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141 Cards in this Set
- Front
- Back
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what are two defining characteristics of impaired gas exchange ie copd
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CONFUSION AND RESTLENESS
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what does shallow breathing do in regard to ventilation
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shallow breathing lowers the lung volume
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WITH INITIAL HYPOXIA...WHAT HAPPENS TO THE VITAL SIGNS
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BP HR RESP ALL RISE
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WHEN A PT HAS HYPOXIA AND RESPIRATIONS DECREASE,,,WHAT HAPPENS TO PACO2 LEVELS
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THEY INCREASE
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PTS WITH COPD SHOULD NOT RECEIVE ...
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HIGH LEVELS OF O2
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EXCESSIVE O2 LEVELS IN A COPD PT COULD RSULT IN
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APNEA
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AN INCENTIVE SPIROMETER REDUCES WHAT
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ALVEOLAR COLLAPSE
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HOW IS CYANOSIS BEST IDENTIFIED
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MUCOS MEMBRANES OF THE EYES AND ORAL CAVITY
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WHAT HAPPENS TO PULSE AND RESPIRATORY RATES DURING A FEVER
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P RESP. WILL RISE DUE TO THE INCREASED METABOLIC RATE...ATTEMPTING TO PUMP OXYGENATED BLOOD TO THE TISSUES
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A PT W/ SHOCK...WHAT HAPPENS TO RESPIRATIONS
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INCREASE...TO MEET O2 NEEDS
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WHAT IS APNEA
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TEMPORARY CESATION OF BREATHING,,,PREVENTING OXYGENATION
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WHY ARE HYPOXIC PTS RESTLESS
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LACK OF O2 TO THE BRAIN
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DEFINITION OF DYSPNEA
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SEVERE SHORTNESS OF BREATH (SOB)
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DEFINE PURSED LIP BREATHING
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DEEP INSPIRATION AND LONG EXPIRATION
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PURSED LIP BREATHING
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YOUR LIPS BEING PURSED MAKES YOUR EXPIRATION LONGER BECAUSE LESS AIR IS LEAVING,,,THIS CAUSES POSITIVE AIR PRESSURE ...PREVENTING COLLAPSE OF THE AIRWAY
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ONCE THE GOAL IS ACHIEVED ON AN INCENTIVE SPIROM.. HOW LONG SHOULD IT BE HELD
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2-6 SECONDS
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WHAT 2 MASKS COVER THE MOUTH
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VENTURRI NONBREATHER
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CLUBBING OF THE FINGERS AND TOES OCCURS WHEN
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LONG TERM LACK OF O2
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HOW LONG CAN THE BRAIN BE HYPOXIC B4 PERM DAMAGE OCCURS
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3-5 MINS
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DEFINE ORTHOPNEA
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ONLY ABLE TO BREATH STANDING UP
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MAX DIFFERENCE IN BP IN BOTH ARMS ON ASSESSMENT
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10 MM HG MAX DIFFERENCE
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PULSE OX CAN BE THE EARLIEST INDICATOR OF HYPOXEMIA
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NOTE
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DEFINE HYPOXEMIA
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DECREASED O2 [ ] IN ARTERIAL BLOOD
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WHAT IS THE NURSING DIAGNOSIS BASED ON
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THE BEHAVIOR AND RESPONSE OF THE PT
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NORMAL TEMP
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36- 38 C
96.8 100.4 |
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NORMAL PULSE RATE
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60-100
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NORMAL RESPIRATIONS
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12-20
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NORMAL BP
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120/80
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NORMAL PULSE PRESSURE
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30-50 MMHG
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WHAT DOES VASODILATION PROMOTE
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HEAT LOSS
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IN REGARDS TO VASO DILATION WHAT HAPPENS TO BP...WHY
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BP WILL LOWER...MORE ROOM 4 THE BLOOD 2 FLOW
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VASOCONSTRICTORSDO WHAT TO BP
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INCREASE BP
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SHIVERING INCREASE HEAT PRODUCTION
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BY 4-5 X
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DURING A FEVER, WHAT HAPPENS TO 02 CONSUMPTION
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O2 CONSUMPTION INCREASES DURING A FEVER
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DURING A FEVER..WHAT HAPPENS TO HEART RATE AND RESPIRATIONS
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THEY INCREASE
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DEFINE DYSRYTHMIA
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AN IRREGULAR INTERRUPTION IN HEARTBEAT
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DEFINE RESPIRATION
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THE MECHANISM THE BODY USES TO XCHANGE GASES BTWN THE ATMOSPHERE AND THE BLOOD...AND THE BLOOD AND THE CELLS
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DEFINE VENTILATION
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the movement of gases in and out of the lungs
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DEFINE DIFFUSION
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THE MOVEMENT OF O2 AND C02 BTWN THE ALVEOLI AND THE RED BLOOD CELLS
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DEFINE PERFUSION
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THE DISTRIBUTION OF RED BLOOD CELLS TO AND FROM THE PULMONARY CAPILLARIES.
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WHAT ARE THE (3 ) CRITEREIA USED TO ASSESS VENTILATION
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1 DETERMINE RESP. RATE
2 DEPTH 3 RHYTHM |
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HOW IS DIFFUSION ASSESSED
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DIFFUSION IS ASSESSED THROUGH O2 SATURATION
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HOW IS DIFFUSION ASSESSED
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DIFFUSION IS ASSESSED BY DETERMINING O2 SATURATION
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WHAT IS THE MOST IMPORTANT FACTOR THAT CONTROLS VENTILATION
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THE LEVEL OF C02 IN ARTERIAL BLOOD
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IF A PT HAD AN ELEVATION IN C02 LEVEL... WHAT WOULD THE BRAIN ( RESP. CONTROL SYS) DO TO INTERVENE
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THE BRAIN WOULD INCREASE THE RATE AND DEPTH OF BREATHING
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what is the term used for excessive c02 levels
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HYPERCARBIA
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PT'S W/ HYPERCARBIA HAVE SEVERE REACTIONS TO WHAT
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HIGH LEVELS OF 02 CAN BE FATAL TO THESE PT'S
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WHY ARE PT'S WITH HYPERCARBIA ABLE TO BREATH
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LOW LEVELS OF ARTERIAL O2 PROVIDE THE STIMULUS THAT ALLOWS THE PT TO BREATHE.
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DEFINE HYPOXEMIA
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LOW LEVELS OF ARTERIAL 02
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WHAT IS THE TERM USED TO DESCRIBE THE NORMAL RATE AND DEPTH OF VENTILATION
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EUPNEA (AKA QUIET BREATHING)
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WHAT ARE THE THREE STEPS IN THE PROCESS OF OXYGENATION
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VENTILATION
PERFUSION DIFFUSION |
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DEFINE VENTILATION
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THE PROCESS OF MOVING GASES INTO AND OUT OF THE LUNGS
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DEFINE PERFUSION
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THE CARDIOVASCULAR SYSTEM PUMPS OXYGENATED BLOOD TO THE TISSUES AND RETURNDS DEOXYGENATED BLOOD TO THE LUNGS
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DEFINE DIFUSION
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THE MOVEMENT OF MOLECULES FROM ONE AREA TO ANOTHER....FROM A HIGH [ ] TO A LOW [ ]
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TERM USED TO DESCRIBE THE EASE OF LUNG INHALATION
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COMPLIANCE
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WHAT HAPPENS WITH DECREASED LUNG COMPLIANCE ( EASE)
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MORE ENERGY IS SPENT--> THE BODY INCREASES METABOLIC RATE---> THE INCREASED METABOLIC RATE = THE NEED FOR MORE 02---> THEREFORE CO2 ELIMINATION INCREASES
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WHAT IS THE MAIN FUNCTION OF PULMONARY CIRCULATION
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TO MOVE BLOOD TO AND FROM THE ALVEOLI FOR GAS EXCHANGE
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DEFINE EDEMA
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AN ACCUMULATION OF FLUID IN THE ALVEOLI WHICH MAY BLOCK THE EXCHANGE OF 02 AND CO2 AND PRODUCE RESPIRATORY FAILURE
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DEFINE EFFUSION
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THE ESCAPE OF A FLUID
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DEFINE EMPHYSEMA
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AN INCREASE IN THE SIZE OF THE AIR SPACES OF THE LUNGS ...WHICH RESULTS IN LESS ELASTICITY OF THE LUNG
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WHAT IS A SYMPTOM OF EMPHYSEMA
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DIFICULTY BREATHING ...ESPECIALLY DURING EXHILATION
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WHAT DOES C02 DIFUSE INTO
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CO2 DIFUSES INTO RED BLOOD CELLS
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WHEN DISCUSSING HYPERVENTILATION....WHAT HAPPENS TO C02 LEVELS IN THE BLOOD
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CO2 LEVELS IN THE BLOOD DECREASE DURING HYPERVENTILATION
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DEFINE HYPOCAPNIA
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REDUCED LEVELS OF C02 IN THE BLOOD USUALLY CAUSED BY HYPERVENTILATION
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ONE AFFECT OF HYPOCAPNIA WOULD BE
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CEREBRAL VASOCONSTRICTION WHICH CAN LEAD TO CEREBRAL HYPOXIA
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WHAT HAPPENS TO BREATHING DURING HYPOVENTILATION
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THE "SLOW BREATHING" INCREASES C02 LEVELS
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TERM FOR A LOWER THAN NORMAL HEMOGLOBIN LEVEL
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ANEMIA
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WHAT ARE THE SYMPTOMS OF ANEMIA
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FATIGUE, DECREASED ACTIVITY, INCREASED BREATHLESNESS, AND PALLOR ESPECIALLY IN THE EYE
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WHAT HAPPENS TO HR ON A PT W/ ANEMIA
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HEART RATE INCREASES
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DEFINE HYPO/ VOL/ EMIA
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DECREASED BLOOD VOLUME
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WHAT ARE TWO CAUSES OF HYPOVOLEMIA
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SHOCK AND SEVERE DEHYDRATION
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DEFINE HYPOVOLEMIA
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WHEN YOU LOSE THESE FLUIDS AND YOUR CIRCULATING BLOOD VOLUME DECREASES...THE BODY INCREASES HR,,,INCREASES VASOCONSTRICTION WHICH INCREASES THE AMT OF BLOOD RETURNED TO THE HEART ...WHICH INCREASES CARDIAC OUTPUT
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WHAT WOULD THE ASSESSMENT FINDINGS BE FOR A PT WITH HYPOXEMIA
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^ HR
^ DEPTH OF RESPIRATION PURSED LIP BREATHING DECREASED ACTIVITY TOLERANCE |
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WHAT WOULD THE ASSESSMENT FINDINGS BE FOR A PT W/ HYPERCAPNIA
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^ HR
^ DEPTH OF RESPIRATION PURSED LIP BREATHING DECREASED ACTIVITY TOLERANCE |
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WHAT HAPPENS TO CARDIAC OUTPUT DURING TACHYDYSRHYTHMIAS
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CARDIAC OUTPUT IS REDUCED BY DECREASING THE SYSTOLIC FILLING TIME
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WHAT HAPPENS TO CARDIAC OUTPUT DURING BRADY DYSRHYTHMIAS
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CARDIAC OUTPUT IS DECREASED BECAUSE OF DECREASED HR
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WHAT CAUSES LT SIDED HEART FAILURE
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IMPAIRED FUNCTIONING OF THE LT VENTRICLE
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WHAT ARE THE ASSESSMENT FINDINGS FOR LT SIDED HEART FAILURE
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DECREASED ACTIVITY TOLERANCE, BREATHLESNESS, DIZZY, AND CONFUSED
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DESCRIBE CARDIAC OUTPUT IN LT SIDED HEART FAILURE
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CARDIAC OUTPUT IS LOW WHICH RESULTS IN TISSUE HYPOXIA
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RT SIDED HEART FAILURE IS CAUSED BY
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RT VENTRICLE FAILURE
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HOW IS RT SIDE HEART FAILURE CHARACTERIZED
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RT SIDED HEART FAILURE IS CHARACTERIZED BY BY VENOUS CONGESTION IN THE SYSTEMIC CIRCULATORY SYSTEM.
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WHAT IS THE PRIMARY FACTOR IN RT SIDED HEART FAILURE
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ELEVATED PULMONARY VASCULAR RESISTANCE
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TERM FOR "BLOCKED"
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STENOSIS
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TERM FOR " TO ENLARGE"
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HYPERTROPHY
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DEFINE ISCHEMIA
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A TEMPORARY DEFICIENCY OF BLOOD FLOW FROM AN ORGAN OR TISSUE
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DESCRIBE MYOCARDIAL ISCHEMIA
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AN INADEQUATE SUPPLY OF BLOOD AND O2 TO MEET THE METABOLIC DEMANDS OF THE HEART MUSCLE
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WHAT ARE THE TWO KINDS OF MYOCARDIAL ISCHEMIA
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ANGINA PECTORIS\
MYOCARDIAL INFARCTTION |
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WHAT ARE THE SIGNS OF ANGINA PECTORIS
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AN ACHING, SHARP, TINGILING, BURNING PAIN THAT FEELS LIKE PRESSURE
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WHAT IS THE CAUSE OF ANGINA PECTORIS
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INADEQUATE BLOOD FLOW AND OXYGENATION TO THE HEART MUSCLE
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WHEN IS ANGINA PECTORIS MOST LIKELY TO OCCUR
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USUALLY OCCURS AFTER EXCERCISE, ANXIETY OR STRESS
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DEFINE MYOCARDIAL INFARCTION ( MI )
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THE TERM myocardial infarction is derived from myocardium (the heart muscle) and infarction (tissue death due to oxygen starvation).
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DEFINE NECROSIS
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THE DEATH OF CELLS, TISSUES OR ORGANS DUE TO INSUFFICIENT BLOOD / O2 SUPPLY
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MI
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THE LOSS OF LIVING HEART MUSCLE -----> CAUSED BY SUDDEN DECREASES IN CORONARY BLOOD FLOW
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WHAT ARE THE (2) FACTORS THAT CAUSE AN MI
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ISCHEMIA ( REVERSIBLE)
NECROSIS ( NON- REVERSIBLE) |
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LIST THE SIGNS AND SYMPTOMS OF AN MI
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A CRUSHING, STABBING PAIN THAT LASTS MORE THAN 30 MINUTES..THE PAIN IS NOT RELIEVED NY REST OR NITOGLYCERIN
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WHAT ARE THE (3) ALTERATIONS IN RESPIRATORY FUNCTIONING
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1 HYPERVENTILATION
2 HYPOVENTILATION 3 HYPOXIA |
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WHAT IS THE GOAL OF VENTILATION IN REGARD TO PACO2 LEVEL
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35-45 MMHG
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WHAT IS THE GOAL OF VENTILATION IN REGARD TO PA02 ARTERIAL OXYGEN TENSION
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BTWN 95-100 MM HG
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DEFINE HYPOXIA
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A DECREASE IN THE ARTERIAL O2 LEVELS
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DEFINE HYPERVENTILATION
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EXCESSIVE RAPID, DEEP BREATHING ---> CAUSES TOO MUCH C02 EXHALATION
NOTE: BREATHING INTO A PAPER BAG IS NOT RECOMMENDED BY THE TEXT |
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HYPERVENTILATION AND FEVER
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A FEVER INCREASE THE METABOLIC RATE.
A FEVER IS ASSOCIATED WITH AN INCREASE IN CO2 PRODUCTION ( DUE TO ABOVE) A FEVER IS ASSOCIATED WITH ^ RATE AND DEPTH OF RESPIRATION |
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DESCRIBE RATE AND DEPTH OF BREATHING RELATED TO HYPOVENTILATION
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REDUCED RATE AND DEPTH OF BREATHING WHY...AS ALVEOLAR VENTILATION ( EXCHANGE OF GAS IN THE ALVEOLI) DECREASES PAC02 IS ELEVATED
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DEFINE ATELECTASIS
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A COLLAPSE OF THE ALVEOLI IN THE LUNG
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WHICH WOULD OCCUR IN THE CASE OF ATELECTASIS HYPO OR HYPER VENTILATION AND WHY
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HYPOVENTILATION WOULD OCCUR...THE COLLAPSE OF THE ALVEOLI WOULD PREVENT THE EXCHANGE OF 02 AND CO2 WHICH PREVENTS THE LUNF FROM FULLY BEING VENTILATED
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PT'S W/ COPD HAVE HIGH LEVELS OF WHAT IN THEIR SYSTEM
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HIGH LEVELS OF CO2....AND DECREASED LEVELS OF 02
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ADMINISTERING HIGH LEVELS OF O2 TO A PT W/ COPD ( CHRONIC OBSTUCTIVE PULMONARY DISEASE) CAUSE THE PT TO
HYPERVENTILATE OR HYPOVENTILATE |
HYPOVENTILATION OCCURS...THE ADMINISTRATION OF HIGH LEVELS OF O2 OBLITERATE THE STIMULUS TO BREATHE CAUSING HYPOVENTILATION...THIS LEADS TO EXCESSIVE RETENTION OF CO2 AND COULD EVENTUALLY LEAD TO RESPIRATORY ARREST
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HYPOXIA
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INADEQUATE TISSUE OXYGENATION AT THE CELLULAR LEVEL
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WHAT ARE (2) POSSIBLE CAUSES OF HYPOXIA
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INADEQUATE:DELIVERY OF O2,
USAGE OF 02 |
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HYPOXIA AND PNEUMONIA
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DECREASED DIFFUSION OF 02 FROM THE ALVEOLI TO THE BLOOD
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HYPOXIA AND SHOCK
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POOR TISSUE PERFUSION(WITH OXYGENATED BLOOD )In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue).
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WHAT ARE THE CLINICAL SIGNS OF HYPOXIA
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APPREHENSION, RESTLENESS, INABILITY TO CONCENTRATE, DECLINING LEVEL OF CONSCIOUSNESS, UNABLE TO LIE DOWN ( RESTLESS) FATIGUED , AND AGITATED
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A PT WITH HYPOXIA WOULD HAVE WHAT KIND OF PULSE, AND RATE AND DEPTH OF BREATHING
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PULSE RATE AND RESPIRATIONS WOULD BE INCREASED ( RATE AND DEPTH OF RESP. ARE INCREASED)
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WHY DOES A PT W/HYPOXIA SUFFER FROM CYANOSIS
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THE BLUE DISCOLORATION OF THE SKIN IS CAUSED BY DESATURATED HEMOGLOBIN IN THE CAPILLARIES
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WHAT DOES CENTRAL CYANOSIS INDICATE
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Central cyanosis...
Central cyanosis suggests a circulatory or ventilatory problem that leads to poorer blood oxygenation in the lungs or greater oxygen extraction due to slowing down of blood circulation in the skin's blood vessels. Acute cyanosis can be a result of asphyxiation or choking, and is one of the surest signs that respiration is being blocked. The elementary principle behind cyanosis is that deoxygenated hemoglobin produces the bluish discoloration, and also produces vasoconstriction that makes it more evident. Thus oxygen deficiency - hypoxia - leads to blue discoloration of the lips and other mucus membranes CENTRAL CYANOSIS INDICATES HYPOXEMIA Hypoxemia (or hypoxaemia) is an abnormally low partial pressure of oxygen (PO2) in arterial blood (West J. "Pulmonary Pathophysiology: The Essentials" p22). A frequent error is to use the term hypoxemia to mean low oxygen content in arterial blood. It is possible to have a low oxygen content (eg due to anemia) but a high PO2 so incorrect use can lead to confusion. Hypoxemia is different from hypoxia as that is an abnormally low oxygen availability to the body or an individual tissue or organ. The type of hypoxia that is caused by hypoxaemia is referred to as hypoxemic hypoxia. Because of the frequent incorrect use of hypoxemia, this is sometimes erroneously stated as hypoxic hypoxia. [edit] Causes Causes are classified into 5 groups: Low inspired fractional concentration of oxygen (low FiO2) Alveolar hypoventilation Impairment of diffusion across blood-gas membrane Shunt Ventilation-perfusion inequality Conditions that result in hypoxemia act via one or more of these primary causes. [edit] Low inspired oxygen fraction (low FiO2) See also: FiO2 If the concentration of oxygen in the inspired gas is low, then a reduced amount of oxygen is delivered to the gas exchanging parts (alveoli) of the lung each minute. This can result in hypoxemia even if the lungs are normal. It is the inspired oxygen concentration that is important rather than the atmospheric concentration as the person may not be breathing atmospheric gas (eg during an anesthetic). [edit] Alveolar hypoventilation If the alveolar ventilation is low, there may be insufficient oxygen delivered to the alveoli each minute. This can cause hypoxemia even if the lungs are normal, as the cause may be outside the lungs (eg airway obstruction, depression of the brain's respiratory center, or muscular weakness). [edit] Impaired diffusion Impaired diffusion across the blood-gas membrane in the lung can cause hypoxaemia. However this is a very rare cause as it is only in extremely unusual circumstances that actually does cause a problem. Most of the past cases once thought to be due to a diffusion problem are now recognised as being due to ventilation-perfusion inequality. [edit] Shunt Shunt of blood from the right side to the left side of the circulation (right-to-left shunt) is a powerful cause of hypoxaemia. The shunt may be intracardiac or may be intrapulmonary. This cause can be readily distinguished from the others as it is the only cause that cannot be corrected by the administration of 100% oxygen. [edit] Ventilation-perfusion inequality Ventilation-perfusion inequality (or ventilation perfusion mismatch) is a common cause of hypoxaemia in people with lung disease. It is the areas of the lung with V/Q ratios that are less than one (but not zero) that cause hypoxaemia by this mechanism. (A V/Q ratio of zero is actually shunt so does not contribute to this cause). |
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CYANOSIS IN THE PERIPHERALS IS AN INDICATION OF WHAT
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COULD BE A SIGN OF VASOCONSTRICTION
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OBESITY
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INREASED METABOLIC DEMANDS = AN INCREASE IN THE DEMAND FOR 02
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RESPIRATORY EXCURSION
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THE MOVEMENT OF THE DIAPHRAM FROM ITS LEVEL DURING FULL EXHALATION ---TO ITS FULL LEVEL DURING FULL INHALATION
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DEFINE ANEMIA
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A REDUCTION IN THE MASS OF CIRCULATING RBC. ANEMIA IS NOT A DISEASE, RATHER A SYMPTOM OF OTHER ILLNESS
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WHEN SMOKING, THE INHALED NICOTINE CAUSES
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VASOCONSTRICTION OF PERIPHERAL AND CORONARY BLOOD VESSELS
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WHAT DOES SMOKING DO TO BP
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SMOKING CAUSES BP TO INCREASE ( DUE TO THE CONSTRICTION---LESS ROOM FOR THE BLOOD TO FLOW...HIGHER PRESSURE)
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DEFINE DYSPNEA
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BREATHLESSNESS, COULD BE A SIGN OF HYPOXIA. DIFFICULT OR UNCOMFORTABLE BREATHING.USUALLY ASSOCIATED W/ EXCERCISE, EXCITEMENT, OR PULMONARY DISEASE, CARDIOVASCULAR DISEASE, AND PREGNANT. AN EXAGGERATED RESPIRATORY EFFORT
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THEMOST SENSITIVE AREA FOR COUGH PRODUCTION IS THE
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CARINA
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SPUTUM
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CONTAINS MUCOS, CELLULAR DEBRIS, AND MICROORGANISMS, (MAY CONTAIN PUS OR BLOOD)
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BRONCHITAS ( CHRONIC)
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INFLAMMATION OF THE MUCOS MEMBRANES. CAUSED BY IRRITATION OR AN INFECTION
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HEMOPTHYSIS
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BLOODY SPUTUM
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CLUBBED NAILS ARE SIGNS OF WHAT
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PROLONGED O2 DEFICIENCY...THIS IS NOT AN EARLY INDICATOR
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DEFINE PALPATION
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AN EXAM OF THE EXTERNAL BODY W/ HANDS AND FINGERS
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AT WHAT POINT DOES 02 NEED TO BE HUMIDIFIED
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ANY PT RECEIVING MORE THAN 4L/MIN NEEDS TO BE HUMIDIFIED
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HOW DOES HUMIDIFICATION ASSIST WITH PULMONARY SECRETIONS
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02 WITH HIGH LEVELS OF RELATIVE HUMIDITY ASSISTS IN LOOSENING PULMONARY SECRETIONS
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NEBULIZATION
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THE PRODUCTION OF PARTICLES SUCH AS SPRAY( AEROSOL) OR MIST FROM LIQUID
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SHOCK
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INADEQUATE PERFUSION AND OXYGENATION OF CELLS TISSUES AND ORGANS
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SHOCK
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LOW BLOOD PRESSURE
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HYPER/ EMIA
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AN INCREASE IN BLOOD FLOW --- SKIN BECOMES WARM AND RED
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AN ADAPTATION FOR SHOCK WOULD BE
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LOW BP
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HEART RATE FOR A PT IN SHOCK
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INCREASED HR...LOW BP
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DEFINING CHARACTERISTIC OF HYPOTHERMIA
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MENTAL CONFUSION
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PURULENT
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CONTAINING PUS ( ie in sputum) THIS IS RELATED TO HYPOVENTILATION IMMOBILITY, AND INEFFECTIVE COUGHING
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WHAT IS THE EXPECTED OUTCOME FOR AN INCENTIVE SPIROMETER
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TO INCREASE INHALATION VOLUME
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PALPATION OF ANY ARTERY IS KNOWN AS A
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THRILL
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DEFINE BRUIT
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LISTENING TO THE JUGULAR VEIN W/ A STETHOSCOPE
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DEPENDENT EDEMA
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LOWER THAN THE HEART VENOUS RETURN IS POOR CAUSING THE LEGS TO SWELL
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