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dam93732_ch18.qxd 12/7/05 6:57 AM Page 501 F indings from physical assessment of the peripheral vascular and lymphatic systems include normal and abnormal pulses (see Table 18.2 Table 18.2) and common alterations of the peripheral vascular and lymphatic systems as shown in Figures 18.25 through 18.31. Normal and Abnormal Pulses NAME OF PULSE C H A R AC T E R I S T I C S A RT E R I A L WAV E F O R M PAT T E R N Normal • Regular, even in intensity • Normal Absent • No palpable pulse, no waveform • Arterial line disconnected • Cardiac arrest Weak/thready • Intensity of pulse is 1 • May wax and wane • May be difficult to find • Shock • Severe peripheral vascular disease Bounding • Intensity of pulse is 4 • Very easy to observe in arterial locations near surface of skin • Very easy to palpate and difficult to obliterate with pressure from fingerrips • Hyperdynamic states such as seen with hyperthyroidism, exercise, anxiety, vasodilation seen in high cardiac output syndromes • May be due to normal aging secondary to arterial wall stiffening • Aortic regurgitation • Anemia Biferiens • Has two systolic peaks with a dip in between • Easier to detect in the carotid location • In the case of hypertrophic obstructive cardiomyopathy only one systolic peak palpated, but waveform demonstrates double systolic peak • Aortic regurgitation • Combination of aortic regurgitation and stenosis • Hypertrophic obstructive cardiomyopathy Pulsus Alternans • Alternating strong and weak pulses • Equal interval between each pulse • Aortic regurgitation • Terminal left ventricular heart failure • Systemic hypertension Pulsus Bigeminus • Alternating strong and weak pulses, but the weak pulse comes in early after the strong pulse • Regular bigeminal dysrhythmias such as PVCs and PACs Pulsus Paradoxus • Reduced intensity of pulse during inspiration versus expiration Expiration Inspiration Water-hammer, Corrigan’s Pulse • Rapid systolic upstroke and no dicrotic notch secondary to rapid Unequal • Difference in intensity or amplitude between right and left pulses CONTRIBUTING CONDITIONS • • • • Cardiac tamponade Acute pulmonary embolus Pericarditis May be present in clients with chronic lung disease • Hypovolemic shock • Pregnancy • Aortic regurgitation Right femoral • Dissecting aneurysm (location of aneurysm determines where the difference in amplitude is felt) Left femoral ©2007 Pearson Education, Inc.
