E Respiratory System

RESPIRATORY
SYSTEM
RESPIRATORY SYSTEM
PRIMARY FUNCTIONS
• Provides O2 for metabolism in the tissues
• Removes CO2, the waste product of metabolism
SECONDARY
FUNCTIONS
• Facilitates sense of smell
• Produces speech
• Maintains acid-base balance
• Maintains body water levels
• Maintains heat balance
UPPER RESPIRATORY TRACT
NOSE
Humidifies, warms & filters inspired air
SINUSES
• Air-filled cavities within the hollow bones that surround
the nasal passages
• Provide resonance during speech
PHARYNX
• Located behind the oral & nasal cavities
• Divided into the nasopharynx, oropharynx &
laryngopharynx
• Passageway for both the respiratory & digestive tracts
UPPER RESPIRATORY TRACT
LARYNX
• Located above the trachea & just below the pharynx at
the root of the tongue
• Commonly called the “VOICE BOX”
• Contains 2 pairs of vocal cords, the false & true cords
• The opening between the true vocal cords is the
GLOTTIS
GLOTTIS - Valsalva Maneuver
EPIGLOTTIS
• Leaf-shaped elastic structure that is attached along
one end to the top of the larynx
• Prevents the food from entering the tracheo-bronchial
tree by closing over the glottis during swallowing
LOWER RESPIRATORY TRACT
TRACHEA
• Located in front of the esophagus
• Branches into the right & left mainstem bronchi at the
carina
MAINSTREAM BRONCHI
• Begin at the carina
• RIGHT BRONCHUS is slightly wider, shorter, &
more vertical than the left bronchus
• Mainstream bronchi divide into 5 secondary or lobar
bronchi that enter each of the 5 lobes of the lung
• The bronchi are lined with cilia which propel mucus up
& away from the lower airway to the trachea where it
can be expectorated or swallowed
Cebu Nursing Review Center
LOWER RESPIRATORY TRACT
BRONCHIOLES
Branch from the secondary bronchi & subdivide into small
terminal & respiratory bronchioles
• Contain no cartilage & depend on the elastic recoil of the lung
for patency
• Terminal bronchioles contain no cilia & don’t participate in gas
exchange
ALVEOLAR DUCTS & ALVEOLI
•- used to indicate all structures distal to the terminal bronchiole
• Alveolar ducts branch from the respiratory bronchioles
• Alveolar sacs which arise from the ducts contain clusters of
alveoli which are basic units of gas exchange
• Cells in the walls of the alveoli secrete surfactant
- phospholipid CHON the reduces the surface tension in the
alveoli
- without surfactant the alveoli would collapse
LOWER RESPIRATORY RACT
LUNGS
• Located in in the pleural cavity in the thorax
• Extend from just above the clavicles to the diaphragm -
the diaphragm is the major muscle of respiration
• RIGHT LUNG - is larger than the left; divided into 3 lobes:
the upper, middle & lower lobes
• LEFT LUNG - somewhat narrower than the right lung to
accommodate the heart ; divided into 2 lobes
• Innervation of the respiratory structures is accomplished
by the PHRENIC NERVE, VAGUS NERVE & THORACIC
NERVES
• PARIETAL PLEURA - lines the inside of the thoracic
cavity including the upper surface of the diaphragm
• VISCERAL PLEURA - covers the pulmonary surfaces
• A thin fluid layer produced by the cells lining the pleura,
lubricates the visceral & parietal pleura
LOWER RESPIRATORY RACT
ACCESSORY MUSCLES OF
RESPIRATION
SCALENE MUSCLES
• Elevate the first 2 ribs
STERNOCLEIDOMASTOID
MUSCLES
• Raises the sternum
TRAPEZIUS & PECTORALIS

MUSCLES
•
THE RESPIRATORY
during inspirationPROCESS
• the diaphragm descends into the abdominal cavity
causing (-) pressure in the lungs
• the (-) pressure draws the air from the area of greater
pressure (THE ATMOSPHERE) into an area of lesser
pressure (THE LUNGS)
• In the lungs, air passes thru the terminal bronchioles
into the alveoli to oxygenate the body tissues
• At the end of inspiration, the diaphragm & intercostal
muscles relax & the lungs recoil
• As the lungs recoil, pressure within the lungs becomes
greater than atmospheric pressure, causing the air
which now contains the cellular waste products of CO2
& H2O to move from the alveoli in the lungs to the
atmosphere
• Expiration is a passive process
RISK FACTORS FOR
RESPIRATORY DISEASE
 Smoking
 Use of chewing tobacco
 Allergies
 Frequent respiratory illnesses
 Chest injury
 Surgery
 Exposure to chemicals & environmental pollutants
 Family history of infectious disease
 Geographic residence & travel to foreign countries
ADULT
RESPIRATORY
DISORDERS

CHEST INJURIES
A. RIB FRACTURE
- results from blunt chest trauma
- causes a potential for intra-thoracic injury:
pneumothorax or pulmonary contusion
ASSESSMENT
 Pain
 Tenderness
 Shallow respirations
 Client splints chest
 Fractures noted on CXR
CHEST INJURIES
B. FLAIL CHEST
- a blunt chest trauma associated w/ accidents
- resulting to loose chest wall
ASSESSMENT
 Paradoxical respirations
 Severe chest pain
 Dyspnea
 Cyanosis
 Tachycardia
 Hypotension
 Tachypnea
 Diminished breath sounds

CHEST INJURIES
C. PULMONARY CONTUSION
- intra-alveolar hemorrhage resulting to ADULT
RESPIRATORY DISTRESS SYNDROME (ARDS)
ASSESSMENT
 Dyspnea
 Hypoxemia
  bronchial secretions
 Hemoptysis
 Restlessness
 Decreased breath sounds
 Rales & wheezes
CHEST INJURIES
D. PNEUMOTHORAX
- accumulation of atmospheric air in the pleural space
- may lead to lung collapse
KINDS
1. SPONTANEOUS PNEUMOTHORAX
2. OPEN PNEUMOTHORAX
3. TENSION PNEUMOTHORAX

PNEUMOTHORAX
ASSESSMENT
 Dyspnea
 Tachycardia
 Tachypnea
 Sharp chest pain
 Absent breath sounds
  chest expansion unilaterally
 Cyanosis
 Hypotension
 Sucking sound
 Tracheal deviation to the unaffected side
with tension pneumothorax
CHEST TUBE DRAINAGE SYSTEM
- returns (-) pressure to the intra-pleural space
- remove abnormal accumulation of air & fluids
- serves as lungs while healing is going on
A. COLLECTION CHAMBER
B. WATER SEAL CHAMBER
C. SUCTION CONTROL
CHAMBER

PRINCIPLES:
1. a. Gravity
b. Suction
c. Waterseal
2. Drainage
3. Waterseal
4. Suction
5. Bottle should be below the chest
6. Hemostats
7. If chest tube removed from the chest
8. If chest tube removed from the bottle
9. Don’t strip

• Occlusive dressing
 A CXR assesses the position of the tube & determines
re-expansion
 Assess respiratory status
 Monitor for signs of remissions
 Keep the drainage system below the chest
 Ensure secure connections
 Coughing &DBE
 Change client’s position q 2

ADULT RESPIRATORY DISTRESS
SYNDROME (ARDS)
(ARDS
- caused by a lung injury leading to extravascular lung
fluid
- interstitial edema
- respiratory acidosis & hypoxemia
- the CXR film shows interstitial edema

ADULT RESPIRATORY DISTRESS
SYNDROME (ARDS)
ASSESSMENT
 Tachypnea
 Dyspnea
  breath sounds
 Deteriorating blood gas
  O2

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)
- a group of diseases that includes EMPHYSEMA,
ASTHMA, BRONCHIECTASIS & CHRONIC
BRONCHITIS
- COPD leads to pulmonary insufficiency, pulmonary

hypertension & cor pulmonale

CHRONIC
BRONCHITIS
Bronchial Inflamation   mucus   cilia  r.acidosis
Causes:
• Smoking
• Pollution
• Allergens
CHRONIC BRONCHITIS
Assessment:
1. Chronic Cough
2. Blue Bloater: cyanotic edema
chronic cough exertional
dyspnea,RR
hypoxia polycythemia- RBC
hypercapnia cor pulmonale-RVH &
resp. acidosis dilatation
 incidence in heavy cigarette smokers
EMPHYSEMA
Destruction and Overdistension of the Alveoli

Air Trapping

Respi. Acidosis

EMPHYSEMA
CAUSES:
1. Smoking, Pollution and Allergens
2.  alpha-antitrypsin – causes expansion of the
alveoli
- strengthens the walls of the
alveoli(blebs)

EMPHYSEMA
Assessment:
•pink puffer:
 mucus speaks in short & jerky sentence
coughing anxious
orthopneic pos. Frequently develop URTI
barrelled chest Prolonged expiratory time
DOB digital clubbing
wheezing Cebu Nursing Review Center
EMPHYSEMA
ASSESSMENT:
1. Exertional Dyspnea
2. Barrelled chest
3. Hyperesonance
4. Spontaneous pneumothorax

ASTHMA
- Characterized by recurring episodes of paroxysmal

dyspnea, wheezing on inspiration/expiration caused by
constriction of the bronchi and viscous mucus secretions.
TYPES:
1. Extrinsic
2. Intrinsic – asthma w/ physiological cause
3. Status Asthmaticus – severe form of constriction &
inflamation despite treatment; may lead to respiratory or
cardiac failure.
ASTHMA
ASSESSMENT:
1. Severe dyspnea
2. Wheezing
3. Anxiety
4. Fever -  grade fever
5. Orthopneic position

BRONCHIECSTASIS
Permanent dilation & distension of the bronchi; may lead to
 mucus production  respi. Acidosis
CAUSES:
1. Infection
2. Atelectasis
3. Aspiration
ASSESSMENT:
1. Mucupurelent mucus
2. Dyspnea
3. Fever
4. Orthopneic position
5. Anxiety Cebu Nursing Review Center
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
1. Bronchodilators:
Xanthines, aminophyline, theophyline
2. Adrenergics:
Isoproterenol(Isuprel), Terbutaline,(Brethine),
Metaproterenol(Aluputent)
3. Expectorants: Guaifenessin(Robitusin)
4. Mucolytics: Acetylcysteine(Mucomyst)
5. Steroids: Prednisone
6. Propylaxis (anti-allergy): Cromolyn Na(Intal)

PNEUMONIA
ASSESSMENT
 grade fever
Chills
Chest pain
Grating sound
Rusty Sputum
Rales or crackles on auscultation
Dullness or hyperesonance
Dx test:
x-ray
gram-staining
sputum culture & sensitivity

LUNG CANCER
- Tumor in the Bronchial Epithelium; men 40 & 
TYPES:
1. Epidermoid/Squamous:
2. Adenocarcinoma
3. Small cell(Oat cell)
4. Large cell

LUNG CANCER
CAUSES:
1. Genetics
2. Carcinogens
3. Infection
4. Smoking

LUNG CANCER
ASSESSMENT:
1. Respiratory Pattern Changes
2. Hemoptysis
3. Dyspnea
4. Chest Pain
5. Fatigue
6. Anorexia
7. Persistent Dry Cough
8. Dx Test:
Sputum cytology
Lung biopsy
BronchoscopyCebu Nursing Review Center
PULMONARY
TUBERCULOSIS
Highly communicable disease caused by a gram + acid-fast
bacili (mycobacterium tuberculosis)
Causes/  Risk groups:

1. Imunosuppression
2. Overcrowding
3. 3rd world country
4. Children 5 yrs.old
5. Alcoholics
6. Smoking
PULMONARY
TUBERCULOSIS
ASSESSMENT:
1. Asymptomatic
2. Anorexia
3. Wt. Loss
4. Fatigue
5. Low grade P.M. fever
6. Night sweats
7. Sputum – yellow green
8. Hemoptysis
9. Chest pain
10.  tactile fremitus
PULMONARY
TUBERCULOSIS
11. Dx Test:
Sputum test
Sputum Culture – TOC
Tuberculin test – Check for the presence of antibodies
due to exposure
a. Mantoux test
b. Multiple puncture test(Tine or Monovac)

PLEURAL EFFUSION
- the collection of fluid in the pleural space
ASSESSMENT
 Sharp pleuritic pain
Dyspnea
Dry non-productive cough
Tachycardia
 temperature
 breath sounds
 CXR shows pleural effusion & a mediastinal shift away
from the fluid

PLEURAL EFFUSION
NURSING CARE
 Identify & treat underlying cause
 Monitor breath sounds
 Monitor pulse oximetry
 Fowler’s
 Coughing & DBE
 Thoracentesis
 If pleural effusion is recurrent, prepare the
client for pleurectomy or pleurodesis

PLEURECTOMY & PLEURODESIS
PLEURECTOMY
- surgically stripping the parietal pleura
- PLEURODESIS
- involves instillation of a sclerosing substance into the pleural space
via a thoracotomy tube

EMPYEMA
- pus within the pleural cavity
- fluid is thick, opaque & foul smelling
ASSESSMENT
 Fever & chills
 Chest pain
 Cough
 Dyspnea
 Anorexia & wt. loss
 Malaise
 Night sweats
 Diminished chest wall movement on the affected side
 Pleural exudate on chest CXR

PLEURISY
- inflammation of the visceral & parietal membranes
- may be caused by pulmonary infarction or pneumonia
ASSESSMENT
 Knife-like pain
 Dyspnea
 Pleural friction
Apprehension

PULMONARY EMBOLISM
- Dislodgement of thrombus to the pulmonary artery
- Caused by thrombus & pulmonary emboli
- Other risk factors: deep vein thrombosis,
immobilization, surgery, obesity, pregnancy, CHF,
advanced age, prior history of thromboembolism

PULMONARY EMBOLISM
ASSESSMENT
 Dyspnea
 Chest pain
 Tachypnea & tachycardia
 Hypotension
 Shallow respirations
 Rales on auscultation
 Cough
 Blood-tinged sputum
 Distended neck veins
 Cyanosis

CARBON MONOXIDE POISONING
- Carbon monoxide is a colorless, odorless & tasteless gas
ASSESSMENT LEVELS OF CARBON MONOXIDE

LEVEL ASSESSMENT FINDING
5% to 10% Impaired visual acuity
11% to 20% Flushing
21% to 30% Nausea & impaired dexterity
31% to 40% Vomiting, dizziness, & syncope
41% to 50% Tachypnea & tachycardia
 50% Coma & death

HISTOPLASMOSIS
- Fungal infection caused by spores of Histoplasma
capsulatum
- Transmitted by inhalation of spores, which are
commonly located in contaminated soil
- Found in bird droppings
ASSESSMENT
 Dyspnea
 Chills
 Fever
 Chest pain
 Pulmonary infiltrates on CXR
 Elevated WBC
Splenomegaly & hepatomegaly
SARCOIDOSIS
- Epitheloid cell tubercles in lung
- cause is unknown
ASSESSMENT
 Night sweats
 Fever
 Weight loss
 Cough
 Skin nodules
 Polyarthritis
 (+) KVEIM TEST

OCCUPATIONAL LUNG DISEASE :
SILICOSIS
- Known as ASBESTOSIS and COAL WORKER’S
PNEUMONIA
- caused by the inhalation of inorganic dusts
- common in miners & sandblasters
- Tuberculosis (PTB) is a frequent complications
ASSESSMENT
 Frequent respiratory infections
 Bloody sputum
 Cough
 CXR: Nodular lesions of the lungs

ACID-BASE BALANCE
Ph – 7.35 – 7.45
ph – acidosis (  H ion conc.)
ph – alkalosis( H ion conc.)
BUFFER SYSTEM:
Bicarbonate : Carbonic acid
HCO3 : CO3
Strong base : Weak acid
20 : 1

ACID-BASE BALANCE
A. Respiratory System: CO2 (acid)
Metabolic acidosis – (Lungs) excrete CO2
Metabolic alkalosis – (Lungs) retain CO2
B. Renal or Metabolic System: H ion(acid) ; HCO3(base)
Respi. acidosis – (Kidney) excrete H+ ; retain HCO3
Respi. alkalosis – (Kidney) retain H+ ; excrete HCO3
Normal ABG Values:
Ph : 7.35 – 7.45
PCO2 : 35 – 45 mgHG
HCO3 : 22-26 meq/L
PO2 : 80-100 mgHg
Base excess : (+2 or –2)Cebu Nursing Review Center
ARTERIAL BLOOD GAS
SITE: Radial Artery

TEST: Allens Test
Ph -  acidosis  alkalosis
PCO2 -  alkalosis  acidosis
HCO3 -  acidosis  alkalosis

ARTERIAL BLOOD GAS
1. Assess ph, PCO2 & HCO3
2. Identify imbalance. If ph is normal use 7.4
 7.4 – acidosis
 7.4 – alkalosis
3. Identify if compensated or uncompensated
uncompensated- if one component is normal & the other is
abnormal
compensated – if both PCO2 & HCO3 are abnormal in
opposite directions
4. If compensated, identify if partially or fully
partially – if ph is abnormal
fully - if ph is normal
Pediatric
RESPIRATORY
DISORDERS

EPIGLOTTITIS
- a bacterial croup
- caused by Haemophilus influenzae type B or
Streptococcus pneumoniae
- age group 2-5 yrs. old
- onset is abrupt
- often occurs in winter
- EMERGENCY SITUATION

EPIGLOTTITIS
ASSESSMENT
  fever
 Sore, red and inflamed throat
 Spontaneous cough
 Drooling
 Dysphagia
 Muffled voice
 Inspiratory stridor
 Agitation
 TRIPOD POSITIONING

BRONCHIOLITIS/RESPIRATORY
SYNCYTIAL VIRUS (RSV)
- an inflammation of the bronchioles
-  mucus production
- RSV
ASSESSMENT
 Rhinorrhea &  fever
 Lethargy
 Poor feeding
 Irritablity
 Tachypnea
 Dyspnea
 Nasal flaring
 Wheezing
Diminished breath sounds
PNEUMONIA
- inflammation
of the alveoli caused by a virus
mycoplasmal agents, bacteria or the aspiration of foreign
substances
TYPES
A. VIRAL PNEUMONIA
B. PRIMARY ATYPICAL
PNEUMONIA
(MYCOPLASMA PNEMONIAE)
- Ages 5 - 12 y.o.
- occurs primarily in the fall & winter months and is more
prevalent in crowded Cebu living conditions
Nursing Review Center
PNEUMONIA
TYPES
C. BACTERIAL PNEUMONIA
- hospitalization is indicated when pleural effusion or
emphyema
- staphylococcal pneumonia
D. ASPIRATION PNEUMONIA
- occurs when food, secretions, liquids, or other materials
enter the lung & cause inflammation

VIRAL PNEUMONIA
ASSESSMENT
 Whitishsputum
 Fever,cough ,malaise and prostration
 WheezIng

PRIMARY ATYPICAL
PNEUMONIA
ASSESSMENT
 Fever
 Malaise
 Headache
 Rhinitis
 Sore throat
 Cough
 Nonproductive cough initially then produces seromucoid
sputum that becomes mucopurulent or bld. streaked
NURSING CARE
 Nursing care: SYMPTOMATIC
BACTERIAL PNEUMONIA
ASSESSMENT
 Fever
INFANT: irritabilty, lethargy, poor feeding, abrupt
fever, respiratory distress
OLDER CHILD: headache, chills, abdominal pain,
chest pain, meningeal symptoms
 Hacking, nonproductive cough
 Diminished breath sounds or scattered crackles
 Purulent sputum

ASTHMA
- is
commonly caused by physical & chemical irritants
- bronchial obstruction
- coughing at night
STATUS ASTHMATICUS
- childdisplays respiratory distress despite vigorous
treatment
- may result in respiratory failure & death if untreated

ASTHMA
ASSESSMENT
 Wheezing
 Dyspnea
 Chest tightness
 Exacerbations
- air is trapped behind occluded or narrow airways
and hypoxemia can occur

ASTHMA
ASSESSMENT
ASTHMATIC EPISODE
 Irritability
 Restlessness
 Headache
 Chest tightness
 Non productive cough
 Later stage: productive, frothy, gelatinous sputum

ASTHMA
MEDICATIONS
1. B2 agonists
- Albuterol (Proventil HFA, Ventolin)
- Metaproterenol sulfate (Alupent )
- Terbutaline sulfate (Brethaire, Brethine,
Bricanyl)
2. ANTICHOLERGENICS
- Atropine sulfate, Ipratropium bromide
(Atrovent)
3. SYSTEMIC CORTICOSTEROIDS

ASTHMA
MEDS. for MAINTENANCE
1. CORTICOSTEROIDS
2. CROMOLYN SODIUM (INTAL)
3. NECOCROMIL SODIUM (TILADE)
4. LONG-ACTING B2 AGONISTS
- for the prevention of exercise-induced
bronchospasm (EIB)
- Albuterol (Proventil HFA, Ventolin)
- Metaproterenol sulfate (Alupent)
- Terbutaline sulfate (Brethaire, Brethine,
Bricanyl)

ASTHMA
MEDS for MAINTENENCE
5. METHYLXANTHINES
6. LEUKOTRIENE MODIFIERS
- Zafirlukast (Accolate) and Zileuton (Zyflo)
- used in children older than 12 years
7. LONG-ACTING BRONCHODILATOR
- Salmeterol (Serevent)

ASTHMA
HOME CARE MEASURES
- Allergens control
- Avoid extremes of temperature
- Avoid exposure to viral respiratory infection
- Recognize early symptoms
- Instruct the child in the administration of
medications as Rx
- Adequate rest, sleep, and a well-balanced
diet
- Adequate fluid intake
- Exercise as tolerated

CYSTIC FIBROSIS
- a multi-system disorder (autosomal recessive trait
disorder)
- Common symptoms:
pancreatic enzyme deficiency - duct blockage
chronic lung disease – infection
sweat gland dysfunction - increased NaCl sweat
concentrations
- SWEAT CHLORIDE TEST

CYSTIC FIBROSIS
RESPIRATORY SYSTEM
- Stagnationof the mucus in the airway
- Emphysema & atelectasis
- Chronic hypoxemia
- Pneumothorax
- Wheezing & dry non-productive cough
- Dyspnea
- Cyanosis
- Clubbing of the fingers & toes
- Repeated episodes of bronchitis & pneumonia

CYSTIC FIBROSIS
GASTROINTESTINAL SYSTEM
- Meconium ileus in the neonate
- Intestinal obstruction
S/S: pain, abdominal distention N&V
- Stearrhea
- Deficiency of A,D, E & K
- Malnutrition & failure to thrive
- Rectal prolapse

CYSTIC FIBROSIS
INTEGUMENTARY SYSTEM
-  of Na & Cl in sweat
- Dehydration & electrolyte imbalances during  weather
REPRODUCTIVE SYSTEM
- Delayed puberty in females
- Infertility
- Sterility

CYSTIC FIBROSIS
DIAGNOSTIC TESTS
1. Sweat Chloride Test
2. Chest X-ray
3. Pulmonary function test
4. Stool / fat or Enzyme analysis

SUDDEN INFANT ‘s DEATH
SYNDROME (SIDS)
- unexpected death of an apparently healthy infant under
the age of 1year
- unknown
MATERNAL RISK FACTORS
 Maternal smoking
 Substance abuse
 Younger mothers
BIRTH RISK FACTORS
 Prematurity
 Low-birth-weight infants
 Multiple births
 Infants with CNS problems
SUDDEN INFANT DEATH SYNDROME (SIDS)
TIME OF YEAR - winter
TIME OF DEATH - during sleep
AGE - 2 months to 4 months of life; less than 1 year
SEX & RACE
- males
- native Americans & blacks
SLEEP RISK FACTORS
 Prone position
 Use of soft bedding
 Overheating (thermal stress)
 Possibly: sleeping with an adult

SUDDEN INFANT DEATH
SYNDROME (SIDS)
APPEARANCE WHEN FOUND
 Apneic & blue
 Frothy blood-tinged fluid in the nose & mouth
 Typically found in a disheveled bed, with blankets over
the head, and huddled in a corner
 Diaper is wet & full of stool

SUDDEN INFANT DEATH
SYNDROME (SIDS)
PREVENTION
 Supine position for sleep
 If with gastroesophageal reflux – side lying
 Avoid mattresses & bedding
 Avoid pillows
 Stuff toys should be removed

THE END
YOU CAN MAKE IT, OUR
GOAL IS TO TAKE IT ONE
TIME.
GOOD LUCK & MAY GOD
BLESS YOU ALL
Merry Christmas

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RESPIRATORY

TRAPEZIUS & PECTORALIS

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

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Cebu Nursing Review Center

- COPD leads to pulmonary insufficiency, pulmonary

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Cebu Nursing Review Center

Cebu Nursing Review Center

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- Characterized by recurring episodes of paroxysmal

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Causes/  Risk groups:

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from the fluid

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ASSESSMENT LEVELS OF CARBON MONOXIDE

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SITE: Radial Artery

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Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

Cebu Nursing Review Center

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