This action might not be possible to undo. Are you sure you want to continue?
Respiratory System Overview of Anatomy and Physiology
HUMIDIFY AND FILTER INHALED AIR • HELP MAKE SOUND AND SEND AIR TO LOWER AIRWAYS . LARYNGOPHARYNX) • LARYNX • WARM. OROPHARYNX.OXYGENATON: the dynamic interaction of gases in the body for the purpose of delivering adequate oxygen essential for cellular survival RESPIRATORY SYSTEM MAIN FUNCTION: GAS EXCHANGE STRUCTURES AND FUNCTIONS UPPER AIRWAYS • NOSE • PHARYNX (NASOPHARYNX.
FURTHER DIVIDES INTO 3 LOBAR BRANCHES LEFT MAINSTEM BRONCHUS: DIVIDES INTO UPPER AND LOWER LOBAR BRONCHI LUNGS MAIN ORGANS OF RESPIRATION BASE: BROAD AREA RESTING ON THE DIAPHRAGM APEX: NARROW SUPERIOR PORTION AT THE LEVEL OF THE CLAVICLE PLEURAL MEMBRANE – SEROUS MEMBRANE OF THE THORACIC CAVITY PARIETAL PLEURA: LINES THE CHEST WALL VISCERAL PLEURA: THE SURFACE OF THE LUNGS IN BETWEEN THE MEMBRANES: SEROUS FLUID PREVENTS FRICTION AND KEEPS THE TWO MEMBRANES TOGETHER DURING BREATHING .5 CM DIAMETER EXTENDS FROM LARYNX TO PRIMARY BRONCHI SUPPORTED BY 16 TO 20 C-SHAPED CARTILAGE RINGS CARINA: AREA WHERE THE TRACHEA DIVIDES INTO 2 BRONCHI .2 MAIN AIRWAYS OF THE LUNGS RIGHT MAINSTEM BRONCHUS: LARGER AND STRAIGHTER THAN THE LEFT.LOWER AIRWAYS TRACHEA 10-13 CM (4-5 INCHES LONG). 2.
PNEUMOTAXIC CENTER – affects the inspiratory effort by limiting the volume of air inspired 2. APNEUSTIC CENTER – prolongs inhalation CHEMORECEPTORS RESPONDS TO CHANGES IN PH INCREASED PACO2 = INCREASE RR .PULMONARY CIRCULATION •PROVIDES FOR REOXYGENATION OF BLOOD AND RELEASE OF CO2 •PULMONARY ARTERIES •PULMONARY VEINS RESPIRATORY MUSCLES •PRIMARY: diaphragm and external intercostal muscles NEUROCHEMICAL CONTROL MEDULLA OBLONGATA – respiratory center initiates each breath by sending messages to primary respiratory muscles over the phrenic nerve •has inspiration and expiration centers PONS – has 2 respiration centers that work with the inspiration center to produce normal rate of breathing 1.
EXPIRATORY AND INSPIRATORY EQUAL IN DURATION . BRONCHIAL – LOUD.reflex that prevents overinflation of the lungs NORMAL BREATH SOUNDS 1. INSPIRATORY LONGER THAN EXPIRATORY 3. HIGH PITCHED SOUNDS. . EXPIRATORY LONGER THAN INSPIRATORY. BRONCHOVESICULAR – INTERMEDIARY IN INTENSITY AND PITCH.HERING – BREUER REFLEX . VESICULAR – SOFT SOUNDS OF AIR FILLING THE ALVEOLI.PRODUCED BY AIR RUSHING THROUGH TRACHEA AND BRONCHI 2.
A. increases alveoli stability & prevents their collapse . PERFUSION – Amount of blood in the pulmonary capillaries. DIFFUSION – Process by which O2 and CO2 are exchanged at the air-blood interface.destroys foreign material.FUNCTIONAL CELLULAR UNITS or GAS-EXCHANGE UNITS OF THE LUNGS TYPE 1 . such as bacteria SURFACTANT . ALVEOLI .reduces surface tension.provide structure to the alveoli TYPE 2 . VENTILATION – Flow of gas in and out of the lungs (Inspiration and Expiration) B. C.secrete SURFACTANT ALVEOLAR MACROPHAGES .
suffocating? ■ Aggravating and alleviating factors? How much activity causes the SOB? Does anything else aggravate it? What do you do to lessen your SOB? ■ Timing? When did you first experience SOB? Does it happen more at any particular time of day or year? ■ Severity? Rate your SOB on a scale of 0 to 10. gasping. with 0 being easy breathing and 10 being the worst shortness of breath you can imagine. ■ Useful other data? Do you have any other symptoms that occur along with the shortness of breath? ■ Patient’s perception? What do you think is causing your shortness of breath? .Assessment of Respiratory Status HEALTH HISTORY • Demographic data • Personal and Family History • Current health problem • Smoking History • History of medication used • History of allergies • Occupational and Socioeconomic status • Environment • Immunization status • Vital signs WHAT’S UP? ■ [Where is it? (not applicable)] ■ How does it feel? Does breathing feel tight.
Assessment of Respiratory Status INSPECTION Primary Indicators of Respiratory Disorders: • Cough • Hemoptysis • Sputum • Dyspnea • Cyanosis .
crepitus • Assess: chest wall symmetry and expansion .Assessment of Respiratory Status PALPATION • Palpate sinuses using thumbs • Use palms to palpate chest for crepitus. or retractions • Palpate: tactile fremitus. tenderness. bulging. alignment.
Assessment of Respiratory Status PERCUSSION • Normal lung tissue = RESONANT • HYPERRESONANCE = areas of increased air in the lungs • DULLNESS = decreased air in the lungs • FLATNESS = noted on consolidated areas • TYMPANY = found over areas where air has collected .
hypoventilation. muscular chest wall Pneumothorax. pleural irritation Emphysema. grating Pleurisy. pneumonia Coarse crackles (rales) Fine crackles (rales) Wheezes Stridor Fluid in airways Moist bubbling sound. atelectasis Narrowed airways Asthma Airway obstruction Obstruction from tumor or foreign body Pleural friction rub Diminished Pleura rubbing together Sound of leather rubbing together. heard on inspiration or expiration Alveoli popping open on inspiration Velcro being torn apart.Assessment of Respiratory Status AUSCULTATION Abnormal (Adventitious) Sound Cause of Sound Description Associated Disorders Pulmonary edema. heard at end of inspiration Fine high-pitched violins mostly on expiration Loud crowing noise heard without stethoscope Heart failure. bronchitis. pneumonectomy Decreased air movement Faint lung sounds Absent No air movement No sounds heard . pneumonia. lung cancer. obesity.
Diagnostic Tests • • • • • Mantoux Test Chest X-ray Bronchoscopy Lung Scan Sputum exam • Pulmonary Function Studies • ABG Studies • Pulmonary Angiography • Pulse Oxymetry • Thoracentesis .
Thick mucus secreted by the tissue lining the respiratory passages. It may be used for diagnostic purposes. it is known as SPUTUM. . When phlegm is ejected through the mouth.
.Visual examination of the bronchi using a bronchoscope. May also be used for operative procedures such as tissue repair or the removal of a foreign object.
May also be used for operative procedures such as tissue repair or the removal of a foreign object.Visual examination of the larynx using a laryngoscope. .
spiro: breath metry: to measure .Testing method that uses a spirometer to record the volume of air inhaled or exhaled and the length of time each breath takes.
indicates possibility of disease and should be followed by additional testing such as chest x-ray and sputum testing. .Screening test to detect tuberculosis Mantoux method or PPD (purified protein derivative test) Skin of the arm is injected with a small amount of harmelss tuberculin protein Negative result: TB is not present Positive result: Hardness within the testing area within 2 to 3 days.
Positive reaction .
. pneumothorax. and emphysema. tuberculosis. lung tumors.Chest x-ray Valuable tool to show pneumonia. pleural effusion.
Nursing Diagnosis • • • • • • • • Impaired Gas Exchange Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Verbal Communication Activity Intolerance Anxiety Altered Nutrition: Less than body requirements Risk for Infection .
• Indications include: arterial hypoxemia .Respiratory Care Modalities: A. ARDS. tissue and cellular hypoxia . COPD. OXYGEN THERAPY • GOAL: to provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium.
Venturi Mask .65% FiO2) 3. PARTIAL REBREATHER MASK (50 – 70 % FiO2) NON REBREATHER MASK (80 – 100% FiO2) 4. 2.Oxygen Delivery Systems: Low Flow System 1. High Flow System 1. NASAL CANNULA (24-40% FiO2) STANDARD MASK (40 .
Respiratory Care Modalities: B. CHEST TUBE DRAINAGE • insertion of a tube into the intrapleural space to maintain negative pressure when air/fluid have accumulated • chest tube is attached to underwater drainage to allow for the escape of air/fluid and to prevent reflux of air into the chest • PRINCIPLES: GRAVITY and WATER SEAL .
Drainage System: .
or thick. for clients with impaired removal of secretions or with ineffective cough • includes the techniques of POSTURAL DRAINAGE. CHEST PHYSIOTHERAPY • used for individuals with increased production of secretions.Respiratory Care Modalities: C. PERCUSSION AND VIBRATION . sticky secretions.
Cup hands when performing chest percussions. .Procedure in which the patient is tilted and propped at different angles to drain secretions from the lungs.
position should be chest above the head. When in the proper postural drainage position.Spinal cord injuries To drain the middle and lower portions of lungs. change position per the following sequence: •Turn side to side •Lay on stomach •Lay on back .
position should be chest above the head.Spinal cord injuries. . other respiratory disorders To drain the upper portion of lungs.
sinuses. larynx. sore throat. which result in symptoms. rhinorrhea. The release of histamine and other substances causes vasodilation and edema. sneezing. and trachea VIRAL RHINITIS (COMMON COLD) The term “common cold” often is used when referring to an upper respiratory tract infection that is self-limited and caused by a virus (viral rhinitis).RESPIRATORY TRACT INFECTIONS UPPER RESPIRATORY TRACT INFECTION Disorders of the upper respiratory tract include problems occurring in the nose. S/Sx: Nasal congestion. and general malaise . pharynx.
rhinorrhea. symptomatic treatment Adequate rest. Increase oral fluid intake Increase Vitamin C intake Expectorants as needed Warm salt-water gargle for sore throat Antihistamines . No specific treatment.to relieve sneezing. and nasal congestion Topical (nasal) decongestant agent NURSING MGT.• • • • • • • MEDICAL MGT. • Teach patient how to break chain of infection • Proper Hand Hygiene • Cough etiquette .
5. 3. . 4.PNEUMONIA Types of Pneumonia: COMMUNITY ACQUIRED PNEUMONIA (CAP) HOSPITAL ACQUIRED PNEUMONIA (HAP) OPPORTUNISTIC PNEUMONIA ASPIRATION PNEUMONIA HYPOSTATIC PNEUMONIA An acute inflammatory process involving the lung parenchyma 1. 2.
Distribution of Lung Involvement: BRONCHOPNEUMONIA OR LOBULAR PNEUMONIA • PNEUMONIA THAT IS DISTRIBUTED IN A PATCHY FASHION LOBAR PNEUMONIA • A SUBSTANTIAL PORTION OF ONE LOBE IS INVOLVED .
chills. lethargy.Signs and Symptoms: • • • • • • • • • • fever. decreased breath sounds. productive cough. pleuritic chest pain. shortness of breath. dullness noted on percussion over the lungs SPUTUM RAINBOW: The colors of sputum and their corresponding bacteria follow: RUST = Streptococcus pneumonia PINK = Staphylococcus aureus GREEN with odor = Pseudomonas aeruginosa . increased RR. crackles.
to causative agent Respiratory precautions Inhalation therapy Postural drainage Bronchodilators Deep breathing exercises Antipyretics Frequent rest periods Increase Oral Fluid Intake Semi Fowlers position PREVENTION • Hand washing • Immunization • Respiratory precaution (masks and gloves when handling secretions) .• • • • • • • • • • MANAGEMENT Antibiotic therapy accdg.
coughing . talking . sneezing.TUBERCULOSIS • Is an infectious disease caused by bacteria (Mycobacterium tuberculosis) that are usually spread from person to person through the air. • MODE OF TRANSMISSION: airborne droplet.
Signs and Symptoms: • • • • • • No symptoms at first (primary infection) Hemoptysis (in advanced cases) Ongoing low grade fever Night sweats Fatigue Weight loss and fatigue .
Diagnostic tests: • Mantoux test. PPD (Tuberculin Skin test) • Chest Xray • Sputum Exam PREVENTIVE MEASURES: • BCG IMMUNIZATION • IMPROVED SOCIAL CONDITIONS .
• DOTS (DIRECT OBSERVED TREATMENT SHORT COURSE) • Is the name for a comprehensive strategy which primary health care services around the world are using to detect and cure TB. .Management: • Simultaneous administration of 3 or more drugs ( increases the therapeutic effects of medication and decreases the development of resistant bacteria • Course of treatment: average 6 – 12 mos.
perspiration.TUBERCULOSIS MEDICATIONS DRUG ISONIAZID (INH) RIFAMPIN SIDE EFFECTS Bactericidal Bactericidal PERIPHERAL NEURITIS Body secretions may turn to orange (urine.) OPTIC NEURITIS (decreased redgreen color discrimination. Hepatotoxicity OTOTOXICTY. NEPHROTOXICITY ETHAMBUTOL Bacteriostatic PYRAZINAMIDE STREPTOMYCIN Bactericidal Bactericidal .ANTI. decreased visual acuity) Hyperuricemia. tears.
commonly referred to as the flu. Mode of transmission: via droplets from coughs and sneezes of infected individuals. .INFLUENZA • Influenza. direct contact • The incubation period from time of exposure to onset of symptoms is 1 to 3 days. is a viral infection of the respiratory tract.
Chills and sweats • Fatigue and malaise • Headache • Muscle aches (myalgia) • Watery. nasal discharge • Sore throat .Symptoms have an abrupt onset • Nonproductive cough • Fever over 101F .
zanamivir (Relenza) and oseltamivir (Tamiflu) may be helpful for high-risk patients if given within 48 hours of exposure . • Antiviral drugs such as amantadine (Symmetrel). • Antibiotics are used only if a secondary bacterial infection is present. Aspirin is avoided in children because it increases the risk for Reye’s syndrome. and myalgia. headache. • Acetaminophen is given for fever. • Rest and fluids.Treatment • Treatment is primarily symptomatic.
• Monitor respiratory status for rate. . effort. • Administer fluids and electrolytes as ordered. skin color. use of accessory muscles.Nursing management: • Administer medications as ordered. and breath sounds.
CHEST TRAUMA An injury to the chest caused by any form of violence. .
on inspiration • point tenderness and bruising at injury site. splinting with shallow respirations. apprehensiveness • diagnostic test: CXR reveals area and degree of fracture .FRACTURED RIBS : MOST COMMON CHEST INJURY RESULTING FROM BLUNT TRAUMA : RIBS 4-8 (LEAST PROTECTD BY CHEST MUSCLES) ARE MOST COMMONLY FRACTURED ASSESSMENT FINDINGS: • pain. esp.
and pneumothorax .Nursing Interventions: • provide pain relief/control : administer analgesics and narcotics as ordered : Semi or High Fowler’s position • Monitor client closely for complications :assess for bloody sputum indicative of lung penetration) : observe for signs of hemo.
HYPERCARBIA AND INCREASED RETAINED SECRETIONS : CAUSED BY TRAUMA .FLAIL CHEST : FRACTURE OF SEVERAL RIBS AND RESULTANT INSTABILITY OF THE AFFECTED CHEST WALL : CHEST WALL UNABLE TO PROVIDE BONY STRUCTURE NECESSARY FOR ADEQUATE VENTILATION : UNDERLYING TISSUE MOVE PARADOXICALLY TO THE REST OF RIB CAGE AND LUNGS : THE FLAIL PORTION IS SUCKED IN DURING INSPIRATION AND BULGES OUT ON EXPIRATION : RESULT IS HYPOXIA.
hypotension Medical Management: • mechanical ventilation • drug therapy . rapid. paradoxical chest wall motion 2. gruntly breathing. shallow.severe dyspnea. tachycardia.ASSESSMENT FINDINGS: 1. cyanosis.
• Maintain open airway, suction secretions • Monitor mechanical ventilation • Encourage turning, deep breathing and coughing exercises • Monitor for signs of shock
:PARTIAL OR COMPLETE COLLAPSE OF THE LUNGS DUE TO ACCUMULATION OF AIR OR FLUID IN THE PLEURAL SPACE TYPES:
1. 2. 3. 4. Spontaneous Pneumothorax Open Pneumothorax Tension Pneumothorax Hemothorax
• :sudden sharp pain in the chest, dyspnea, diminished or absent breath sounds on affected side, hyperresonance on percussion, decreased vocal fremitus, tracheal deviation to opposite side (tension pneumothorax with mediastinal shift) • :weak, rapid pulse, anxiety, diaphoresis
a chest tube system is placed . • Oxygen therapy. • Chest tube placement: removes air or blood from the pleural space so the lung can re-expand. Monitor vital signs. the initial treatment of choice is to insert a large-bore needle into the second intercostal space midclavicular line to relieve pressure. • If chest trauma.Management: • Bed rest to decrease need for oxygen. • Possible surgery: thoracotomy • Pain medications: monitor respirations • Elevate the head of the bed: promotes maximum lung expansion. Next. the doctor may place an epidural catheter to manage pain. decreases work of breathing. • Administer anxiolytics and teach relaxation techniques • If client has a tension pneumothorax.
ATELECTASIS Collapse of lung tissue at any structural level .
pleural effusion. elderly. Aspiration of Gastric contents) . ascites. bedridden.ATELECTASIS TYPES: • PRIMARY – due to decreases surfactant factor • SECONDARY – due to airway obstruction and lung compression RISK – post surgery. obese. obesity) • Localized airway obstruction (FBAO. mucus plug) • Insufficient pulmonary surfactant (RDS. history of smoking CAUSES – reduction in lung distention forces (pneumothorax. inhalation anesthesia.
Signs and Symptoms
• Initially detected on CXR • Some are asymptomatic • IF significant hypoxemia occurs = dyspnea, tachypnea, tachycardia, and cyanosis • Diminished breath sounds and crackles over involved area • Fever: less than 101F (common)
• • • • • • • Treatment is directed toward the cause Change position frequently Early ambulation Deep breathing and coughing exercise Chest physiotherapy Oxygen therapy if with hypoxia Check VS and breath sounds
•EMPHYSEMA •CHRONIC BRONCHITIS •ASTHMA
EMPHYSEMA • PROBLEM WITH THE ALVEOLI THAT IS CHARACTERIZED BY A LOSS OF ALVEOLAR ELASTICITY. OVERDISTENTION AND DESTRUCTION. .WITH SEVERE GAS EXCHANGE IMPAIRMENT.
LATE IN THE DISEASE .MANIFESTATION: • • • • • • • • THIN IN APPEARANCE COUGH IS NOT COMMON SENSATION OF AIR HUNGER USE OF ACCESSORY RESPIRATORY MUSCLES ABG IS NORMAL UNTIL LATE IN THE DISEASE GENERALLY WITHOUT CARDIAC INVOLVEMENT COR PULMONALE.
CHRONIC BRONCHITIS • PROBLEM WITH THE AIRWAY CHARACTERIZED BY EXCESSIVE MUCUS PRODUCTION. . IMPAIRED CILIARY FUNCTION WHICH DECREASES MUCUS CLEARANCE.
MANIFESTATION: • • • • • • • GENERALLY NORMAL OR OVERWEIGHT INCREASED CHRONIC SPUTUM PRODUCTION LOW PaO2. CYANOSIS PRODUCTIVE COUGH EXERCISE INTOLERANCE SOB WITH CARDIAC INVOLVEMENT .
ASTHMA • INTERMITTENT. MUCUS SECRETION AND AIRWAY INFLAMMATION. OBSTRUCTIVE AIRWAY PROBLEM CHARACTERIZED BY EXACERBATION AND REMISSIONS. • CHRONIC INFLAMMATORY PROCESS THAT PRODUCES MUCOSAL EDEMA. . REVERSIBLE.
MANIFESTATION: • • • • • • • • • EPISODIC WHEEZING CHEST TIGHTNESS SOB COUGH ANXIETY USE OF ACCESSORY MUSCLES SIGNS OF HYPOXIA CYANOSIS OCCURS LATE EXERCISE INTOLERANCE .
MANAGEMENT: • PREVENTION OR TREATMENT OF RESPIRATORY INFECTIONS • BRONCHODILATORS • MUCOLYTICS AND EXPECTORANTS • CHEST PHYSIOTHERAPY • BREATHING EXERCISES • CORTICOSTEROIDS .
CARDIOVASCULAR SYSTEM .
CARDIOVASCULAR means Pertaining to the HEART and BLOOD VESSELS .
.Efficient pumping system Supplies all body tissues with oxygen and nutrients. Transports cellular waste products to the appropriate organs for removal from the body.
. Blood cells play important roles in the endocrine system.Efficient pumping system Blood cells play important roles in the immune system.
HEART BLOOD VESSELS BLOOD .
.HEART Hollow muscular organ Located between the lungs Above the diaphragm Furnishes the power to maintain blood flow throughout both the pulmonary and systemic circulatory systems.
Average total heart beats per day:100.000 Lifetime average heartbeat: 3.HEART Weight: between 7 and 15 ounces (200 – 425 grams) Size: A little larger than the size of fist.5 billion times .
Double-walled membrane sac that encloses the heart. . Pericardial fluid between the layers of the pericardium to prevent friction when the heart beats.
. consists of cardiac muscle. MYOCARDIUM – middle and thickest of the three layers. part of the inner layer of pericardial sac.EPICARDIUM – external layer of the heart. ENDOCARDIUM – lining of the heart. inner surface that comes in direct contact with blood being pumped through the heart.
If blood supply is disrupted.prompt removal of waste Coronary artery & veins supply the blood needs of the myocardium. Highly specialized muscle that beats constantly.continuous supply of oxygen and nutrients . . the myocardium in the affected area dies. Must have: .
separated by interatrial septum Ventricle – lower chamber .Atria .receiving chamber .upper chamber of the heart .all vessels leaving the heart emerge from the ventricles -separated by interventricular septum Cardiac Apex: narrow tip of the heart .
Flow of blood is controlled by the following valves: .
Flow of blood is controlled by the following valves: .
. If any of the heart valves is not working properly. blood does not flow properly through the heart and cannot be pumped effectively throughout the body.Valve: A membranous structure in a hollow organ or passage that folds or closes to prevent the return flow of the body fluid passing through it.
.Tricuspid (TV) Controls the opening between the right atrium and right ventricle.
Tricuspid: Having 3 points or cusps .
Pulmonary semilunar valve: located between right ventricle and pulmonary artery. Semilunar: half-moon .
.Mitral Valve (MV): located between left atrium and left ventricle.
Mitral Valve (MV): Bicuspid valve Valve is shaped with two points .
.Aortic Semilunar Valve: located between the left ventricle and the aorta.
.Systemic and Pulmonary Circulation Makes possible the important function of blood: Bringing oxygen to the cells and removing waste products.
The product of heart rate and stroke volume • STROKE VOLUME –volume of blood pumped by the ventricle with each contraction (60-70 cc) .Starling’s law THE GREATER THE MYOCARDIAL CELLS ARE STRETCHED THE MORE FORCEFUL THE CONTRACTION • CONDUCTION SYSTEM: special electrical cells generate and coordinate electrical impulses to myocardial cells • CARDIAC OUTPUT – amt of blood pumped by each ventricle per minute.
hypertension. sedentary lifestyle. allergies to catheterization.Cardiac ASSESSMENT • HEALTH HISTORY – FAMILY HISTORY: Estimates the risk for cardiac disease for the patient – RISK FACTORS: smoking. sex. obesity. medications – HISTORY OF PRESENT ILLNESS . high serum cholesterol level. alcohol use – PAST MEDICAL HISTORY: past illnesses.
EXERTIONAL B. ORTHOPNEA C.COMPLAINTS OF SHORTNESS OF BREATHING.Cardiac ASSESSMENT • SUBJECTIVE DATA: CARDINAL SYMPTOMS 1. PALPITATIONS 5. PAROXYSMAL NOCTURNAL DYSPNEA 2. WEAKNESS AND FATIGUE . DYSPNEA . CHEST PAIN: MOST COMMON COMPLAINT OF PATIENT WITH HEART DISEASE 3. DIZZINESS AND SYNCOPE 4. AWARENESS OF DISCOMFORT A.
Cardiac ASSESSMENT • OBJECTIVE DATA INSPECTION: SKIN COLOR. POINT OF MAXIMAL IMPULSE. APICAL PULSE AUSCULTATION: NORMAL HEART SOUNDS. ABNORMAL PULSES. EXTRA BEAT SOUNDS. FRICTION RUB . MURMURS. NAILBEDS. PERIPHERAL EDEMA PALPATION: PERIPHERAL PULSE. NECK VEIN DISTENTION RESPIRATORY RATE.
NORMAL ACTIVITY PRECIPITATES FATIGUE. NO ANGINAL PAIN • CLASS II PHYSICAL ACIVITY IS SLIGHTLY LIMITED. AND ANGINAL PAIN • CLASS III PHYSICAL ACITIVTY IS MARKEDLY DECREASED. NO DISCOMFORT FROM NORMAL ACTIVITY.CLASSIFICATION OF CARDIOVASCULAR DISESASE • CLASS I PHYSICAL ACITIVITY IS NOT LIMITED. DYSPNEA. LESS THAN NORMAL ACTIVITY PRECIPITATES EXCESSIVE FATIGUE DYSPNEA. AS SIGNS OF CARDIAC INSUFFICIENCY ARE POSITIVE AT REST . COMFORTABLE AT REST. AND ANGINAL PAIN • CLASS IV PHYSICAL ACTIVITY IS SEVERELY RESTRICTED.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.