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