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141 Cards in this Set

  • Front
  • Back
what are two defining characteristics of impaired gas exchange ie copd
CONFUSION AND RESTLENESS
what does shallow breathing do in regard to ventilation
shallow breathing lowers the lung volume
WITH INITIAL HYPOXIA...WHAT HAPPENS TO THE VITAL SIGNS
BP HR RESP ALL RISE
WHEN A PT HAS HYPOXIA AND RESPIRATIONS DECREASE,,,WHAT HAPPENS TO PACO2 LEVELS
THEY INCREASE
PTS WITH COPD SHOULD NOT RECEIVE ...
HIGH LEVELS OF O2
EXCESSIVE O2 LEVELS IN A COPD PT COULD RSULT IN
APNEA
AN INCENTIVE SPIROMETER REDUCES WHAT
ALVEOLAR COLLAPSE
HOW IS CYANOSIS BEST IDENTIFIED
MUCOS MEMBRANES OF THE EYES AND ORAL CAVITY
WHAT HAPPENS TO PULSE AND RESPIRATORY RATES DURING A FEVER
P RESP. WILL RISE DUE TO THE INCREASED METABOLIC RATE...ATTEMPTING TO PUMP OXYGENATED BLOOD TO THE TISSUES
A PT W/ SHOCK...WHAT HAPPENS TO RESPIRATIONS
INCREASE...TO MEET O2 NEEDS
WHAT IS APNEA
TEMPORARY CESATION OF BREATHING,,,PREVENTING OXYGENATION
WHY ARE HYPOXIC PTS RESTLESS
LACK OF O2 TO THE BRAIN
DEFINITION OF DYSPNEA
SEVERE SHORTNESS OF BREATH (SOB)
DEFINE PURSED LIP BREATHING
DEEP INSPIRATION AND LONG EXPIRATION
PURSED LIP BREATHING
YOUR LIPS BEING PURSED MAKES YOUR EXPIRATION LONGER BECAUSE LESS AIR IS LEAVING,,,THIS CAUSES POSITIVE AIR PRESSURE ...PREVENTING COLLAPSE OF THE AIRWAY
ONCE THE GOAL IS ACHIEVED ON AN INCENTIVE SPIROM.. HOW LONG SHOULD IT BE HELD
2-6 SECONDS
WHAT 2 MASKS COVER THE MOUTH
VENTURRI NONBREATHER
CLUBBING OF THE FINGERS AND TOES OCCURS WHEN
LONG TERM LACK OF O2
HOW LONG CAN THE BRAIN BE HYPOXIC B4 PERM DAMAGE OCCURS
3-5 MINS
DEFINE ORTHOPNEA
ONLY ABLE TO BREATH STANDING UP
MAX DIFFERENCE IN BP IN BOTH ARMS ON ASSESSMENT
10 MM HG MAX DIFFERENCE
PULSE OX CAN BE THE EARLIEST INDICATOR OF HYPOXEMIA
NOTE
DEFINE HYPOXEMIA
DECREASED O2 [ ] IN ARTERIAL BLOOD
WHAT IS THE NURSING DIAGNOSIS BASED ON
THE BEHAVIOR AND RESPONSE OF THE PT
NORMAL TEMP
36- 38 C

96.8 100.4
NORMAL PULSE RATE
60-100
NORMAL RESPIRATIONS
12-20
NORMAL BP
120/80
NORMAL PULSE PRESSURE
30-50 MMHG
WHAT DOES VASODILATION PROMOTE
HEAT LOSS
IN REGARDS TO VASO DILATION WHAT HAPPENS TO BP...WHY
BP WILL LOWER...MORE ROOM 4 THE BLOOD 2 FLOW
VASOCONSTRICTORSDO WHAT TO BP
INCREASE BP
SHIVERING INCREASE HEAT PRODUCTION
BY 4-5 X
DURING A FEVER, WHAT HAPPENS TO 02 CONSUMPTION
O2 CONSUMPTION INCREASES DURING A FEVER
DURING A FEVER..WHAT HAPPENS TO HEART RATE AND RESPIRATIONS
THEY INCREASE
DEFINE DYSRYTHMIA
AN IRREGULAR INTERRUPTION IN HEARTBEAT
DEFINE RESPIRATION
THE MECHANISM THE BODY USES TO XCHANGE GASES BTWN THE ATMOSPHERE AND THE BLOOD...AND THE BLOOD AND THE CELLS
DEFINE VENTILATION
the movement of gases in and out of the lungs
DEFINE DIFFUSION
THE MOVEMENT OF O2 AND C02 BTWN THE ALVEOLI AND THE RED BLOOD CELLS
DEFINE PERFUSION
THE DISTRIBUTION OF RED BLOOD CELLS TO AND FROM THE PULMONARY CAPILLARIES.
WHAT ARE THE (3 ) CRITEREIA USED TO ASSESS VENTILATION
1 DETERMINE RESP. RATE

2 DEPTH

3 RHYTHM
HOW IS DIFFUSION ASSESSED
DIFFUSION IS ASSESSED THROUGH O2 SATURATION
HOW IS DIFFUSION ASSESSED
DIFFUSION IS ASSESSED BY DETERMINING O2 SATURATION
WHAT IS THE MOST IMPORTANT FACTOR THAT CONTROLS VENTILATION
THE LEVEL OF C02 IN ARTERIAL BLOOD
IF A PT HAD AN ELEVATION IN C02 LEVEL... WHAT WOULD THE BRAIN ( RESP. CONTROL SYS) DO TO INTERVENE
THE BRAIN WOULD INCREASE THE RATE AND DEPTH OF BREATHING
what is the term used for excessive c02 levels
HYPERCARBIA
PT'S W/ HYPERCARBIA HAVE SEVERE REACTIONS TO WHAT
HIGH LEVELS OF 02 CAN BE FATAL TO THESE PT'S
WHY ARE PT'S WITH HYPERCARBIA ABLE TO BREATH
LOW LEVELS OF ARTERIAL O2 PROVIDE THE STIMULUS THAT ALLOWS THE PT TO BREATHE.
DEFINE HYPOXEMIA
LOW LEVELS OF ARTERIAL 02
WHAT IS THE TERM USED TO DESCRIBE THE NORMAL RATE AND DEPTH OF VENTILATION
EUPNEA (AKA QUIET BREATHING)
WHAT ARE THE THREE STEPS IN THE PROCESS OF OXYGENATION
VENTILATION
PERFUSION
DIFFUSION
DEFINE VENTILATION
THE PROCESS OF MOVING GASES INTO AND OUT OF THE LUNGS
DEFINE PERFUSION
THE CARDIOVASCULAR SYSTEM PUMPS OXYGENATED BLOOD TO THE TISSUES AND RETURNDS DEOXYGENATED BLOOD TO THE LUNGS
DEFINE DIFUSION
THE MOVEMENT OF MOLECULES FROM ONE AREA TO ANOTHER....FROM A HIGH [ ] TO A LOW [ ]
TERM USED TO DESCRIBE THE EASE OF LUNG INHALATION
COMPLIANCE
WHAT HAPPENS WITH DECREASED LUNG COMPLIANCE ( EASE)
MORE ENERGY IS SPENT--> THE BODY INCREASES METABOLIC RATE---> THE INCREASED METABOLIC RATE = THE NEED FOR MORE 02---> THEREFORE CO2 ELIMINATION INCREASES
WHAT IS THE MAIN FUNCTION OF PULMONARY CIRCULATION
TO MOVE BLOOD TO AND FROM THE ALVEOLI FOR GAS EXCHANGE
DEFINE EDEMA
AN ACCUMULATION OF FLUID IN THE ALVEOLI WHICH MAY BLOCK THE EXCHANGE OF 02 AND CO2 AND PRODUCE RESPIRATORY FAILURE
DEFINE EFFUSION
THE ESCAPE OF A FLUID
DEFINE EMPHYSEMA
AN INCREASE IN THE SIZE OF THE AIR SPACES OF THE LUNGS ...WHICH RESULTS IN LESS ELASTICITY OF THE LUNG
WHAT IS A SYMPTOM OF EMPHYSEMA
DIFICULTY BREATHING ...ESPECIALLY DURING EXHILATION
WHAT DOES C02 DIFUSE INTO
CO2 DIFUSES INTO RED BLOOD CELLS
WHEN DISCUSSING HYPERVENTILATION....WHAT HAPPENS TO C02 LEVELS IN THE BLOOD
CO2 LEVELS IN THE BLOOD DECREASE DURING HYPERVENTILATION
DEFINE HYPOCAPNIA
REDUCED LEVELS OF C02 IN THE BLOOD USUALLY CAUSED BY HYPERVENTILATION
ONE AFFECT OF HYPOCAPNIA WOULD BE
CEREBRAL VASOCONSTRICTION WHICH CAN LEAD TO CEREBRAL HYPOXIA
WHAT HAPPENS TO BREATHING DURING HYPOVENTILATION
THE "SLOW BREATHING" INCREASES C02 LEVELS
TERM FOR A LOWER THAN NORMAL HEMOGLOBIN LEVEL
ANEMIA
WHAT ARE THE SYMPTOMS OF ANEMIA
FATIGUE, DECREASED ACTIVITY, INCREASED BREATHLESNESS, AND PALLOR ESPECIALLY IN THE EYE
WHAT HAPPENS TO HR ON A PT W/ ANEMIA
HEART RATE INCREASES
DEFINE HYPO/ VOL/ EMIA
DECREASED BLOOD VOLUME
WHAT ARE TWO CAUSES OF HYPOVOLEMIA
SHOCK AND SEVERE DEHYDRATION
DEFINE HYPOVOLEMIA
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
WHAT WOULD THE ASSESSMENT FINDINGS BE FOR A PT WITH HYPOXEMIA
^ HR
^ DEPTH OF RESPIRATION
PURSED LIP BREATHING
DECREASED ACTIVITY TOLERANCE
WHAT WOULD THE ASSESSMENT FINDINGS BE FOR A PT W/ HYPERCAPNIA
^ HR
^ DEPTH OF RESPIRATION
PURSED LIP BREATHING
DECREASED ACTIVITY TOLERANCE
WHAT HAPPENS TO CARDIAC OUTPUT DURING TACHYDYSRHYTHMIAS
CARDIAC OUTPUT IS REDUCED BY DECREASING THE SYSTOLIC FILLING TIME
WHAT HAPPENS TO CARDIAC OUTPUT DURING BRADY DYSRHYTHMIAS
CARDIAC OUTPUT IS DECREASED BECAUSE OF DECREASED HR
WHAT CAUSES LT SIDED HEART FAILURE
IMPAIRED FUNCTIONING OF THE LT VENTRICLE
WHAT ARE THE ASSESSMENT FINDINGS FOR LT SIDED HEART FAILURE
DECREASED ACTIVITY TOLERANCE, BREATHLESNESS, DIZZY, AND CONFUSED
DESCRIBE CARDIAC OUTPUT IN LT SIDED HEART FAILURE
CARDIAC OUTPUT IS LOW WHICH RESULTS IN TISSUE HYPOXIA
RT SIDED HEART FAILURE IS CAUSED BY
RT VENTRICLE FAILURE
HOW IS RT SIDE HEART FAILURE CHARACTERIZED
RT SIDED HEART FAILURE IS CHARACTERIZED BY BY VENOUS CONGESTION IN THE SYSTEMIC CIRCULATORY SYSTEM.
WHAT IS THE PRIMARY FACTOR IN RT SIDED HEART FAILURE
ELEVATED PULMONARY VASCULAR RESISTANCE
TERM FOR "BLOCKED"
STENOSIS
TERM FOR " TO ENLARGE"
HYPERTROPHY
DEFINE ISCHEMIA
A TEMPORARY DEFICIENCY OF BLOOD FLOW FROM AN ORGAN OR TISSUE
DESCRIBE MYOCARDIAL ISCHEMIA
AN INADEQUATE SUPPLY OF BLOOD AND O2 TO MEET THE METABOLIC DEMANDS OF THE HEART MUSCLE
WHAT ARE THE TWO KINDS OF MYOCARDIAL ISCHEMIA
ANGINA PECTORIS\
MYOCARDIAL INFARCTTION
WHAT ARE THE SIGNS OF ANGINA PECTORIS
AN ACHING, SHARP, TINGILING, BURNING PAIN THAT FEELS LIKE PRESSURE
WHAT IS THE CAUSE OF ANGINA PECTORIS
INADEQUATE BLOOD FLOW AND OXYGENATION TO THE HEART MUSCLE
WHEN IS ANGINA PECTORIS MOST LIKELY TO OCCUR
USUALLY OCCURS AFTER EXCERCISE, ANXIETY OR STRESS
DEFINE MYOCARDIAL INFARCTION ( MI )
THE TERM myocardial infarction is derived from myocardium (the heart muscle) and infarction (tissue death due to oxygen starvation).
DEFINE NECROSIS
THE DEATH OF CELLS, TISSUES OR ORGANS DUE TO INSUFFICIENT BLOOD / O2 SUPPLY
MI
THE LOSS OF LIVING HEART MUSCLE -----> CAUSED BY SUDDEN DECREASES IN CORONARY BLOOD FLOW
WHAT ARE THE (2) FACTORS THAT CAUSE AN MI
ISCHEMIA ( REVERSIBLE)

NECROSIS ( NON- REVERSIBLE)
LIST THE SIGNS AND SYMPTOMS OF AN MI
A CRUSHING, STABBING PAIN THAT LASTS MORE THAN 30 MINUTES..THE PAIN IS NOT RELIEVED NY REST OR NITOGLYCERIN
WHAT ARE THE (3) ALTERATIONS IN RESPIRATORY FUNCTIONING
1 HYPERVENTILATION

2 HYPOVENTILATION

3 HYPOXIA
WHAT IS THE GOAL OF VENTILATION IN REGARD TO PACO2 LEVEL
35-45 MMHG
WHAT IS THE GOAL OF VENTILATION IN REGARD TO PA02 ARTERIAL OXYGEN TENSION
BTWN 95-100 MM HG
DEFINE HYPOXIA
A DECREASE IN THE ARTERIAL O2 LEVELS
DEFINE HYPERVENTILATION
EXCESSIVE RAPID, DEEP BREATHING ---> CAUSES TOO MUCH C02 EXHALATION

NOTE: BREATHING INTO A PAPER BAG IS NOT RECOMMENDED BY THE TEXT
HYPERVENTILATION AND FEVER
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
DESCRIBE RATE AND DEPTH OF BREATHING RELATED TO HYPOVENTILATION
REDUCED RATE AND DEPTH OF BREATHING WHY...AS ALVEOLAR VENTILATION ( EXCHANGE OF GAS IN THE ALVEOLI) DECREASES PAC02 IS ELEVATED
DEFINE ATELECTASIS
A COLLAPSE OF THE ALVEOLI IN THE LUNG
WHICH WOULD OCCUR IN THE CASE OF ATELECTASIS HYPO OR HYPER VENTILATION AND WHY
HYPOVENTILATION WOULD OCCUR...THE COLLAPSE OF THE ALVEOLI WOULD PREVENT THE EXCHANGE OF 02 AND CO2 WHICH PREVENTS THE LUNF FROM FULLY BEING VENTILATED
PT'S W/ COPD HAVE HIGH LEVELS OF WHAT IN THEIR SYSTEM
HIGH LEVELS OF CO2....AND DECREASED LEVELS OF 02
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
HYPOXIA
INADEQUATE TISSUE OXYGENATION AT THE CELLULAR LEVEL
WHAT ARE (2) POSSIBLE CAUSES OF HYPOXIA
INADEQUATE:DELIVERY OF O2,
USAGE OF 02
HYPOXIA AND PNEUMONIA
DECREASED DIFFUSION OF 02 FROM THE ALVEOLI TO THE BLOOD
HYPOXIA AND SHOCK
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).
WHAT ARE THE CLINICAL SIGNS OF HYPOXIA
APPREHENSION, RESTLENESS, INABILITY TO CONCENTRATE, DECLINING LEVEL OF CONSCIOUSNESS, UNABLE TO LIE DOWN ( RESTLESS) FATIGUED , AND AGITATED
A PT WITH HYPOXIA WOULD HAVE WHAT KIND OF PULSE, AND RATE AND DEPTH OF BREATHING
PULSE RATE AND RESPIRATIONS WOULD BE INCREASED ( RATE AND DEPTH OF RESP. ARE INCREASED)
WHY DOES A PT W/HYPOXIA SUFFER FROM CYANOSIS
THE BLUE DISCOLORATION OF THE SKIN IS CAUSED BY DESATURATED HEMOGLOBIN IN THE CAPILLARIES
WHAT DOES CENTRAL CYANOSIS INDICATE
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).
CYANOSIS IN THE PERIPHERALS IS AN INDICATION OF WHAT
COULD BE A SIGN OF VASOCONSTRICTION
OBESITY
INREASED METABOLIC DEMANDS = AN INCREASE IN THE DEMAND FOR 02
RESPIRATORY EXCURSION
THE MOVEMENT OF THE DIAPHRAM FROM ITS LEVEL DURING FULL EXHALATION ---TO ITS FULL LEVEL DURING FULL INHALATION
DEFINE ANEMIA
A REDUCTION IN THE MASS OF CIRCULATING RBC. ANEMIA IS NOT A DISEASE, RATHER A SYMPTOM OF OTHER ILLNESS
WHEN SMOKING, THE INHALED NICOTINE CAUSES
VASOCONSTRICTION OF PERIPHERAL AND CORONARY BLOOD VESSELS
WHAT DOES SMOKING DO TO BP
SMOKING CAUSES BP TO INCREASE ( DUE TO THE CONSTRICTION---LESS ROOM FOR THE BLOOD TO FLOW...HIGHER PRESSURE)
DEFINE DYSPNEA
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
THEMOST SENSITIVE AREA FOR COUGH PRODUCTION IS THE
CARINA
SPUTUM
CONTAINS MUCOS, CELLULAR DEBRIS, AND MICROORGANISMS, (MAY CONTAIN PUS OR BLOOD)
BRONCHITAS ( CHRONIC)
INFLAMMATION OF THE MUCOS MEMBRANES. CAUSED BY IRRITATION OR AN INFECTION
HEMOPTHYSIS
BLOODY SPUTUM
CLUBBED NAILS ARE SIGNS OF WHAT
PROLONGED O2 DEFICIENCY...THIS IS NOT AN EARLY INDICATOR
DEFINE PALPATION
AN EXAM OF THE EXTERNAL BODY W/ HANDS AND FINGERS
AT WHAT POINT DOES 02 NEED TO BE HUMIDIFIED
ANY PT RECEIVING MORE THAN 4L/MIN NEEDS TO BE HUMIDIFIED
HOW DOES HUMIDIFICATION ASSIST WITH PULMONARY SECRETIONS
02 WITH HIGH LEVELS OF RELATIVE HUMIDITY ASSISTS IN LOOSENING PULMONARY SECRETIONS
NEBULIZATION
THE PRODUCTION OF PARTICLES SUCH AS SPRAY( AEROSOL) OR MIST FROM LIQUID
SHOCK
INADEQUATE PERFUSION AND OXYGENATION OF CELLS TISSUES AND ORGANS
SHOCK
LOW BLOOD PRESSURE
HYPER/ EMIA
AN INCREASE IN BLOOD FLOW --- SKIN BECOMES WARM AND RED
AN ADAPTATION FOR SHOCK WOULD BE
LOW BP
HEART RATE FOR A PT IN SHOCK
INCREASED HR...LOW BP
DEFINING CHARACTERISTIC OF HYPOTHERMIA
MENTAL CONFUSION
PURULENT
CONTAINING PUS ( ie in sputum) THIS IS RELATED TO HYPOVENTILATION IMMOBILITY, AND INEFFECTIVE COUGHING
WHAT IS THE EXPECTED OUTCOME FOR AN INCENTIVE SPIROMETER
TO INCREASE INHALATION VOLUME
PALPATION OF ANY ARTERY IS KNOWN AS A
THRILL
DEFINE BRUIT
LISTENING TO THE JUGULAR VEIN W/ A STETHOSCOPE
DEPENDENT EDEMA
LOWER THAN THE HEART VENOUS RETURN IS POOR CAUSING THE LEGS TO SWELL