Palpate the node regions systematically — cervical, supraclavicular, axillary, and inguinal — noting size, tenderness, mobility, and whether soft or hard, matted or discrete.
Measure limb girth at consistent landmarks and compare the affected to the unaffected side and to prior measurements.
Inspect the skin for peau d’orange, fibrosis, and breakdown, and assess for pitting.
Look specifically for lymphangitic streaking, warmth, and tenderness and check for fever where infection is suspected.
Assess the at-risk limb for early increases in girth and for any break in the skin that could seed infection.
Check the compression garment or bandage for fit and wear and inspect the skin beneath it.
Distinguish a soft, mobile, tender node (often reactive) from a hard, fixed, matted, non-tender node (concerning), and compare to baseline.
For lymphangitis with systemic signs, escalate rather than continuing a full exam.
