Prelims Pointers to Review.pdf

NCMB312: MEDICAL SURGICAL NURSING PRELIMS POINTERS TO REVIEW PROFESSOR: SIR GERARDO A. NICOLAS | OLFU VAL COLLEGE OF NURSING 3 RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO ANATOMY OF THE HEART Endocardium...

NCMB312: MEDICAL SURGICAL NURSING PRELIMS POINTERS TO REVIEW PROFESSOR: SIR GERARDO A. NICOLAS | OLFU VAL COLLEGE OF NURSING 3 RD YEAR 1ST SEMESTER | A.Y. 2024 – 2025 | TRANSCRIBER: RIZALYN RANGEL DIAVARRO ANATOMY OF THE HEART Endocardium  I nnermost layer  Cone-shaped hollow muscular organ  Consists of endothelial tissue and lines the located in the mediastinum betw een the inside of the heart and v alves lungs  Mediastinum - it occupies the space 2 LAYERS OF PERICARDIUM betw een the lungs (mediastinum) and rests on the diaphragm Visceral Pericardium  I t w eighs approximately 300 g (10.6 oz);  Adhering to the epicardium the w eight and size of the heart are Parietal Pericardium influenced by age, gender, body w eight,  Env eloping the v isceral pericardium extent of physical exercise and  A tough fibrous tissue that attaches to conditioning, and heart disease. the great v essels, diaphragm, sternum,  The heart pumps blood to the tissues, and v ertebral column and supports the supplying them w ith oxygen and other heart in the mediastinum nutrients.  Pumps about 60ml/beat or 5L/min Pericardial Space  Pericardium – thin, fibrous sac w hich  Space betw een these two layers serv es as a protective cov ering of the  Normally filled w ith about 20 ml of fluid, heart w hich lubricates the surface of the heart and reduces friction during systole HEART CHAMBERS  The pumping action of the heart is accomplished by the rhythmic relaxation and contraction of the muscular w alls of its four chambers. o Right atrium (0-5 mmHg) - SVC, IVC, Coronary sinus o Right Ventricle (25 mmHg) - lies anteriorly (just beneath the sternum) o Left atrium o Left ventricle - situated posteriorly Apical Impulse 3 LAYERS OF CARDIAC MUSCLE TISSUE  Pulsation created during normal v entricular contraction Epicardium  Also called the point of maximal impulse  Outermost layer (PMI )  I n the normal heart, it is located at the Myocardium  Middle layer intersection of the midclav icular line of the left chest w all and the fifth intercostal  Made up of muscle fibers space and is HEART VALVES responsible for the pumping Atrioventricular (AV) Valves action  Separate the atria from the v entricles RIZALYN RANGEL DIAVARRO 1|N C M B31 2 PRELIMS POINTERS TO REVIEW  Tricuspid valve - composed of three v alve  pulmonary artery  lungs cusps or leaflets, separates the right atrium from the right v entricle. LEFT SIDE  Mitral or bicuspid (two cusps) valve - pulmonary v eins  left atrium  mitral valve lies betw een the left atrium and the left  left v entricle  aortic v alve  aorta  v entricle tissues of the body Semilunar Valves CORONARY ARTERIES  The tw o semilunar v alv es are  The left and right coronary arteries and composed of three leaflets, w hich are their branches supply arterial blood to the shaped like half-moons. heart.  Pulmonic valve - the v alve between  These arteries originate from the aorta just the right v entricle and the pulmonary abov e the aortic v alve leaflets. artery  The heart has high metabolic  Aortic valve - the v alve betw een the requirements, extracting approximately left v entricle and the aorta is called the 70% to 80% of the oxygen delivered (other  The semilunar v alves are closed during organs extract, arteries are perfused diastole during diastole.  At this point, the pressure in the  With a normal heart rate of 60 to 80 bpm pulmonary artery and aorta decreases, there is ample time during diastole for causing blood to flow back toward the myocardial perfusion. semilunar v alves Left Coronary Artery  Has three branches: o Left main coronary artery - the artery rom the point of origin o Left anterior descending artery - arise from the left main coronary artery w hich courses down the anterior wall of the heart; LV, Ventricular septum, chordae tendinae, papillary muscle, RV (lesser extent) o Circumflex artery - also arise from the left main coronary artery w hich circles around to the lateral left w all of the heart; LA, lateral & posterior surfaces of LV, portion of interv entricular septum, SA node, AV node Right Coronary Artery  Supplied by the right coronary artery, w hich leads to the inferior w all of the heart.  posterior descending artery - an additional branch from the right coronary artery w hich supplies blood to the posterior wall of the heart  Superficial to the coronary arteries are the coronary veins.  Venous blood from these v eins returns to RIGHT SIDE the heart primarily through the coronary superior/inferior v ena cava  right atrium  tricuspid v alve  right v entricle  pulmonary RIZALYN RANGEL DIAVARRO 2| N C M B 3 1 2 PRELIMS POINTERS TO REVIEW sinus, w hich is located posteriorly in the to treat certain blood v essel, heart right atrium. and lung conditions.  RA, RV, inferior portion of LV  Reason for medication o Helps to prev ent blood clots from Note: Branching pattern of the coronary forming in the blood v essels. arteries v aries considerably among o May prev ent the clots from indiv iduals. becoming larger and causing more serious problems. o Often prescribed to prev ent first or recurrent stroke or heart attack. Antiplatelet Agents & Dual Antiplatelet Therapy (DAPT)  Some commonly prescribed include: o Aspirin o Clopidogrel (Plav ix) o Dipyridamole (Persantine) o Prasugrel (Effient) o Ticagrelor (Brilinta) MYOCARDIUM  What the medication does?  The middle, muscular layer of the atrial o Keeps blood clots from forming by and v entricular walls. prev enting blood platelets from  I t is composed of specialized cells called sticking together. myocytes, w hich form an interconnected  Reason for medication netw ork of muscle fibers. o Helps prev ent clotting in people  These fibers encircle the heart in a figure- w ho hav e had a heart attack, of eight pattern, forming a spiral from the unstable angina, ischemic strokes, base (top) of the heart to the apex TI A (transient ischemic attacks) (bottom). and other forms of cardiov ascular  During contraction, this muscular disease. configuration facilitates a tw isting and o Can also be used prev entively compressive mov ement of the heart that w hen plaque buildup is ev ident begins in the atria and mov es to the but there is not yet a major v entricles. blockage in the artery. o Certain people w ill be prescribed CARDIO DRUGS aspirin combined w ith another Anticoagulants antiplatelet drug – also known as  (Also know n as blood thinners.) dual antiplatelet therapy (DAPT).  Some commonly prescribed include: Dual Antiplatelet Therapy (DAPT) o Apixaban (Eliquis) o Dabigatran (Pradaxa) Some people w ho hav e heart attacks, that o Edoxaban (Sav aysa) hav e stents placed in their coronary arteries, o Heparin (v arious) or undergo coronary artery bypass graft o Riv aroxaban (Xarelto) surgery (CABG) are treated w ith tw o types of o Warfarin (Coumadin) antiplatelet agents at the same time to  What the medication does? prev ent blood clotting. This is called dual o Decreases the clotting antiplatelet therapy (DAPT). (coagulating) ability of the blood. One antiplatelet agent is aspirin. Almost Sometimes called blood thinners, ev eryone w ith coronary artery disease, although they do not actually thin including those w ho have had a heart attack, the blood. They do not dissolve stent, or CABG are treated w ith aspirin for the existing blood clots and are used rest of their liv es. A second type of antiplatelet RIZALYN RANGEL DIAVARRO 3| N C M B 3 1 2 PRELIMS POINTERS TO REVIEW agent, called a P2Y12 inhibitor, is usually  What the medication does? prescribed for months or years in addition to o Angiotensin I I receptor blockers the aspirin therapy. prev ent angiotensin II from having any effect on the heart and blood The type of medication and the duration of v essels. This keeps blood pressure your treatment w ill v ary based on your from rising. condition and other risk factors. The risks and  Reason for medication benefits of DAPT should be discussed w ith your o Used to treat or improve health care team. symptoms of cardiov ascular How long you need to take this medicine conditions including high blood depends on w hy it’s being prescribed and pressure and heart failure. your future risk of blood clots and bleeding. Angiotensin Receptor-Neprilysin Inhibitors Angiotensin-Converting Enzyme (ACE) (ARNIs) Inhibitors  ARNI s are a drug combination of a  Some commonly prescribed include: neprilysin inhibitor and an ARB. o Benazepril (Lotensin)  Commonly prescribed include: o Captopril (Capoten) o Sacubitril/valsartan (Entresto) o Enalapril (Vasotec)  What the medication does? o Fosinopril (Monopril) o ARNI s improv e artery opening and o Lisinopril (Priniv il, Zestril) blood flow , reduce sodium (salt) o Moexipril (Univasc) retention, and decrease strain on o Perindopril (Aceon) the heart. o Quinapril (Accupril)  Reason for medication o Ramipril (Altace) o For the treatment of heart failure o Trandolapril (Mav ik) Beta Blockers  What the medication does? o Low ers blood pressure by  Also know n as Beta-adrenergic blocking w idening blood v essels. This agents reduces the w orkload of the  Some commonly prescribed include: heart. o Acebutolol (Sectral) o Reason for medication o Atenolol (Tenormin) o Used to treat or improve o Betaxolol (Kerlone) symptoms of cardiov ascular o Bisoprolol/hydrochlorothiazide conditions including high blood (Ziac) pressure and heart failure. o Bisoprolol (Zebeta) o They also prov ide health benefit to o Metoprolol (Lopressor, Toprol XL) people w ho hav e had a heart o Nadolol (Corgard) attack. o Propranolol (I nderal) o Sotalol (Betapace) Angiotensin II Receptor Blockers/Inhibitors  What the medication does?  Also know n as ARBs o Slow s the heart rate and force of  Some commonly prescribed include: contraction, w hich low ers blood o Azilsartan (Edarbi) pressure and makes the heart o Candesartan (Atacand) beat more slow ly and w ith less o Eprosartan (Tev eten) force. o I rbesartan (Av apro)  Reason for medication o Losartan (Cozaar) o Used to treat some types of heart o Olmesartan (Benicar) attacks, high blood pressure, o Telmisartan (Micardis) chest pain (angina) caused by o Valsartan (Diov an) reduced blood supply to the heart muscle and some RIZALYN RANGEL DIAVARRO 4|N C MB312 PRELIMS POINTERS TO REVIEW arrhythmias (abnormal heart o Cholesterol absorption inhibitor: rhythms). Ezetimibe (Zetia) o Used to help prev ent future heart o Combination statin and attacks in people w ho hav e had cholesterol absorption inhibitors: a heart attack. Ezetimibe/Simv astatin (Vytorin)  What the medication does? Combined Alpha and Beta-Blockers o Various medications can lower  Combined alpha and beta-blockers are blood cholesterol levels, but drugs used to treat high blood pressure and other than statins are usually only heart failure. used for patients in w hom statins  Some commonly prescribed include: are not effective or w ho have o Carv edilol (Coreg, Coreg CR) serious side effects from statin o Labetalol hydrochloride therapy. They w ork in the body in (Normodyne, Trandate) different w ays. Some affect the  A noted possible side effect of liv er, some w ork in the intestines combined alpha and beta-blockers: and some interrupt the formation o May cause a drop in blood of cholesterol from circulating in pressure when you stand up. the blood. Watch an animation of how statins w ork. Calcium Channel Blockers  Reason for medication  Also know n as calcium antagonists or o Used to low er LDL ("bad") calcium blockers cholesterol.  Some commonly prescribed include: o Some cholesterol-lowering o Amlodipine (Norv asc) medications may interact w ith o Diltiazem (Cardizem, Tiazac) grapefruit, grapefruit juice, o Felodipine (Plendil) pomegranate and pomegranate o Nifedipine (Adalat, Procardia) juice. Please talk to your health o Nimodipine (Nimotop) care professional about any o Nisoldipine (Sular) potential risks. o Verapamil (Calan, Verelan) Digitalis Preparations  What the medication does? o I nterrupts the mov ement of  Commonly prescribed include: calcium into the cells of the heart o Digoxin (Lanoxin) and blood v essels. May decrease  What the medication does? the heart's pumping strength and o I ncreases the force of the heart's relax blood v essels. beat and slow s a fast heart rate.  Reason for medication Can be beneficial in treating o Used to treat high blood pressure, heart failure and irregular chest pain (angina) caused by heartbeats. reduced blood supply to the heart  Reason for medication muscle and some arrhythmias o Used to reliev e heart failure (abnormal heart rhythms). symptoms, especially w hen the patient isn't responding to other Cholesterol-Lowering Medications standard treatments including  Some commonly prescribed include: ACE inhibitors, ARBs and diuretics. o Statins: Atorv astatin (Lipitor), o Also slow s certain types of irregular Fluv astatin (Lescol), Lov astatin heartbeat (arrhythmias), (Mev acor), Pitav astatin (Liv alo), particularly atrial fibrillation. Prav astatin (Prav achol), Diuretics Rosuv astatin (Crestor), Simv astatin (Zocor)  Also know n as w ater pills o Nicotinic acids: Niacin  Some commonly prescribed include: RIZALYN RANGEL DIAVARRO 5| N C M B 3 1 2 PRELIMS POINTERS TO REVIEW o Acetazolamide (Diamox)  Reason for medication o Amiloride (Midamor) o Used to ease chest pain (angina) o Bumetanide (Bumex) o Used to treat essential high blood o Chlorothiazide (Diuril) pressure o Chlorthalidone (Hygroton) o Treats high blood pressure caused o Furosemide (Lasix) by pregnancy o Hydro-chlorothiazide (Esidrix, DIAGNOSTIC/LABORATORY TESTS Hydrodiuril) o I ndapamide (Lozol) SERUM MARKERS OF MYOCARDIAL DAMAGE o Metalozone (Zaroxolyn) (CARDIAC MARKERS) o Spironolactone (Aldactone) o Torsemide (Demadex)  Troponin (T=