Abnormal findings might be documented as: “Visible lymph nodes in the neck, hard, matted, and palpable cervical and supraclavicular lymph nodes on the right side, 3 cm.Normal findings might be documented as: “No lymph nodes palpable in the head and neck, no swelling, no asymmetry, no discolouration or increased temperature over lymph node locations, and no pain.”.If lymph nodes are visible or palpable, palpate the temperature over the lymph node areas of the head and neck using the dorsa of your hands, comparing bilaterally.If a lymph node is palpable, assess them as per Table 2 noted above.Normally, lymph nodes are not palpable, but remember that normal lymph nodes can sometimes be palpable in young children.For the supraclavicular nodes, you can ask the client to gently raise their shoulders. 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. 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. Recall to palpate nodes bilaterally at the same time: for example, assess the preauricular nodes on the left and right side at same time.Consider lymphatic drainage patterns (see Figure 9) this approach allows you to reflect on the origins of the cause when there is an abnormality. Palpate for lymph nodes using a systematic approach moving from proximal to distal thus moving from preauricular to supraclavicular area (see Figure 8, Table 3 and Video 1).Abnormal findings may include asymmetry and visible nodes due to swelling with erythema overlying the skin.Normally, the lymphatic areas are symmetrical between sides with no discolouration, swelling, or visible nodes. Inspect the lymph node areas on the head and neck (see Figure 8) for swelling, asymmetry, and erythema.Steps for assessing lymph nodes of the head and neck are as follows: Symmetry (is the node the same on both sides of the person’s body?) 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?) Node movability (can you move it around when you palpate it?) Node consistency, e.g., rubbery, hard, soft (what is the consistency of the node?) Node size (what is the size of the node?) Node location (where is the node located?) Presence of pain/tenderness (is the node painful or tender?) Skin changes over the node (what is the skin colour and temperature?) Presence of observable swelling (is the node swollen and observable upon inspection?) See Table 2 for what to note when assessing lymph nodes and abnormal characteristics. Conclude by asking the client if they had any pain or tenderness.Typically, you palpate bilaterally at the same time and compare the right side to the left side.This should be done about two to three times in each area. After you palpate in one spot, shift your fingers to a new spot within the same area, because there are strands of lymph nodes in each area.Use a light touch with gentle pressure so that you don’t forcefully push the node inwards.Use the finger pads of two to three fingers and move them in a circular motion.Prior to palpation, say to the client “let me know if you have any pain or tenderness when I touch you.”.Use the following techniques to palpate the lymph nodes: 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. NOTE: Lymph nodes are located in many areas of the body, some of which are not physically accessible.This assessment is often performed with the client sitting upright on the exam table to assess the lymph nodes in the head and neck, the upper arm, and the axillae, and then with the client repositioned into a supine position to assess the lymph nodes in the groin. Inspection and Palpation of the Lymph Nodes
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