Page 421 - Critical Care Nursing Demystified

406 CRITICAL CARE NURSING DeMYSTIFIED

Check the patient’s oral cavity. Is the tongue large, smooth, and beefy red?
Is the mouth inflamed? Both of these conditions can be seen in iron-deficiency
anemias. Is there easy bleeding of the mucous membranes? Are there white,
patchy areas that can be invasion of the mucous membranes by thrush in a
patient with low white cell counts?
Can you see an enlarged spleen or liver? Examine the lymph nodes for swell-
ing; you will be palpating these areas next.

Palpation

Palpate the patient’s peripheral pulses. Thrombus formation can cause dimin-
ished blood flow to the extremities, but a pulse should be present. Is there
peripheral edema; is it pitting or nonpitting?
Lymph nodes can be palpated for signs of infection or an immune disorder.
They are usually palpated from head to groin and include cervical, subman-
dibular, axillary, and inguinal (see Figure 9–1). As you gently palpate these nodes
note if they are hard, firm, soft, or freely moveable. Also note if they are painful
or tender. Enlarged, hard, inflamed nodes could indicate infection or tumor. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Submandibular

Cervical

Lymph
node Axillary

Inguinal

FIGURE 9–1 • Location of lymph nodes.