to toe assessment in order to avoid duplication and increase efficiency. However, they need to be assessed, so we thought it was important to show you.

You’re going to start by inspecting for any obvious edema or swelling in the extremities and where the lymph nodes are
Then you’re going to palpate for the lymph nodes. There are 6 major lymph node locations you want to assess. Remember they should NOT be palpable or tender. First is the preauricular – that’s in front of the ears. Just use a small, gentle, circular motion to feel for the nodes.
Then submandibular – under the jaw. If they are palpable, it will feel like a little lump or a marble under your fingers.
Then you’ll feel for the cervical lymph nodes down the sides of the neck
Then feel for the supraclavicular nodes above the clavicle.
Next you’ll palpate under each arm for the axillary lymph nodes. Many patients who have had mastectomies have also had these lymph nodes removed – so make sure you know your patient’s history.
Finally, you want to gently assess for the inguinal lymph nodes. This is something you could do while you check for a femoral pulse and look for any sign of inguinal hernias as well. Be respectful of the patient and maintain their modesty.

Remember the lymphatic system has a system of vessels and ducts and nodes just like the blood vessels. They transport waste products, excess fluid, and immune cells. Under normal circumstances you should NOT be able to feel or see them and they should not be tender. If they are – it could indicate some sort of infection or illness.

So that’s your lymphatic assessment. Now, go out and be your best self today. And, as always, happy nursing!

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