{"id":1236,"date":"2022-12-01T14:36:22","date_gmt":"2022-12-01T19:36:22","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-and-palpation-of-the-lymph-nodes\/"},"modified":"2024-11-11T09:50:37","modified_gmt":"2024-11-11T14:50:37","slug":"inspection-and-palpation-of-the-lymph-nodes","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/inspection-and-palpation-of-the-lymph-nodes\/","title":{"raw":"Inspection and Palpation of the Lymph Nodes","rendered":"Inspection and Palpation of the Lymph Nodes"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">This assessment is often performed with the client sitting <strong>upright on the exam table<\/strong> to assess the lymph nodes in the head and neck, the upper arm, and the axillae, and then with the client <strong>repositioned into a supine position<\/strong> to assess the lymph nodes in the groin.\u00a0<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">NOTE: Lymph nodes are located in many areas of the body, some of which are not physically accessible. Although some of the axilla lymph nodes are associated with the breast, other lymph nodes associated with the breast will be explored in another chapter.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Use the following <strong>techniques<\/strong> to palpate the lymph nodes:<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Prior to palpation, say to the client \u201clet me know if you have any pain or tenderness when I touch you.\u201d\u00a0<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Use the <strong>finger pads<\/strong> of two to three fingers and move them in a circular motion.\u00a0<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Use a<strong> light touch<\/strong> with gentle pressure so that you don\u2019t forcefully push the node inwards.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">After you palpate in one spot, <strong>shift your fingers<\/strong> to a new spot within the same area, because there are strands of lymph nodes in each area. This should be done about two to three times in each area.\u00a0<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Typically, you palpate bilaterally at the same time and compare the right side to the left side.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Conclude by asking the client if they had any pain or tenderness.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">See<strong> Table 2<\/strong> for what to note when assessing lymph nodes and abnormal characteristics.\u00a0<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Table 2<\/strong>: Lymph node assessment.<\/span><\/p>\r\n\r\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%\" border=\"0\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 100%\">\r\n<ul>\r\n \t<li>\r\n<p class=\"no-indent\" style=\"text-align: left\"><span style=\"color: #000000\">Presence of observable swelling (is the node swollen and observable upon inspection?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Skin changes over the node (what is the skin colour and temperature?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Presence of pain\/tenderness (is the node painful or tender?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Node location (where is the node located?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Node size (what is the size of the node?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Node consistency, e.g., rubbery, hard, soft (what is the consistency of the node?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Node movability (can you move it around when you palpate it?)<\/span><\/p>\r\n<\/li>\r\n \t<li style=\"text-align: left\">\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Node delimitation (what are the limits or the boundaries of the node in terms of whether it is an individual node or a cluster of nodes matted together?)<\/span><\/p>\r\n<\/li>\r\n \t<li>\r\n<p class=\"no-indent\" style=\"text-align: left\"><span style=\"color: #000000\">Symmetry (is the node the same on both sides of the person\u2019s body?)<\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2><span style=\"color: #000000\">Lymph Nodes of Head and Neck<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Steps for assessing<strong> lymph nodes<\/strong> of the <strong>head and neck<\/strong> are as follows:<\/span><\/p>\r\n\r\n<ol>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspect the lymph node areas<\/strong> on the head and neck (see <strong>Figure 8<\/strong>) for swelling, asymmetry, and erythema.\u00a0<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the lymphatic areas are symmetrical between sides with no discolouration, swelling, or visible nodes.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin.\r\n<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Palpate for lymph nodes<\/strong> using a systematic approach moving from proximal to distal; thus moving from preauricular to supraclavicular area (see<strong> Figure 8<\/strong>,<strong> Table 3<\/strong> and <strong>Video 1<\/strong>). Consider lymphatic drainage patterns (see <strong>Figure 9<\/strong>); this approach allows you to reflect on the origins of the cause when there is an abnormality. <\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Recall to palpate nodes bilaterally at the same time: for example, assess the preauricular nodes on the left and right side at same time. However, for the submental lymph nodes, you should use the fingers of your dominant hand to palpate just under the chin behind the bony prominence. When assessing the deep cervical chain on clients with a muscular neck, you may ask the client to tip their head toward the side you are assessing to relax the sternomastoid muscle; thus, you will need to do one side at a time. For the supraclavicular nodes, you can ask the client to gently raise their shoulders.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, lymph nodes are not palpable, but remember that normal lymph nodes can sometimes be palpable in young children.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">If a lymph node is palpable, assess them as per <strong>Table 2 <\/strong>noted above.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">If lymph nodes are visible or palpable, <strong>palpate the temperature<\/strong> over the lymph node areas of the head and neck using the dorsa of your hands, comparing bilaterally.\u00a0<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:\u00a0<\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo lymph nodes palpable in the head and neck, no swelling, no asymmetry, no discolouration or increased temperature over lymph node locations, and no pain.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cVisible lymph nodes in the neck, hard, matted, and palpable cervical and supraclavicular lymph nodes on the right side, 3 cm. Client indicates they are tender.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Neck-numbered-scaled-1.jpg\" alt=\"Lymph node areas numbered in order on the read and neck from the preauricular to the supraclavicular.\" class=\"aligncenter wp-image-926\" width=\"354\" height=\"446\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 8<\/strong>: Lymph node areas on head and neck<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Table 3<\/strong>: Lymph node locations on the head and neck.<\/span><\/p>\r\n\r\n<table class=\"grid\" style=\"height: 521px\" width=\"825\">\r\n<tbody>\r\n<tr class=\"shaded\" style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Name<\/strong><\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Location<\/strong><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">1 Preauricular<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Anterior to the tragus of the ear.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">2 Posterior auricular<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Along the mastoid process.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">3 Occipital<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Inferior to the occipital bone and on the lateral side of the occipital bone.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">4 Submental<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Under the chin behind the bony prominence.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">5 Submandibular<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Halfway between the submental nodes and the angle of the jaw.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">6 Tonsillar<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Inferior to the angle of the jaw.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">7 Superficial cervical chain<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Along the sternomastoid muscle at the top, just below the mastoid process.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">8 Deep cervical chain<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Further down the sternomastoid muscle.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">9 Posterior cervical chain<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Behind the sternomastoid muscle.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"height: 30px;width: 200.333px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">10 Supraclavicular<\/span><\/p>\r\n<\/td>\r\n<td style=\"height: 30px;width: 596.733px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Superior to the clavicles.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/1.-drainage-patterns-scaled-1.jpg\" alt=\"Lymph node drainage areas identified with green arrows on the head and neck.\" class=\"aligncenter wp-image-945\" width=\"589\" height=\"332\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 9<\/strong>: Lymphatic drainage of head and neck lymph nodes.<\/span><\/p>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/wqWzt0nt4D0[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 1<\/strong>: Palpation of head and neck lymph nodes. [0.58 seconds].<\/span>\r\n<div><\/div>\r\n<h2><span style=\"color: #000000\">Lymph Nodes of Upper Arm and Axillary Area<\/span><\/h2>\r\n<span style=\"color: #000000\">Steps for assessing <strong>lymph nodes<\/strong> of the<strong> upper arm and axillary<\/strong> area:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\">Inspect the area surrounding the upper arm where the epitrochlear lymph nodes are located (see <strong>Figure 10<\/strong>-the area under the finger tips is where you should inspect which is superior and behind the medial epicondyle <span>of the humerus<\/span>) and inspect the axillae where the axillary lymph nodes are located (see<strong> Figure 11<\/strong>).<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the lymphatic areas are symmetrical on each side with no discolouration, swelling, or visible nodes.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin. If a lymph node is palpable, assess it for abnormal characteristics (<strong>Table 2<\/strong>).<\/span><\/li>\r\n \t<li style=\"list-style-type: none\"><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-168x300.png\" alt=\"Shows where the nurse's fingers should be placed superior and behind the medial epicondyle.\" width=\"368\" height=\"657\" class=\"aligncenter wp-image-1231\" \/><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 10<\/strong>: Epitrochlear lymph node area.<\/span><\/p>\r\n<p style=\"text-align: center\"><img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-labeled-1-225x300.jpg\" alt=\"Five lymph node areas identified in the axillary.\" class=\"aligncenter wp-image-1232\" width=\"386\" height=\"515\" \/><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 11<\/strong>: Axillary lymph node area.<\/span><\/p>\r\n\r\n<ol start=\"2\">\r\n \t<li style=\"text-align: left\"><strong style=\"color: #000000;font-size: 1em\">Palpate the epitrochlear (Video 2) and axillary lymph nodes<\/strong><span style=\"color: #000000;font-size: 1em\"> (<\/span><strong style=\"color: #000000;font-size: 1em\">Video 3<\/strong><span style=\"color: #000000;font-size: 1em\"><span style=\"color: #000000;font-size: 1em\"><span style=\"color: #000000;font-size: 1em\">). Prior to palpation, say to the client \u201clet me know if you have any pain or tenderness when I touch you.\u201d <\/span><\/span><\/span><span style=\"color: #000000\"><span style=\"color: #000000\"><span style=\"color: #000000\">For the<strong> epitrochlear lymph nodes<\/strong>: Ask the client to place their forearm on the bedside table with the palm facing up and palpate in a gentle circular motion in about two to three locations just superior to and behind the medial epicondyle of the humerus (about 1\u20132 cm). <\/span><\/span><\/span><span style=\"color: #000000\">For the <strong>axillary lymph nodes<\/strong>: Ask the client to raise their arm and rest their hand on the back of their head. Use a gentle circular motion to palpate. Begin in the axilla: palpate in one row high in the axilla, then palpate in three rows away from the axillae along the upper arm, then three rows away from the axillae down the chest wall, and then in one row medially (see <strong>Figure 12<\/strong>\u00a0for pattern). For each row, palpate about three to four locations.<\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normally, there are no palpable lymph nodes.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">If a lymph node is palpable, assess them as per <strong>Table 2<\/strong> and pay attention to the drainage patterns noted in <strong>Figure 13<\/strong>. It is important to recognize that a large amount of the lymph from the breast drains into the anterior axillary nodes, lymph from the back drains into the posterior axillary nodes, and lymph from the arm drains into the lateral nodes. Additionally, this lymph drains into the central nodes to the apical nodes to the supraclavicular and then, often returns to the vascular system through the subclavian vein via the [pb_glossary id=\"1374\"]thoracic duct[\/pb_glossary].<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/lymph-node-palpation-pattern-axilla-new-225x300.jpg\" alt=\"Lymph node pattern identified related to the axillary lymph nodes.\" class=\"aligncenter wp-image-1233\" width=\"379\" height=\"505\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 12<\/strong>: Axillary lymph node palpation pattern.<\/span><\/p>\r\n&nbsp;\r\n<p style=\"text-align: center\"><img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-3-drain-1-225x300.jpg\" alt=\"Lymph node drainage pattern areas identified with green arrows in the axillary area.\" class=\"alignnone wp-image-1234\" width=\"441\" height=\"588\" \/><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 13<\/strong>: Lymphatic drainage of axillary lymph nodes.<\/span><\/p>\r\n&nbsp;\r\n<ol start=\"3\">\r\n \t<li><span style=\"color: #000000;font-size: 1em\">If lymph nodes are visible or palpable,<\/span><strong style=\"color: #000000;font-size: 1em\"> palpate the temperature<\/strong><span style=\"color: #000000;font-size: 1em\"> over the lymph node areas of the axillary and epitrochlear areas using the dorsa of your hands comparing side to side.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, there is no increase in temperature.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><span style=\"color: #000000\">Some abnormal lymph nodes will have increased localized skin temperature overlying the node.<\/span><\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\"><span style=\"font-size: 1em\">Note the <\/span><strong style=\"font-size: 1em\">findings<\/strong><span style=\"font-size: 1em\">:<\/span>\r\n<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo lymph nodes palpable in the upper arm or axillae, no swelling, no asymmetry, no discolouration and no increased temperature over lymph node locations, and no pain reported by the client.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cHard, matted and palpable lymph nodes on the left axillary side. Tenderness reported by the client.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n[embed]https:\/\/youtu.be\/2JsprgOLEZI[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 2<\/strong>: Palpation of the epitrochlear lymph nodes (showing technique on right arm) [0:25]<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/Rj8MS2c0was[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 3<\/strong>: Palpation of the axillary lymph nodes (showing technique on right side) [1:05]<\/span>\r\n<h2><span style=\"color: #000000\">Lymph Nodes of the Groin<\/span><\/h2>\r\n<span style=\"color: #000000\">Steps for assessing <strong>lymph nodes<\/strong> in the <strong>groin<\/strong> area:<\/span>\r\n<ol>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspect and palpate the groin area<\/strong> for the<strong> inguinal lymph nodes<\/strong>. Assist the client into supine position and provide a drape. Briefly expose one side to inspect and palpate, and then repeat on the other side. Prior to palpation, say to the client \u201clet me know if you have any pain or tenderness when I touch you.\u201d Palpate about four to five times in the groin area (<strong>Figure 14<\/strong>). If nodes are palpable, assess for temperature (comparing bilaterally)<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the lymphatic areas are symmetrical on each side with no discolouration, swelling, or visible or palpable nodes.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin. If a lymph node is palpable, assess it for abnormal characteristics (<strong>Table 2<\/strong>).\r\n<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo lymph nodes palpable in the groin, no swelling, asymmetry, discolouration or increased temperature over lymph node locations, and no pain reported.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cPalpable, soft right-sided inguinal lymph node. Tenderness reported by the client.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-300x214.jpg\" alt=\"Lymph node areas identified with green ovals in the groin area.\" class=\"aligncenter wp-image-1235\" width=\"446\" height=\"318\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 14<\/strong>: Inguinal lymph node area.<\/span><\/p>\r\n\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"color: #000000\">Lymph nodes with abnormal characteristics require further investigation and should be reported to the physician or nurse practitioner. Depending on the client, you may ask about whether they have been recently unwell or have noted any other concerns in the affected area (pain, itching, rashes). You might also ask whether they shave or have had a recent cat scratch or bite. Lymph node swelling can be associated with certain infections such as skin and yeast infections, sexually transmitted infections, and eye, ear, and throat infections. In rare situations, it can also be associated with cancer, particularly when accompanied by other symptoms such as fatigue, unexplained weight loss, persistent fever, fainting, breathing issues, and if the lymph nodes have continued to enlarge with no obvious signs of infection.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n<p style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/p>\r\n<span style=\"color: #000000\">The lymphatic system undergoes changes as a person ages; the lymphatic vessels become thinner and the lymph nodes atrophy. As a result, older people may have more difficulty fighting infection and are more prone to lymphedema.<\/span>\r\n\r\n<span style=\"color: #000000\">Always use a trauma-informed approach, particularly when assessing the inguinal lymph nodes due to their location. Explain what you are doing and why, ask permission to touch, provide a drape, and ask if the client would like someone present (a friend, family member, or another healthcare provider).<\/span>\r\n\r\n<\/div>\r\n<h2>Activity: Check Your Understanding<\/h2>\r\n[h5p id=\"100\"]","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">This assessment is often performed with the client sitting <strong>upright on the exam table<\/strong> to assess the lymph nodes in the head and neck, the upper arm, and the axillae, and then with the client <strong>repositioned into a supine position<\/strong> to assess the lymph nodes in the groin.\u00a0<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">NOTE: Lymph nodes are located in many areas of the body, some of which are not physically accessible. Although some of the axilla lymph nodes are associated with the breast, other lymph nodes associated with the breast will be explored in another chapter.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Use the following <strong>techniques<\/strong> to palpate the lymph nodes:<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Prior to palpation, say to the client \u201clet me know if you have any pain or tenderness when I touch you.\u201d\u00a0<\/span><\/li>\n<li><span style=\"color: #000000\">Use the <strong>finger pads<\/strong> of two to three fingers and move them in a circular motion.\u00a0<\/span><\/li>\n<li><span style=\"color: #000000\">Use a<strong> light touch<\/strong> with gentle pressure so that you don\u2019t forcefully push the node inwards.<\/span><\/li>\n<li><span style=\"color: #000000\">After you palpate in one spot, <strong>shift your fingers<\/strong> to a new spot within the same area, because there are strands of lymph nodes in each area. This should be done about two to three times in each area.\u00a0<\/span><\/li>\n<li><span style=\"color: #000000\">Typically, you palpate bilaterally at the same time and compare the right side to the left side.<\/span><\/li>\n<li><span style=\"color: #000000\">Conclude by asking the client if they had any pain or tenderness.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">See<strong> Table 2<\/strong> for what to note when assessing lymph nodes and abnormal characteristics.\u00a0<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Table 2<\/strong>: Lymph node assessment.<\/span><\/p>\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 100%\">\n<ul>\n<li>\n<p class=\"no-indent\" style=\"text-align: left\"><span style=\"color: #000000\">Presence of observable swelling (is the node swollen and observable upon inspection?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Skin changes over the node (what is the skin colour and temperature?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Presence of pain\/tenderness (is the node painful or tender?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Node location (where is the node located?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Node size (what is the size of the node?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Node consistency, e.g., rubbery, hard, soft (what is the consistency of the node?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Node movability (can you move it around when you palpate it?)<\/span><\/p>\n<\/li>\n<li style=\"text-align: left\">\n<p class=\"no-indent\"><span style=\"color: #000000\">Node delimitation (what are the limits or the boundaries of the node in terms of whether it is an individual node or a cluster of nodes matted together?)<\/span><\/p>\n<\/li>\n<li>\n<p class=\"no-indent\" style=\"text-align: left\"><span style=\"color: #000000\">Symmetry (is the node the same on both sides of the person\u2019s body?)<\/span><\/p>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><span style=\"color: #000000\">Lymph Nodes of Head and Neck<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Steps for assessing<strong> lymph nodes<\/strong> of the <strong>head and neck<\/strong> are as follows:<\/span><\/p>\n<ol>\n<li style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspect the lymph node areas<\/strong> on the head and neck (see <strong>Figure 8<\/strong>) for swelling, asymmetry, and erythema.\u00a0<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, the lymphatic areas are symmetrical between sides with no discolouration, swelling, or visible nodes.<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin.<br \/>\n<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\"><strong>Palpate for lymph nodes<\/strong> using a systematic approach moving from proximal to distal; thus moving from preauricular to supraclavicular area (see<strong> Figure 8<\/strong>,<strong> Table 3<\/strong> and <strong>Video 1<\/strong>). Consider lymphatic drainage patterns (see <strong>Figure 9<\/strong>); this approach allows you to reflect on the origins of the cause when there is an abnormality. <\/span>\n<ul>\n<li><span style=\"color: #000000\">Recall to palpate nodes bilaterally at the same time: for example, assess the preauricular nodes on the left and right side at same time. However, for the submental lymph nodes, you should use the fingers of your dominant hand to palpate just under the chin behind the bony prominence. When assessing the deep cervical chain on clients with a muscular neck, you may ask the client to tip their head toward the side you are assessing to relax the sternomastoid muscle; thus, you will need to do one side at a time. For the supraclavicular nodes, you can ask the client to gently raise their shoulders.<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, lymph nodes are not palpable, but remember that normal lymph nodes can sometimes be palpable in young children.<\/span><\/li>\n<li><span style=\"color: #000000\">If a lymph node is palpable, assess them as per <strong>Table 2 <\/strong>noted above.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">If lymph nodes are visible or palpable, <strong>palpate the temperature<\/strong> over the lymph node areas of the head and neck using the dorsa of your hands, comparing bilaterally.\u00a0<\/span><\/li>\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:\u00a0<\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo lymph nodes palpable in the head and neck, no swelling, no asymmetry, no discolouration or increased temperature over lymph node locations, and no pain.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cVisible lymph nodes in the neck, hard, matted, and palpable cervical and supraclavicular lymph nodes on the right side, 3 cm. Client indicates they are tender.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2022\/12\/Neck-numbered-scaled-1.jpg\" alt=\"Lymph node areas numbered in order on the read and neck from the preauricular to the supraclavicular.\" class=\"aligncenter wp-image-926\" width=\"354\" height=\"446\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 8<\/strong>: Lymph node areas on head and neck<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Table 3<\/strong>: Lymph node locations on the head and neck.<\/span><\/p>\n<table class=\"grid\" style=\"height: 521px; width: 825px;\">\n<tbody>\n<tr class=\"shaded\" style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Name<\/strong><\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Location<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">1 Preauricular<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Anterior to the tragus of the ear.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">2 Posterior auricular<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Along the mastoid process.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">3 Occipital<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Inferior to the occipital bone and on the lateral side of the occipital bone.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">4 Submental<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Under the chin behind the bony prominence.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">5 Submandibular<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Halfway between the submental nodes and the angle of the jaw.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">6 Tonsillar<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Inferior to the angle of the jaw.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">7 Superficial cervical chain<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Along the sternomastoid muscle at the top, just below the mastoid process.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">8 Deep cervical chain<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Further down the sternomastoid muscle.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">9 Posterior cervical chain<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Behind the sternomastoid muscle.<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"height: 30px;width: 200.333px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">10 Supraclavicular<\/span><\/p>\n<\/td>\n<td style=\"height: 30px;width: 596.733px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Superior to the clavicles.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/1.-drainage-patterns-scaled-1.jpg\" alt=\"Lymph node drainage areas identified with green arrows on the head and neck.\" class=\"aligncenter wp-image-945\" width=\"589\" height=\"332\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 9<\/strong>: Lymphatic drainage of head and neck lymph nodes.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Palpation of Head and Neck Lymph Nodes.\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/wqWzt0nt4D0?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 1<\/strong>: Palpation of head and neck lymph nodes. [0.58 seconds].<\/span><\/p>\n<div><\/div>\n<h2><span style=\"color: #000000\">Lymph Nodes of Upper Arm and Axillary Area<\/span><\/h2>\n<p><span style=\"color: #000000\">Steps for assessing <strong>lymph nodes<\/strong> of the<strong> upper arm and axillary<\/strong> area:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\">Inspect the area surrounding the upper arm where the epitrochlear lymph nodes are located (see <strong>Figure 10<\/strong>-the area under the finger tips is where you should inspect which is superior and behind the medial epicondyle <span>of the humerus<\/span>) and inspect the axillae where the axillary lymph nodes are located (see<strong> Figure 11<\/strong>).<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normally, the lymphatic areas are symmetrical on each side with no discolouration, swelling, or visible nodes.<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin. If a lymph node is palpable, assess it for abnormal characteristics (<strong>Table 2<\/strong>).<\/span><\/li>\n<li style=\"list-style-type: none\"><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: left\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-168x300.png\" alt=\"Shows where the nurse's fingers should be placed superior and behind the medial epicondyle.\" width=\"368\" height=\"657\" class=\"aligncenter wp-image-1231\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-168x300.png 168w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-573x1024.png 573w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-768x1372.png 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-860x1536.png 860w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-1146x2048.png 1146w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-65x116.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-225x402.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node-350x625.png 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Figure-10-epitrochlear-lymph-node.png 1208w\" sizes=\"auto, (max-width: 368px) 100vw, 368px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 10<\/strong>: Epitrochlear lymph node area.<\/span><\/p>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-labeled-1-225x300.jpg\" alt=\"Five lymph node areas identified in the axillary.\" class=\"aligncenter wp-image-1232\" width=\"386\" height=\"515\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-labeled-1-225x300.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-labeled-1-65x87.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-labeled-1-350x466.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-labeled-1.jpg 619w\" sizes=\"auto, (max-width: 386px) 100vw, 386px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 11<\/strong>: Axillary lymph node area.<\/span><\/p>\n<ol start=\"2\">\n<li style=\"text-align: left\"><strong style=\"color: #000000;font-size: 1em\">Palpate the epitrochlear (Video 2) and axillary lymph nodes<\/strong><span style=\"color: #000000;font-size: 1em\"> (<\/span><strong style=\"color: #000000;font-size: 1em\">Video 3<\/strong><span style=\"color: #000000;font-size: 1em\"><span style=\"color: #000000;font-size: 1em\"><span style=\"color: #000000;font-size: 1em\">). Prior to palpation, say to the client \u201clet me know if you have any pain or tenderness when I touch you.\u201d <\/span><\/span><\/span><span style=\"color: #000000\"><span style=\"color: #000000\"><span style=\"color: #000000\">For the<strong> epitrochlear lymph nodes<\/strong>: Ask the client to place their forearm on the bedside table with the palm facing up and palpate in a gentle circular motion in about two to three locations just superior to and behind the medial epicondyle of the humerus (about 1\u20132 cm). <\/span><\/span><\/span><span style=\"color: #000000\">For the <strong>axillary lymph nodes<\/strong>: Ask the client to raise their arm and rest their hand on the back of their head. Use a gentle circular motion to palpate. Begin in the axilla: palpate in one row high in the axilla, then palpate in three rows away from the axillae along the upper arm, then three rows away from the axillae down the chest wall, and then in one row medially (see <strong>Figure 12<\/strong>\u00a0for pattern). For each row, palpate about three to four locations.<\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normally, there are no palpable lymph nodes.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">If a lymph node is palpable, assess them as per <strong>Table 2<\/strong> and pay attention to the drainage patterns noted in <strong>Figure 13<\/strong>. It is important to recognize that a large amount of the lymph from the breast drains into the anterior axillary nodes, lymph from the back drains into the posterior axillary nodes, and lymph from the arm drains into the lateral nodes. Additionally, this lymph drains into the central nodes to the apical nodes to the supraclavicular and then, often returns to the vascular system through the subclavian vein via the <button class=\"glossary-term\" aria-describedby=\"1236-1374\">thoracic duct<\/button>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/lymph-node-palpation-pattern-axilla-new-225x300.jpg\" alt=\"Lymph node pattern identified related to the axillary lymph nodes.\" class=\"aligncenter wp-image-1233\" width=\"379\" height=\"505\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/lymph-node-palpation-pattern-axilla-new-225x300.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/lymph-node-palpation-pattern-axilla-new-65x87.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/lymph-node-palpation-pattern-axilla-new-350x466.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/lymph-node-palpation-pattern-axilla-new.jpg 614w\" sizes=\"auto, (max-width: 379px) 100vw, 379px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 12<\/strong>: Axillary lymph node palpation pattern.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-3-drain-1-225x300.jpg\" alt=\"Lymph node drainage pattern areas identified with green arrows in the axillary area.\" class=\"alignnone wp-image-1234\" width=\"441\" height=\"588\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-3-drain-1-225x300.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-3-drain-1-65x87.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-3-drain-1-350x467.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/Axilla-3-drain-1.jpg 612w\" sizes=\"auto, (max-width: 441px) 100vw, 441px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 13<\/strong>: Lymphatic drainage of axillary lymph nodes.<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"3\">\n<li><span style=\"color: #000000;font-size: 1em\">If lymph nodes are visible or palpable,<\/span><strong style=\"color: #000000;font-size: 1em\"> palpate the temperature<\/strong><span style=\"color: #000000;font-size: 1em\"> over the lymph node areas of the axillary and epitrochlear areas using the dorsa of your hands comparing side to side.<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, there is no increase in temperature.<\/span><\/li>\n<li><span style=\"color: #000000\"><span style=\"color: #000000\">Some abnormal lymph nodes will have increased localized skin temperature overlying the node.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\"><span style=\"font-size: 1em\">Note the <\/span><strong style=\"font-size: 1em\">findings<\/strong><span style=\"font-size: 1em\">:<\/span><br \/>\n<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo lymph nodes palpable in the upper arm or axillae, no swelling, no asymmetry, no discolouration and no increased temperature over lymph node locations, and no pain reported by the client.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cHard, matted and palpable lymph nodes on the left axillary side. Tenderness reported by the client.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Palpation of the Epitrochlear Lymph Nodes - Lymphatic System Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/2JsprgOLEZI?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 2<\/strong>: Palpation of the epitrochlear lymph nodes (showing technique on right arm) [0:25]<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-3\" title=\"Palpation of the Axillary Lymph Nodes - Lymphatic System Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/Rj8MS2c0was?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 3<\/strong>: Palpation of the axillary lymph nodes (showing technique on right side) [1:05]<\/span><\/p>\n<h2><span style=\"color: #000000\">Lymph Nodes of the Groin<\/span><\/h2>\n<p><span style=\"color: #000000\">Steps for assessing <strong>lymph nodes<\/strong> in the <strong>groin<\/strong> area:<\/span><\/p>\n<ol>\n<li style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspect and palpate the groin area<\/strong> for the<strong> inguinal lymph nodes<\/strong>. Assist the client into supine position and provide a drape. Briefly expose one side to inspect and palpate, and then repeat on the other side. Prior to palpation, say to the client \u201clet me know if you have any pain or tenderness when I touch you.\u201d Palpate about four to five times in the groin area (<strong>Figure 14<\/strong>). If nodes are palpable, assess for temperature (comparing bilaterally)<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, the lymphatic areas are symmetrical on each side with no discolouration, swelling, or visible or palpable nodes.<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin. If a lymph node is palpable, assess it for abnormal characteristics (<strong>Table 2<\/strong>).<br \/>\n<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cNo lymph nodes palpable in the groin, no swelling, asymmetry, discolouration or increased temperature over lymph node locations, and no pain reported.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cPalpable, soft right-sided inguinal lymph node. Tenderness reported by the client.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-300x214.jpg\" alt=\"Lymph node areas identified with green ovals in the groin area.\" class=\"aligncenter wp-image-1235\" width=\"446\" height=\"318\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-300x214.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-768x547.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-65x46.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-225x160.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new-350x249.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/inguinal-new.jpg 804w\" sizes=\"auto, (max-width: 446px) 100vw, 446px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 14<\/strong>: Inguinal lymph node area.<\/span><\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"color: #000000\">Lymph nodes with abnormal characteristics require further investigation and should be reported to the physician or nurse practitioner. Depending on the client, you may ask about whether they have been recently unwell or have noted any other concerns in the affected area (pain, itching, rashes). You might also ask whether they shave or have had a recent cat scratch or bite. Lymph node swelling can be associated with certain infections such as skin and yeast infections, sexually transmitted infections, and eye, ear, and throat infections. In rare situations, it can also be associated with cancer, particularly when accompanied by other symptoms such as fatigue, unexplained weight loss, persistent fever, fainting, breathing issues, and if the lymph nodes have continued to enlarge with no obvious signs of infection.<\/span><\/p>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/p>\n<p><span style=\"color: #000000\">The lymphatic system undergoes changes as a person ages; the lymphatic vessels become thinner and the lymph nodes atrophy. As a result, older people may have more difficulty fighting infection and are more prone to lymphedema.<\/span><\/p>\n<p><span style=\"color: #000000\">Always use a trauma-informed approach, particularly when assessing the inguinal lymph nodes due to their location. Explain what you are doing and why, ask permission to touch, provide a drape, and ask if the client would like someone present (a friend, family member, or another healthcare provider).<\/span><\/p>\n<\/div>\n<h2>Activity: Check Your Understanding<\/h2>\n<div id=\"h5p-100\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-100\" class=\"h5p-iframe\" data-content-id=\"100\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Lymphatics: Inspection and Palpation of the Lymph Nodes\"><\/iframe><\/div>\n<\/div>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"1236-1374\" hidden><p>is the largest lymphatic vessel in the body that returns lymph to the vasculature.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[85],"license":[56],"class_list":["post-1236","chapter","type-chapter","status-publish","hentry","contributor-january-2023","license-cc-by-nc"],"part":1211,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":9,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1236\/revisions"}],"predecessor-version":[{"id":3562,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1236\/revisions\/3562"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1211"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1236\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=1236"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=1236"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=1236"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=1236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}