discussion for the nurses' review regards the medical surgical problems in relation to the nursing practice rsm, md

6. THE HEART

12. MYOCARDIAL INFARCTION Myocardial Infarction – refers to the process by which the myocardial/ cardiac tissue is destroyed in the region of the heart that are deprived of an adequate blood supply (reduced coronary artery blood flow) Causes/Etiologies: - narrowing or complete occlusion of coronary artery - decreased coronary blood flow - increased demand for oxygen Myocardial Infarction maybe defined by the location of the injury to the heart muscle or by the point in time in the process of infarction

18. Right Coronary Artery (RCA) I, aVL II, III, aVF, V 1 , V 4 R, V 5 R, V 6 R Right ventricular (Usually associated with Inferior) Posterior Descending (PDA) (branch of the RCA or Circumflex (LCX) ) V 1 ,V 2 ,V 3 , V 4 V 7 , V 8 , V 9 Posterior (Usually associated with Inferior or Lateral but can be isolated) Circumflex (LCX) or Obtuse Marginal II, III, aVF I, aVL, V 5 , V 6 Lateral Right Coronary Artery (RCA) or Circumflex (LCX) I, aVL II, III, aVF Inferior Left main coronary artery (LCA) II, III, aVF V 1 ,V 2 ,V 3 , V 4 , V 5 , V 6 , I, aVL Extensive anterior (Sometimes called Anteroseptal with Lateral extension) Left Anterior Descending (LAD) , Circumflex (LCX) , or Obtuse Marginal II, III, aVF V 3 , V 4 , V 5 , V 6 , I, aVL Anterolateral Left Anterior Descending (LAD) None V 1 , V 2 , V 3 , V 4 Anteroseptal Left Anterior Descending (LAD) None V 3 , V 4 Anterior Left Anterior Descending (LAD) None V 1 , V 2 Septal Suspected Culprit Artery Leads Showing Reciprocal ST Segment Depression Leads Showing ST Segment Elevation Wall Affected

24. Right Coronary Artery (RCA) I, aVL II, III, aVF, V 1 , V 4 R, V 5 R, V 6 R Right ventricular (Usually associated with Inferior) Posterior Descending (PDA) (branch of the RCA or Circumflex (LCX) ) V 1 ,V 2 ,V 3 , V 4 V 7 , V 8 , V 9 Posterior (Usually associated with Inferior or Lateral but can be isolated) Circumflex (LCX) or Obtuse Marginal II, III, aVF I, aVL, V 5 , V 6 Lateral Right Coronary Artery (RCA) or Circumflex (LCX) I, aVL II, III, aVF Inferior Left main coronary artery (LCA) II, III, aVF V 1 ,V 2 ,V 3 , V 4 , V 5 , V 6 , I, aVL Extensive anterior (Sometimes called Anteroseptal with Lateral extension) Left Anterior Descending (LAD) , Circumflex (LCX) , or Obtuse Marginal II, III, aVF V 3 , V 4 , V 5 , V 6 , I, aVL Anterolateral Left Anterior Descending (LAD) None V 1 , V 2 , V 3 , V 4 Anteroseptal Left Anterior Descending (LAD) None V 3 , V 4 Anterior Left Anterior Descending (LAD) None V 1 , V 2 Septal Suspected Culprit Artery Leads Showing Reciprocal ST Segment Depression Leads Showing ST Segment Elevation Wall Affected

33. CARDIAC CONDUCTION SYSTEM

36. Approximate normal conduction velocity at each part of the pathway is summarized below: 0.5 m/s Ventricular Tissue 1-4 m/s Purkinje Fibers 2 m/s Bundle Branches 2 m/s His Bundle 0.05 m/s AV Node 1 m/s Atrial Tissue Conduction velocity Location

96. THE RESPIRATORY SYSTEM

100. Bronchial Asthma Asthma is a chronic disease that affects your airways. The airways are the tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways are inflamed (swollen) The inflammation makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating . When the airways react, they get narrower , and less air flows through to your lung tissue. This causes symptoms like wheezing (a whistling sound when you breathe), coughing, chest tightness , and trouble breathing , especially at night and in the early morning.

108. The septum or partitions/ divisions between alveoli (abnormal increase in lung’s size) are destroyed in Chronic Obstructive Pulmonary Disease with increase mucus (phlegm)

119. Adult Immunization Schedule Vaccine is usually given once to individuals > 65 years of age. A repeat dose may be given 5 years later for those at higher risk. Immunization is also recommended for younger people with chronic medical problems, such as heart disease, diabetes, renal failure, and sickle cell anemia, and for those who work or live with high-risk persons. Streptococcus pneumoniae (polysaccharide) Vaccine is administered yearly to individuals > 55 years of age; to younger people with chronic medical problems, such as heart disease and diabetes; and to those who work or live with high-risk persons Influenza 2 doses are given to individuals > 13 years of age who have not had chickenpox. The 2 nd dose is given 1 -2 months after the 1 st Varicella A 3-dose schedule applies for individuals who have not received an initial immunization series in childhood. The 2 nd dose is given 1 month after the 1 st and the 3 rd dose 6 months after the 2 nd . Boosters are given every 10 years Tetanus/Diptheria toxoids, absorbed 1 dose is given to adults born in 1957 or later and not previouslt immunized. A second dose may be required in some work or school settings Measles/Mumps/Rubella 3 doses are given, with the 2 nd dose 1 month after the 1 st , and 3 rd dose 5 months after the 2 nd Hepatitis B 2 doses are recommended for long-term protection, with the 2 nd dose 6 – 12 months after the first Hepatitis A Timing of Immunization Vaccine