Chapter 4 Vital Signs and Anthropomorphic Data

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Chapter 4Vital Signs and Anthropomorphic Data

• ?? Feng Xin

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Main contents

• Vital signs
• temperature
• pulse
• breathing
• blood pressure

• Anthropomorphic data
• height
• weight
• Mental status
• Gait
• Skin
• Lymphatic system

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VITAL SIGNS
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VTAL SIGNS
Vital signs are measurements of the body's most
basic functions.

• body temperature
• pulse
• breathing
• blood pressure

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BODY TEMPERATURE
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BODY TEMPERATURE

• The importance of body temperature
• Internal body temperature is tightly regulated to
  maintain normal cellular function of vital
  organs.
• Deviation of temperature by more than 4? above or
  below normal can produce life-threatening
  cellular dysfunction.

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BODY TEMPERATURE

• Regulation of internal temperature is
  controlled by the hypothalamus which maintains a
  set point for temperature.

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BODY TEMPERATURE

• How is the temperature taken

thermometer
Mercury-filled glass thermometer
electronic thermometer
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BODY TEMPERATURE

• Mercury-filled glass thermometers have been
  largely replaced by electronic thermometers that
  give rapid, accurate readings when they are well
  calibrated.

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BODY TEMPERATURE

• The temperature may be measured in the
• mouth, axilla, rectum
• placing the thermometer under the patients
  tongue for 3 minutes.

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BODY TEMPERATURE

• Simultaneous Temperatures in Various Regions
• The rectal temperature is about 0.3? higher than
  that of the oral reading
• The axillary temperature is about 0.5 ? less
  than the oral value.

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BODY TEMPERATURE

• Scales on clinical thermometers
• Fahrenheit ( F )
• Celsius ( ? )
• In our country the Celsius scale is usually
  used ,but in the united states often uses the
  Fahrenheit scale.

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normal temperature
BODY TEMPERATURE

• The population range of this set point varies
  from 36.0-37.5 ?.
• minimum temperature
• 300 to 400 a.m.
• maximum temperature
• between 800 and 1000 p.m

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BODY TEMPERATURE

• The normal body temperature of a person varies
  depending on gender, recent activity, food and
  fluid consumption, time of day.
• Record the patients temperature at each visit.
  Doing so establishes an individualized baseline
  for future reference and detects deviations from
  this baseline, either fever or hypothermia
• It is impossible to know an individuals normal
  temperature without a prior established baseline.
  

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abnormal temperature
BODY TEMPERATURE

• Body temperature may be abnormal due to
• fever (high temperature)
• a maximum oral temperature above 37.5 ?
• a axillary temperature exceeding 37.3 ?.
• a rectal temperature exceeding 38.0 ?.
• hypothermia (low temperature).
• usually is defined as 35.0 C

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BODY TEMPERATURE

• Falsely low levels
• incomplete closure of the mouth , breathing
  through the mouth ,leaving the thermometer in
  place for too short a time , or the recent
  ingestion of cold substances.
• Falsely elevated levels
• inadequate shaking down of the thermometer ,
  previous ingestion of warm substances , smoking ,
  recent strenuous activity , or even a very warm
  bath.

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THE PULSE
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pulse
PULSE
The pulse is the physical expansion of the
artery. As the heart pushes blood through the
arteries, the arteries expand and contract with
the flow of the blood. The pulse rate is a
measurement of the heart rate, or the number of
times the heart beats per minute.
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PULSE

• Palpation of the Arterial Pulse
• Using the first and second fingertips, press
  firmly but gently on the arteries until you feel
  a pulse.
• Count your pulse for 60 seconds (or for 15
  seconds and then multiply by four to calculate
  beats per minute).

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PULSE

• the pulse may be palpated in any of the
  accessible arteries.
• Wrist (Radial artery)
• Neck (Carotid artery)
• Inside of the elbow (Brachial artery)
• Behind the knee (Popliteal artery)
• Ankle joint (Posterior tibial artery)
• The examiner ascertains the contour of the pulse
  wave and its volume, rate, and rhythm.

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PULSE

• Pulse Rate
• normal between 55 and 100 beats per
• minute(BPM).

• Infants and children have higher normal heart
  rates. an infant would have a normal pulse rate
  ranging between 100-160 bpm.
• For a well-trained athlete, a normal resting
  heart rate may be closer to 40 beats a minute.

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PULSE

• bradycardias lower than 55 BPM
• tachycardias above 100 BPM

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RESPIRATIONS
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RESPIRATIONS

• Normal Respirations
• Respirations are when you breathe in and out.
• Your respiratory, or breathing rate is the
  number of times you breathe in and out in 1
  minute.

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RESPIRATIONS

• Normal Respirations
• At rest, the normal respiratory rate in adults is
  between 14 - 18 cycles per minute, in the
  newborn, the rate is about 44, gradually the rate
  diminishes until maturity. Women have slightly
  higher rates than men.

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RESPIRATIONS

• How to count a person's respirations?
• Ask the person to sit upright.
• Try to count the other person's respirations
  without him knowing
• Use a watch with a second hand and count his
  breaths for 60 seconds.
• Use any of the following methods to count
• Look at his chest rise and fall. One rise and one
  fall are counted as 1 breath.
• Listen to his breaths.
• Place your hand on the person's chest to feel the
  rise and fall

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BLOOD PRESSURE AND PULSE PRESSURE
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BLOOD PRESSURE AND PULSE PRESSURE

• Arterial Blood Pressure
• Blood pressure (BP) is the pressure exerted by
  circulating blood upon the walls of blood
  vessels, and is one of the principal vital signs.

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BLOOD PRESSURE AND PULSE PRESSURE

• Measurement of Arterial Blood Pressure
• sphygmomanometer

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BLOOD PRESSURE AND PULSE PRESSURE

• Measurement of Arterial Blood Pressure

• The patient may be either sitting or lying in the
  supine position. In some cases, the pressure may
  be quite different with changes in posture.
• The patient should have been resting for some
  time.

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BLOOD PRESSURE AND PULSE PRESSURE

• Bare the arm and affix the collapsed cuff snugly
  and smoothly, so the distal margin of the cuff is
  at least 3cm proximal to the antecubital fossa.
  Rest the arm on the table or bed with the
  antecubital fossa approximately at the level of
  the heart.

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BLOOD PRESSURE AND PULSE PRESSURE

• Palpate for the exact location of the brachial
  arterial pulse
• Place the end of the stethoscope on the elbow

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BLOOD PRESSURE AND PULSE PRESSURE

• Inflate the cuff using the inflation bulb until
  the flow of blood is cut off.
• Open the valve slightly so the pressure drops
  gradually while making observations by
  auscultation.

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BLOOD PRESSURE AND PULSE PRESSURE

• The pressure where the first sound was heard is
  the systolic pressure and the last sound heard is
  the diastolic pressure.

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BLOOD PRESSURE AND PULSE PRESSURE

• normal blood pressure
• Less than 140 mm Hg systolic pressure and
• Less than 90 mm Hg diastolic pressure
• Hypertession (high blood pressure)
• 140 mm Hg or greater systolic pressure or
• 90 mm Hg or greater diastolic pressure
• hypotenssion (low blood pressure)
• Systolic pressure less than 90 mm Hg or
• diastolic pressure less than 60 mm Hg

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ANTHROPOMORPHIC DATA
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HEIGHT
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HEIGHT

• Height development
• Linear growth infancy, childhood and
  adolescence
• Linear grow requires
• the presence of growth homone
• adequate nutrition
• a skeleton able to respond to these signals

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HEIGHT

• Height development
• mature height After achieving mature height,
  height should not change throughout the years of
  maturity into old age.
• Mature height is determined by
• genetic
• environmental factors, especially nutrition

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HEIGHT

• Height development
• loss of height with aging there is a
  hormone-independent loss of bone mineral density,
  leading to a slow and gradual loss of height.
  Addition of pathologic states such as
  osteoporosis and spinal compression fractures
  produce sometimes dramatic loss of height.

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HEIGHT

• Expected stature
• Expected stature can be estimated from
  standard scales or by adding 6.5cm(2.6 in )for
  boys and subtracting 6.5cm (2.6 in )for girls
  from the mid-parental height.

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HEIGHT

• standardized growth charts
• Growth is plotted on standardized growth
  charts, which give a rapid, visual indication of
  current stature and growth trends over time.

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HEIGHT

• standardized growth charts
• Height should be measured and recorded
  regularly as part of well child examinations
  throughout infancy and childhood. Once stable
  mature height is reached, it need not be measured
  more than once a year, or less, until the person
  reaches age 60. At this time, yearly measurement
  should be done.

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Short Stature
HEIGHT

• Short stature indicates a failure of growth
  hormone production, decreased tissue receptivity,
  or impaired nutrition.

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Excessive Height
HEIGHT

• Growth hormone accelerates linear bone growth at
  open epiphyses.
• Linear growth in excess of that predicted by
  parental height, especially if a significant
  deviation from the previous record, suggests an
  overproduction of growth hormone from a pituitary
  tumor, gigantism.

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HEIGHT
Loss of height long bone
length, Loss of cartirage in lower extremity
joints vertebral height
intervertebral disc spaces excessive spinal
curvatures.
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HEIGHT
Loss of Height

• A careful history and physical examination,
  combined with a minimum of radiographic
  investigation, can quikly identify the specific
  conditions affecting each individual patient.
• Unfortunately, unless height is measured
  regularly, the slow progression of height loss
  may go undetected until changes are severe and
  significant disability brings the patient to the
  physicians attention.

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WEIGHT
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WEIGHT

• Weight is recorded in pounds or kilograms,
  preferably without heavy clothing or shoes.
• 1 pound0.454 kilogram

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Body-Mass Index(BMI)
WEIGHT

• Did you know you had a BMI?
• Body mass index is a calculation that uses your
  height and weight to estimate how much body fat
  you have. Too much body fat is a problem because
  it can lead to illnesses and other health
  problems.
• The formulae universally used in medicine produce
  a unit of measure of kg/m2
• BMImass(kg)/height(m2)

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Body-Mass Index(BMI)
WEIGHT
lt 18.5 underweight
18.5 to 24.9 healthy
25 to 29.9 overweight
 30 to 34.9 grade 1 obesity
35 to 39.9 grade 2 obesity
gt40 grade 3 (morbid obesity)
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Body-Mass Index(BMI)
WEIGHT

• Growth charts using the body-mass index have been
  developed and are being used increasingly in
  well-child care. Calculation of BMI and setting
  weight loss goals based on the BMI are clinically
  useful. It allows patients to compare themselves
  with other individuals and the population risks
  associated with their current and target BMI.

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Weight Loss
WEIGHT

• adrenal insufficiency, diabetes.
• Idiopathic advanced age , any debilitating
  disease.
• any systemic inflammatory disease.
• Infectious
• maldigestion dieting, decreased intake and
  starvation.
• bowel obstruction, dental and chewing problems
• cancers
• Psychosocial dieting dementia, depression

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Weight Gain
WEIGHT

• Increased intake overeating, mild
  hyperthyroidism,
• Decreased metabolic demands hypothyroidism,
  inactivity,
• Salt and water retention congestive heart
  failure, kidney failure, nephrotic syndrome,
  hepatic insufficiency

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS

• Psychiatric and social disorders are common in
  medical settings. They are associated with an
  increased risk for nonpsychiatric illness and
  frequently confound the evaluation of patients
  presenting with nonspecific complaints .
• It is imperative to recognize that the presence
  of a psychiatric diagnosis in no way decreases
  the probability of serious organic disease in a
  patient with appropriate signs or symptoms.

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Perceptions

• Abnormal perceptions arising from primary injury
  to the sensory organs and their pathways are
  often negative or represent an exaggeration or
  distortion of the normal sensory signal.
• Abnormal perceptions arising in the processing
  centers and cortex are more often complex.

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Affect Mood

• Feelings are the way we react emotionally to the
  perceptions and events of our lives. Normally we
  have a range of feelings throughout the day and
  the intensity of our feelings may vary over time,
  from periods or relative intensity to periods of
  less intensity.
• Abnormal extremes of feelings, either in degree
  or duration, may indicate psychiatric disorders.

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Thinking

• Thinking is the process by which we connect and
  explain events to ourselves and others. It is a
  relational activity of great complexity.
• disorders may be manifest by verbal symptoms
  expressed by the patient or by abnormal behaviors
  resulting from the disordered thoughts.

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Memory

• AmnesiaAmnesia is a loss of memory. It can be
  retrograde for events of the past,or antegrade,
  the inability to form new memories.I t can be
  either global or selective for particular events
  or domains of memory.
• It is indicative of brain injury or psychological
  disorder.

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Abnormal Behaviors

• How we behave, our actions in private and public,
  is the result of how we feel, how we think, and
  how we perceive the constraints and rewards of
  the social environment.
• Behaviors which are consistently abnormal or
  unacceptable are indicative of personality or
  psychiatric disorders.

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THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL
EVALUATIONS
Thought Disorders

• Schizophrenia and Other Psychoses As the
  prototypical psychosis, schizophrenia is now
  considered to comprise a group of diseases that
  are probably etiologically distinct
• Primary psychotic disorders occur in adolescence
  or young adult life.
• Onset of psychotic symptoms at older ages should
  raise concern about organic brain disease, drug
  intoxication or withdrawal.
• Schizophrenia involves problems in thinking,
  affect, socializing, action, language, and
  perception.

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GAIT
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GAIT

• Gait is a complex activity requiring normal
  sensory input from the feet, spinal cord, and
  vestibular system, and normal motor and
  cerebellar function.
• Impairments in any of these systems leads to
  characteristic changes in the gait. Careful
  inspection of gait can greatly aid identification
  of the site of the lesion.

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GAIT

• The gait influenced by the rate, rhythm, and the
  character of the movements employed in walking.
  In assessing the neurologic contribution to gait,
  painful and restrictive conditions of the joints,
  muscles, and other structures must be excluded.

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GAIT

• Observe the patients usual gait in a
  well-lighted hallway.
• Note the posture of the head, neck and trunk,
  swing of each arm, leg swing, width of stance,
  size of steps
• Be sure to observe all three phases of gait
• touch down, which should occur with the lateral
  heel,
• stance which should be centered
• push-off which should come off the great toe.

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GAIT

• observe the turn for loss of balance or multiple
  small steps to get turned around.
• have the patient walk away from you on the toes,
  observing from behind, turn and walk toward you
  on the heels observing from the front. Note how
  far the heels and toes, respectively, are held
  off the ground.
• Examine the wear on the patients shoes, abnormal
  wear pattern is a good clue to disorders of the
  foot and gait.

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SKIN
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SKIN
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SKIN COLORATION
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SKIN COLORATION

• In human beings,the color of the normal skin
  results from a blend of four pigments
• melanin (brown), brown hues that come from
  melanin pigment
• Carotene (yellow), yellow hues that come from the
  nature color of nonvascularized collagen and from
  bile and carotene pigments
• Oxyhemoglobin (red), erythematous hues that
  come from oxygenated hemoglobin contained in the
  cutaneous vasculature
• reduced hemoglobin (bluish-red).

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SKIN COLORATION

• The amount of melanin is the determinant of the
  normal skin color.
• Melanin pigment lesions ly deep in the dermis

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Pallor
SKIN COLORATION

• Pallor is the lack of the normal red color
  imparted to the skin and mucous membranes by the
  blood in the superficial vessels.
• Inspection for generalized pallor is always
  supplemented by observing the color of the
  conjunctivae, the oral mucosa and palmar creases.
  
• Pallor can be produced by
• edema
• anemia

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Cyanosis
SKIN COLORATION

• Cyanosis is the blue color seen through the skin
  and mucous membranes
• when the reduced hemoglobin concentrations in
  capillary blood exceed 4.05.0g/dL,0.51.5g of
  methemoglobin, or 0.5g of sulfhemoglobin. The
  amount of oxyhemoglobin does not affect the color.

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Cyanosis
SKIN COLORATION

• Generalized cyanosis is seen in the lips, nail
  beds, ears, and malar regions.

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Cyanosis
SKIN COLORATION

• DDX(differential diagnosis)

• Local Cyanosis localized venous stasis or
  arterial obstructions, Raynaud phenomenon,
  extravasations of blood in superficial tissues.
• Central cyanosis Central cyanosis is often due
  to a circulatory or ventilatory problem that
  leads to poor blood oxygenation in the lungs.

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Changes in Skin Color
SKIN COLORATION

• Constitutive Diffuse Brown Skin
• Normal melanin pigmentation. This is the
  inherited constitutive skin color.
• Acquired Diffuse Brown Skin
• Melanism, hemochromatosis.
• Blue-grey Color
• Silver(argyria),
• Acquired Diffuse Yellow Skin
• Jaundice
• Carotenemia

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SKIN COLORATION

• Carotenemia
• The carotene surplus occurs
• (1) from excessive ingestion of the pigment in
  oranges, mangos, carrots, and all green
  vegetables.
• (2) when the liver fails to metabolize the
  carotene in myxedema and diabetes mellitus.
• Excessive deposition of carotene appears as
  yellowness of the skin, especially on the
  forehead, the nasolabial folds, behind the ears,
  and in the palms

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SKIN COLORATION
Jaundice
Carotenemia
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SKIN COLORATION

• Erythema
• Erythema is a diffuse reddening of the skin
  caused by dilation of the cutaneous
  vasculature. It is often accompanied by increased
  skin temperature. The borders are not discrete.
• Depigmentation
• Loss of normal skin pigmentation may be
  patchy or diffuse,usually with discrete
• Hyperpigmentation
• Increased melanin deposition in the skin can
  result from either local or systemic factors.

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SKIN MOISTURE
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SKIN MOISTURE

• 1.Dry skin
• Loss of adequate sebaceous and (or) sweat gland
  function lead to excessive drying of the skin.
• The skin is dry, often cracked and leathery in
  texture.

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SKIN MOISTURE

• 2.Decreased Skin Turgor
• Skin turgor is the skin's ability to change shape
  and return to normal.
• The turgor of the skin is decreased with losses
  of extracellular fluid volume. Loss of
  extracellular fluid leads to increased viscosity
  of the interstitial space fluid.
• Skin turgor is a sign commonly used by health
  care workers to assess the degree of fluid loss
  or dehydration. Dehydration can occur with
  vomiting, diarrhea, or fever.

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SKIN MOISTURE

• Evaluation of skin turgor

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SKIN MOISTURE

• 3.Decreased Skin Elasticity
• Destruction or disruption of the elastic fibers
  in the skin results in decreased elasticity.
  Decreased elasticity is evident wrinkling and
  redundancy of the skin.

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SKIN ERUPTION
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SKIN ERUPTION

• Macules
• These are localized changes in the skin color or
  appearance. But, by definition, they are not
  palpable. The areas may be small or large. They
  occur in many shapes and colors. There may be
  desquamation or scaling.

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SKIN ERUPTION

• Maculopapules
• These are macules with slightly elevated portions
  of the lesion.
• The term Maculopapular comes from two words
  macules meaning flat, small, non-elevated spots
  on the surface of the skin and papules meaning
  small, swollen bumps.

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SKIN ERUPTION

• Papules
• The lesions are solid and elevated. They are
  defined as less than 5mm in diameter. Their
  borders and tops may assume various forms.

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SKIN ERUPTION

• Plaques
• Because papules have a diameter of less than
  5mm,any elevated area of greater size is a
  plaque, usually formed from confluent papules.

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SKIN ERUPTION

• Nodules
• The lesions are solid and elevated. They are
  distinguished from papules by extending deeper
  into the dermis or even the subcutaneous tissue.
  They are usually greater than 5mm in diameter.

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SKIN ERUPTION

• Wheals
• Caused by edema of the skin, are edema areas in
  the epidemis and dermis. these areas are
  circumscribed, irregular, and relatively
  transient . Their color varies from red to pale,
  depending on the amount of fluid in the skin.

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SKIN ERUPTION

• Vesicles
• An accumulation of fluid in the superficial
  layers of the skin produces an elevation covered
  by a translucent epithelium that is easily
  punctured to release the fluid. By definition,
  their diameter is limited to less than 5mm.

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SKIN ERUPTION

• Bullae
• Accumulations of fluid between the layers of the
  skin that are larger than 5mm in diameter are
  bullae. If the layer of separation is deep to the
  epidermal basal layer, the bullous will be tense
  if it is superficial to the basal layer, it will
  be flaccid and more easily ruptured.

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SKIN ERUPTION

• Pustules
• Vesicles or bullae that become filled with pus
  and tiny abscesses in the skin are termed
  pustules.Through the translucent skin covering,
  their contents appear milky,orange,yellow,or
  green,depending somewhat on the infecting
  organisms.

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SKIN ERUPTION

• Vegetations
• Elevated irregular growths are called
  vegetations. When their covering is keratotic or
  dried, they are verrucous. When covered by normal
  epidermis, they are papillomatous.

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SKIN ERUPTION

• Scales
• Thin plates of partly separated dried cornified
  epithelium cling to the epidermis.

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SKIN ERUPTION

• Macules
• entirely flat
• Maculopapules
• macules with slightly elevated portions of the
  lesion.
• Papules
• solid and elevated. less than 5mm in diameter.
• Plaques
• greater size, confluent papules.
• Nodules
• deeper into the dermis. greater than 5mm in
  diameter.

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SKIN ERUPTION

• Wheals---edema areas in the epidemis and dermis
• Vesicles-- An accumulation of fluid in the
  superficial layers.
• diameter less than 5mm.
• Bullae-- Accumulations of fluid between the
  layers ,larger than
• 5mm in diameter.
• Pustules---Vesicles or bullae that filled with
  pus and tiny
• abscesses, milky, yellow,
• Vegetations---Elevated irregular growths.
  covering is keratotic
• or dried, they are
  verrucous. When covered by
• normal epidermis,
  they are papillomatous.
• .

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intradermal hemorrhage
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INTRADERMAL HEMORRHAGE
INTRADERMAL HEMORRHAGE

• Petechia a round, discrete hemorrhagic area
  less than 2mm in diameter. The bleeding causes
  the petechiae to appear red, brown or purple.
  Usually flat to the touch, petechiae don't lose
  color when you press on them.
• Ecchymosis a larger spot

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INTRADERMAL HEMORRHAGE
INTRADERMAL HEMORRHAGE

• Purpura when hemorrhages of either size occur in
  groups, the condition is termed Purpura. purpuric
  lesions may become confluent and they usually do
  not elevate the skin or mucosa.
• Hematoma is an area in which underlying
  hemorrhage causes elevation of the skin or
  mucosa(gt5mm)

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INTRADERMAL HEMORRHAGE

• Arterial Spider
• A telangiectatic arteriole in the skin having
  capillary branches that radiate from a central
  area in a manner similar to legs from the body of
  a spider. Also called arterial spider.

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INTRADERMAL HEMORRHAGE

• Arterial Spider
• Spiders occur commonly in the face and neck
  and,in diminishing order of frequency,on the
  shoulders,anterior onest,back,arms ,forearms,and
  dorsa of the hands and fingers rarely are they
  found below the umbilicus.

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INTRADERMAL HEMORRHAGE

• Arterial Spider
• Clinical Occurrence
• Occasionally ,in normal persons, hepatic disease,
  pregnancy (disappearing after delivery).

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INTRADERMAL HEMORRHAGE

• Palmar Erythema
• Palmar erythema is a reddening of the skin on the
  palmar aspect of the hands, usually over the
  hypothenar eminence. It may also involve the
  thenar eminence and fingers.
• Clinical occurrence
• Hepatic disease
• Pregnancy (disappearing
• after delivery),

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SCAR
SCAR

• Injury to epidermis can heal without scarring.
  but may leave alterations in pigmentation.
• Injury to the elastic and collagen fibers in the
  dermis results in scarring.
• Deeper injury to the subcutaneous fat and muscle
  can result in visible depressions or masses.
• All cutaneous scars are initially raised and
  red. They fade through pink to a pallid
  hypopigmented hue over months to years as the
  vascularity of the fibrous tissue diminishes.

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LYMPHATIC SYSTEM
109
LYMPHATIC SYSTEM

• EXAMINATION OF THE LYMPH NODES
• Enlarged nodes may be visible by inspection.
• Examination is primarily by palpation.

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EXAMINATION OF THE LYMPH NODES
LYMPHATIC SYSTEM

• Palpation
• Note six major qualities
• number
• size
• consistency
• Degree of tenderness
• mobility
• Whether they are discrete or matted together.

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LYMPHATIC SYSTEM

• Palpation of the Cervical Lymph Nodes
• Seat the patient in a chair stand behind the
  patient to palpate the neck with your fingertips.
  Examine, in sequence ,the various lymph node
  sites
• (1)submental, under the chin in the midline and
  on either side.
• (2)submandibular,under the jaw near its angle.
• (3)jugular, along the anterior border of the
  sternocleidomastoid.
• (4)supraclavicular,behind the midportion of the
  clavicle.
• (5)poststernocleidomastoid (posterior triangle),
  behind the posterior border of the upper half of
  the sternocleidomastoid.
• (6)postauricular,behind the pinna on the mastoid
  process.
• (7)preauricular,slightly in front of the tragus
  of the pinna.
• (8)suboccipital, in the midline under the occiput
  and to either side.
• (9)pretrapezius, in front of the upper border of
  the trapezius.

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EXAMINATION OF THE LYMPH NODES
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LYMPHATIC SYSTEM

• Palpation of Axillary Infraclavical and
  Supraclavicular Lumph Nodes
• The central group of nodes occurs near the middle
  of the thoracic wall of the axilla.
• The lateral axillary group is located near the
  upper part of the humerus and is beat
  dimonstrated by having the patients arm elevated
  so that you can feel along the axillary vein.
• the pectoral group with the patients arm
  elevated,feel along beneath the lateral edge of
  the pectoralis major muscle .
• the subscapular nodes Palpate the subscapular
  nodes from behind the patient with the arm
  raised,palpating with the left hand under the
  anterior edge of the latissimus dorsi muscle.
• the infraclavicular group Palpate under the
  clavicle for the infraclavicular group.
  Enlargement in the supraclavicular group is
  sought by feeling the soft tissues above and
  behind the clavicle.

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EXAMINATION OF THE LYMPH NODES
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LYMPHATIC SYSTEM

• Palpation of the lnguinal Nodes
• Palpate at and just below the inguinal ligament
  then distally along the course of the greater
  saphenous vein.

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INOCULATION LESION WITHREGIONAL LUMPHADENOPATHY
LYMPHATIC SYSTEM

• Cutaneous inoculation of infectious agents is
  followed by spread through the subcutaneous
  lymphatics,with varying degrees of inflammation
  and induration,to regional lymph nodes.The
  cutaneous inoculation site may show minimal signs
  or may be marked by local inflammation,ulceration,
  and/or necrosis with eschar formation.A careful
  history, including the time of year and
  occupational or avocational exposures,is
  essential to an accurate and timely diagnosis.

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Some questions for you

• What are the vital signs?
• How to calculate body mass index?
• When will cyanosis occur?

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Thank You !