The superior vena cava and the pulmonary trunk are attached to the right side of the heart. The aorta and pulmonary veins are attached to the left side of the heart. The right ventricle forms most of the ventral surface of the heart, and the left ventricle forms most of the dorsal surface.
The coronary arteries and cardiac veins pervade cardiac muscle. The coronary arteries bring oxygen and nutrients to cardiac cells, which derive no benefit from blood coursing through the heart.
Oxygen rich and oxygen poor blood never mix.
The heart has four valves. The atrioventricular valves allow blood to pass from the atria to the ventricles, and the semilunar valves allow blood to pass out of the heart.
This diagrammatic representation of the heart allows you to trace the path of the blood through the heart.
If the SA node fails to work properly, the heart still beats due to impulses generated by the AV node, but the beat is slower (40 to 60 beats per minute). To correct this condition, it is possible to implant an artificial pacemaker, which automatically gives an electrical stimulus to the heart.
The SA node sends out a stimulus, which cause the atria to contract. When this stimulus reaches the AV node, it signals the ventricles to contract. Impulses pass down the two branches of the atrioventricular bundle to the Purkinje fibers, and thereafter the ventricles contract.
A normal ECG (top) indicates that the heart is functioning properly. The P wave occurs just prior to atrial contraction; the QRS complex occurs just prior to ventricular contraction; and the T wave occurs when the ventricles are recovering from contraction. Ventricular fibrillation (bottom) produces an irregular electrocardiogram due to irregular stimulation of the ventricles. Ventricular fibrillation is of special interest because it can be caused by an injury or drug overdose. It is the most common cause of sudden cardiac death in a seemingly healthy person over age 35. Once the ventricles are fibrillating, they have to be defibrillated by applying a strong electrical current for a short period of time. Then the SA node may be able to reestablish a coordinated beat.
The blue-colored vessels carry O 2 -poor blood, and the red-colored vessels carry O 2 -rich blood; the arrows indicate the flow of blood. Capillaries are present in all parts of the body, so no cell is located far from a capillary.
A realistic representation of the major blood vessels of the systemic circuit shows how the systemic arteries and veins are arranged in the body.
A portal system begins and ends with capillaries. The hepatic portal system begins with capillaries in the small intestine, continues with the hepatic portal vein leading to the liver, and ends with capillaries in the liver.
Although the blood pressure in the brachial artery is typically about 120/80, blood pressure actually varies throughout the body. Blood pressure is highest in the aorta and lowest in the venae cavae.
Blood pressure and blood velocity drop off in capillaries because capillaries have a greater cross-sectional area than arteries.
Blood vessels require oxygen and nutrients, so larger ones have blood vessels in their walls.
The walls of arteries and veins have three layers. The inner layer is composed largely of endothelium, with a basement membrane that has elastic fibers; the middle layer is smooth muscle tissue; the outer layer is connective tissue (largely collagen fibers). Arteries (on left) have a thicker wall than veins because they have a larger middle layer than veins. Capillary walls (center) are one-cell-thick endothelium. Veins (on right) are larger in diameter than arteries, so that collectively veins have a larger holding capacity than arteries.
The inner layer of an artery wall is a simple squamous epithelium called endothelium with a connective tissue basement membrane with elastic fibers. The outer layer is fibrous connective tissue near the middle layer, but it becomes loose connective tissue at its periphery.
Capillaries have one-cell-thick walls composed only of endothelium with a basement membrane. Capillaries form vast networks with a total surface area of 6,000 square meters in humans.
A capillary bed forms a maze of capillary vessels that lies between an arteriole and a venule. When sphincter muscles are relaxed, the capillary bed is open, and blood flows through the capillaries. When sphincter muscles are contracted, blood flows through a shunt that carries blood directly from an arteriole to a venule. As blood passes through a capillary in the tissues, it gives up its oxygen (O 2 ). Therefore, blood goes from being O 2 -rich in the arteriole (red color) to being O 2 -poor in the vein (blue color).
When blood is transferred to a test tube and prevented from clotting, it forms tw layers. The transparent, yellow top layer is plasma, the liquid portion of the blood. The formed elements are the bottom layer.
Hemoglobin is a red pigment, thus imparting a red color to red blood cells. A hemoglobin molecule contains four polypeptide chains that make up the protein globin.
Red blood cells move in single file through the capillaries. Each red blood cell is a biconcave disk containing many molecules of hemoglobin, the respiratory pigment. Hemoglobin contains four polypeptide chains (in blue). There is an iron-containing heme group in the center of each chain. Oxygen loosely combines with hemoglobin when oxygenated. Oxyhemoglobin is bright red, and deoxyhemoglobin is a dark maroon color.
In iron-deficiency anemia, the most common type of anemia, the hemoglobin levels are low, probably due to a diet that does not contain enough iron.
Leukemia is a form of cancer characterized by uncontrolled production of abnormal white blood cells. There are two types of lymphocytes, B lymphocytes and T lymphocytes, have different roles in immunity. Their specific roles are covered in Chapter 14.
Monocyte-derived macrophages are the body’s scavengers. They engulf microbes and debris in the body’s fluids and tissues, as illustrated in this colorized scanning electron micrograph. The macrophage is in red, and the bacteria are in green.
Vitamin K, found in green vegetables and also formed by intestinal bacteria, is necessary for the production of prothrombin. Hemorrhagic disorders might develop if this vitamin is missing.
As soon as blood vessel repair is initiated, an enzyme called plasmin destroys the fibrin network and restores the fluidity of the plasma. If blood is allowed to clot in a test tube, a yellowish fluid develops above the clotted material. This fluid is called serum. Serum contains all the components of plasma except fibrinogen.
Platelets and damaged tissue cells release prothrombim activator, which acts on prothrombin in the presence of calcium ions (Ca 2+ ) to produce thrombin. Thrombin acts on fibrinogen in the presence of Ca 2+ to form fibrin threads. The scanning electron micrograph of a blood clot shows red blood cells caught in the fibrin threads.
The use of adult stem cells does not require that an embryo be sacrificed.
Multipotent stem cells give rise to two specialized stem cells. The myeloid stem cell gives rise to still other cells, which become red blood cells, platelets, and all the white blood cells except lymphocytes. The lymphoid stem cell gives rise to lymphoblasts, which become lymphocytes.
Osmotic pressure in the blood is created by the presence of salts and the plasma proteins.
At the arterial end of a capillary, the blood pressure is higher than the osmotic pressure; therefore, water tends to leave the bloodstream. In the midsection, oxygen and carbon dioxide follow their concentration gradients. At the venous end of a capillary, the osmotic pressure is higher than the blood pressure; therefore, water tends to enter the bloodstream.
Thromboembolism is a clot that has moved and is now stationary in a new blood vessel where it can cause damage.
During this operation, the surgeon grafts segments of another vessel, usually a small vein from the leg, between the aorta and the coronary vessels, bypassing areas of blockage. Patients who require surgery often receive two to five bypasses in a single operation.
On the left, a plastic tube is inserted into the coronary artery until it reaches the clogged area. In the middle diagram, a metal tip with a balloon attached is pushed out the end of the plastic tube into the clogged area. On the right, when the balloon is inflated, the vessel opens. Sometimes metal coils or slotted tubes, called stents, are inserted to keep the vessel open.
Cardiovascular System Nhelia B. Perez RN, MSN Northeastern College Santiago City Philippines 3311
<ul><li>The heart is a cone-shaped, muscular organ located between the lungs behind the sternum. </li></ul><ul><li>The heart muscle forms the myocardium , with tightly interconnect cells of cardiac muscle tissue. </li></ul><ul><li>The pericardium is the outer membranous sac with lubricating fluid. </li></ul>The Heart
<ul><li>The heart has four chambers: two upper, thin-walled atria , and two lower, thick-walled ventricles . </li></ul><ul><li>The septum is a wall dividing the right and left sides. </li></ul><ul><li>Atrioventricular valves occur between the atria and ventricles – the tricuspid valve on the right and the bicuspid valve on the left; both valves are reenforced by chordae tendinae attached to muscular projections within the ventricles. </li></ul>
Passage of Blood Through the Heart <ul><li>Blood follows this sequence through the heart: superior and inferior vena cava -> right atrium -> tricuspid valve -> right ventricle -> pulmonary semilunar valve -> pulmonary trunk and arteries to the lungs -> pulmonary veins leaving the lungs -> left atrium -> bicuspid valve -> left ventricle -> aortic semilunar valve -> aorta -> to the body . </li></ul>
<ul><li>The pumping of the heart sends out blood under pressure to the arteries. </li></ul><ul><li>Blood pressure is greatest in the aorta; the wall of the left ventricle is thicker than that of the right ventricle and pumps blood to the entire body. </li></ul><ul><li>Blood pressure then decreases as the cross-sectional area of arteries and then arterioles increases. </li></ul>
The Heartbeat <ul><li>Each heartbeat is called a cardiac cycle . </li></ul><ul><li>When the heart beats, the two atria contract together, then the two ventricles contract; then the whole heart relaxes. </li></ul><ul><li>Systole is the contraction of heart chambers; diastole is their relaxation. </li></ul><ul><li>The heart sounds , lub-dup, are due to the closing of the atrioventricular valves, followed by the closing of the semilunar valves. </li></ul>
Intrinsic Control of Heartbeat <ul><li>The SA ( sinoatrial ) node , or pacemaker , initiates the heartbeat and causes the atria to contract on average every 0.85 seconds. </li></ul><ul><li>The AV ( atrioventricular ) node conveys the stimulus and initiates contraction of the ventricles. </li></ul><ul><li>The signal for the ventricles to contract travels from the AV node through the atrioventricular bundle to the smaller Purkinje fibers . </li></ul>
Extrinsic Control of Heartbeat <ul><li>A cardiac control center in the medulla oblongata speeds up or slows down the heart rate by way of the autonomic nervous system branches: parasympathetic system (slows heart rate) and the sympathetic system (increases heart rate). </li></ul><ul><li>Hormones epinephrine and norepinephrine from the adrenal medulla also stimulate faster heart rate. </li></ul>
The Electrocardiogram <ul><li>An electrocardiogram ( ECG ) is a recording of the electrical changes that occur in the myocardium during a cardiac cycle. </li></ul><ul><li>Atrial depolarization creates the P wave , ventricle depolarization creates the QRS wave , and repolarization of the ventricles produces the T wave . </li></ul>
The Vascular Pathways <ul><li>The cardiovascular system includes two circuits: </li></ul><ul><li>Pulmonary circuit which circulates blood through the lungs, and </li></ul><ul><li>Systemic circuit which circulates blood to the rest of the body. </li></ul><ul><li>Both circuits are vital to homeostasis. </li></ul>
The Pulmonary Circuit <ul><li>The pulmonary circuit begins with the pulmonary trunk from the right ventricle which branches into two pulmonary arteries that take oxygen-poor blood to the lungs. </li></ul><ul><li>In the lungs, oxygen diffuses into the blood, and carbon dioxide diffuses out of the blood to be expelled by the lungs. </li></ul><ul><li>Four pulmonary veins return oxygen-rich blood to the left atrium. </li></ul>
The Systemic Circuit <ul><li>The systemic circuit starts with the aorta carrying O 2 -rich blood from the left ventricle. </li></ul><ul><li>The aorta branches with an artery going to each specific organ. </li></ul><ul><li>Generally, an artery divides into arterioles and capillaries which then lead to venules. </li></ul>
<ul><li>The vein that takes blood to the vena cava often has the same name as the artery that delivered blood to the organ. </li></ul><ul><li>In the adult systemic circuit, arteries carry blood that is relatively high in oxygen and relatively low in carbon dioxide, and veins carry blood that is relatively low in oxygen and relatively high in carbon dioxide. </li></ul><ul><li>This is the reverse of the pulmonary circuit. </li></ul>
Major arteries and veins of the systemic circuit
<ul><li>The coronary arteries serve the heart muscle itself; they are the first branch off the aorta. </li></ul><ul><li>Since the coronary arteries are so small, they are easily clogged, leading to heart disease. </li></ul><ul><li>The hepatic portal system carries blood rich in nutrients from digestion in the small intestine to the liver, the organ that monitors the composition of the blood . </li></ul>
Blood Flow <ul><li>The beating of the heart is necessary to homeostasis because it creates pressure that propels blood in arteries and the arterioles. </li></ul><ul><li>Arterioles lead to the capillaries where nutrient and gas exchange with tissue fluid takes place. </li></ul>
Blood Flow in Arteries <ul><li>Blood pressure due to the pumping of the heart accounts for the flow of blood in the arteries. </li></ul><ul><li>Systolic pressure is high when the heart expels the blood. </li></ul><ul><li>Diastolic pressure occurs when the heart ventricles are relaxing. </li></ul><ul><li>Both pressures decrease with distance from the left ventricle because blood enters more and more arterioles and arteries. </li></ul>
Cross-sectional area as it relates to blood pressure and velocity
Blood Flow in Capillaries <ul><li>Blood moves slowly in capillaries because there are more capillaries than arterioles. </li></ul><ul><li>This allows time for substances to be exchanged between the blood and tissues. </li></ul>
Blood Flow in Veins <ul><li>Venous blood flow is dependent upon: </li></ul><ul><li>skeletal muscle contraction, </li></ul><ul><li>presence of valves in veins, and </li></ul><ul><li>respiratory movements. </li></ul><ul><li>Compression of veins causes blood to move forward past a valve that then prevents it from returning backward. </li></ul>
<ul><li>Changes in thoracic and abdominal pressure that occur with breathing also assist in the return of blood. </li></ul><ul><li>Varicose veins develop when the valves of veins become weak. </li></ul><ul><li>Hemorrhoids (piles) are due to varicose veins in the rectum. </li></ul><ul><li>Phlebitis is inflammation of a vein and can lead to a blood clot and possible death if the clot is dislodged and is carried to a pulmonary vessel. </li></ul>
The Blood Vessels <ul><li>The cardiovascular system has three types of blood vessels: </li></ul><ul><li>Arteries (and arterioles ) – carry blood away from the heart </li></ul><ul><li>Capillaries – where nutrient and gas exchange occur </li></ul><ul><li>Veins (and venules ) – carry blood toward the heart. </li></ul>
The Arteries <ul><li>Arteries and arterioles take blood away from the heart. </li></ul><ul><li>The largest artery is the aorta . </li></ul><ul><li>The middle layer of an artery wall consists of smooth muscle that can constrict to regulate blood flow and blood pressure. </li></ul><ul><li>Arterioles can constrict or dilate, changing blood pressure. </li></ul>
The Capillaries <ul><li>Capillaries have walls only one cell thick to allow exchange of gases and nutrients with tissue fluid. </li></ul><ul><li>Capillary beds are present in all regions of the body but not all capillary beds are open at the same time. </li></ul><ul><li>Contraction of a sphincter muscle closes off a bed and blood can flow through an arteriovenous shunt that bypasses the capillary bed. </li></ul>
The Veins <ul><li>Venules drain blood from capillaries, then join to form veins that take blood to the heart. </li></ul><ul><li>Veins have much less smooth muscle and connective tissue than arteries. </li></ul><ul><li>Veins often have valves that prevent the backward flow of blood when closed. </li></ul><ul><li>Veins carry about 70% of the body’s blood and act as a reservoir during hemorrhage . </li></ul>
Blood <ul><li>Blood separates into two main parts: plasma and formed elements . </li></ul><ul><li>Plasma accounts for 55% and formed elements 45% of blood volume. </li></ul><ul><li>Plasma contains mostly water (90–92%) and plasma proteins (7–8%), but it also contains nutrients and wastes. </li></ul><ul><li>Albumin is a large plasma protein that transports bilirubin; globulins are plasma proteins that transport lipoproteins. </li></ul>
The Red Blood Cells <ul><li>Red blood cells ( erythrocytes or RBCs ) are made in the red bone marrow of the skull, ribs, vertebrae, and the ends of long bones. </li></ul><ul><li>Normally there are 4 to 6 million RBCs per mm 3 of whole blood. </li></ul><ul><li>Red blood cells contain the pigment hemoglobin for oxygen transport; hemogobin contains heme , a complex iron-containing group that transports oxygen in the blood. </li></ul>
<ul><li>The air pollutant carbon monoxide combines more readily with hemoglobin than does oxygen, resulting in oxygen deprivation and possible death. </li></ul><ul><li>Red blood cells lack a nucleus and have a 120 day life span. </li></ul><ul><li>When worn out, the red blood cells are dismantled in the liver and spleen. </li></ul>
<ul><li>Iron is reused by the red bone marrow where stem cells continually produce more red blood cells; the remainder of the heme portion undergoes chemical degradation and is excreted as bile pigments into the bile. </li></ul><ul><li>Lack of enough hemoglobin results in anemia . </li></ul><ul><li>The kidneys produce the hormone erythropoietin to increase blood cell production when oxygen levels are low. </li></ul>
The White Blood Cells <ul><li>White blood cells ( leukocytes ) have nuclei, are fewer in number than RBCs, with 5,000 – 10,000 cells per mm 3 , and defend against disease. </li></ul><ul><li>Leukocytes are divided into granular and agranular based on appearance. </li></ul><ul><li>Granular leukocytes ( neutrophils , eosinophils , and basophils ) contain enzymes and proteins that defend the body against microbes. </li></ul>
<ul><li>The aganular leukocytes ( monocytes and lymphocytes ) have a spherical or kidney-shaped nucleus. </li></ul><ul><li>Monocytes can differentiate into macrophages that phagocytize microbes and stimulate other cells to defend the body. </li></ul><ul><li>Lymphocytes are involved in immunity. </li></ul><ul><li>An excessive number of white blood cells may indicate an infection or leukemia ; HIV infection drastically reduces the number of lymphocytes. </li></ul>
The Platelets and Blood Clotting <ul><li>Red bone marrow produces large cells called megakaryocytes that fragment into platelets at a rate of 200 billion per day; blood contains 150,000–300,000 platelets per mm 3 . </li></ul><ul><li>Twelve clotting factors in the blood help platelets form blood clots. </li></ul>
Blood Clotting <ul><li>Injured tissues release a clotting factor called prothrombin activator , which converts prothrombin into thrombin. </li></ul><ul><li>Thrombin, in turn, acts as an enzyme and converts fibrinogen into insoluble threads of fibrin . </li></ul><ul><li>These conversions require the presence of calcium ions (Ca 2+ ). </li></ul><ul><li>Trapped red blood cells make a clot appear red. </li></ul>
Hemophilia <ul><li>Hemophilia is an inherited clotting disorder due to a deficiency in a clotting factor. </li></ul><ul><li>Bumps and falls cause bleeding in the joints; cartilage degeneration and resorption of bone can follow. </li></ul><ul><li>The most frequent cause of death is bleeding into the brain with accompanying neurological damage. </li></ul>
Bone Marrow Stem Cells <ul><li>A stem cell is capable of dividing into new cells that differentiate into particular cell types. </li></ul><ul><li>Bone marrow is multipotent , able to continually give rise to particular types of blood cells. </li></ul><ul><li>The skin and brain also have stem cells, and mesenchymal stem cells give rise to connective tissues including heart muscle . </li></ul>
Capillary Exchange <ul><li>At the arteriole end of a capillary, water moves out of the blood due to the force of blood pressure . </li></ul><ul><li>At the venule end, water moves into the blood due to osmotic pressure of the blood. </li></ul><ul><li>Substances that leave the blood contribute to tissue fluid , the fluid between the body’s cells. </li></ul>
<ul><li>In the midsection of the capillary, nutrients diffuse out and wastes diffuse into the blood. </li></ul><ul><li>Since plasma proteins are too large to readily pass out of the capillary, tissue fluid tends to contain all components of plasma except it has lesser amounts of protein. </li></ul><ul><li>Excess tissue fluid is returned to the blood stream as lymph in lymphatic vessels . </li></ul>
Cardiovascular Disorders <ul><li>Cardiovascular disease ( CVD ) is the leading cause of death in Western countries. </li></ul><ul><li>Modern research efforts have improved diagnosis, treatment, and prevention. </li></ul><ul><li>Major cardiovascular disorders include atherosclerosis, stroke, heart attack, aneurysm, and hypertension. </li></ul>
Atherosclerosis <ul><li>Atherosclerosis is due to a build-up of fatty material ( plaque ), mainly cholesterol, under the inner lining of arteries. </li></ul><ul><li>The plaque can cause a thrombus (blood clot) to form. </li></ul><ul><li>The thrombus can dislodge as an embolus and lead to thromboembolism . </li></ul>
Stroke, Heart Attack, and Aneurysm <ul><li>A cerebrovascular accident , or stroke , results when an embolus lodges in a cerebral blood vessel or a cerebral blood vessel bursts; a portion of the brain dies due to lack of oxygen. </li></ul><ul><li>A myocardial infarction , or heart attack , occurs when a portion of heart muscle dies due to lack of oxygen. </li></ul>
<ul><li>Partial blockage of a coronary artery causes angina pectoris , or chest pain. </li></ul><ul><li>An aneurysm is a ballooning of a blood vessel, usually in the abdominal aorta or arteries leading to the brain. </li></ul><ul><li>Death results if the aneurysm is in a large vessel and the vessel bursts. </li></ul><ul><li>Atherosclerosis and hypertension weaken blood vessels over time, increasing the risk of aneurysm. </li></ul>
Coronary Bypass Operations <ul><li>A coronary bypass operation involves removing a segment of another blood vessel and replacing a clogged coronary artery. </li></ul><ul><li>It may be possible to replace this surgery with gene therapy that stimulates new blood vessels to grow where the heart needs more blood flow. </li></ul>
Clearing Clogged Arteries <ul><li>Angioplasty uses a long tube threaded through an arm or leg vessel to the point where the coronary artery is blocked; inflating the tube forces the vessel open. </li></ul><ul><li>Small metal stents are expanded inside the artery to keep it open. </li></ul><ul><li>Stents are coated with heparin to prevent blood clotting and with chemicals to prevent arterial closing. </li></ul>
Dissolving Blood Clots <ul><li>Medical treatments for dissolving blood clots include use of t-PA ( tissue plasminogen activator ) that converts plasminogen into plasmin, an enzyme that dissolves blood clots, but can cause brain bleeding. </li></ul><ul><li>Aspirin reduces the stickiness of platelets and reduces clot formation and lowers the risk of heart attack. </li></ul>
Heart Transplants and Artificial Hearts <ul><li>Heart transplants are routinely performed but immunosuppressive drugs must be taken thereafter. </li></ul><ul><li>There is a shortage of human organ donors. </li></ul><ul><li>Work is currently underway to improve self-contained artificial hearts , and muscle cell transplants may someday be useful . </li></ul>
Hypertension <ul><li>About 20% of Americans suffer from hypertension ( high blood pressure ). </li></ul><ul><li>Hypertension is present when systolic pressure is 140 or greater or diastolic pressure is 100 or greater; diastolic pressure is emphasized when medical treatment is considered. </li></ul><ul><li>A genetic predisposition for hypertension occurs in those who have a gene that codes for angiotensinogen , a powerful vasoconstrictor. </li></ul>
Cardiac Signs and Symptoms <ul><li>Chest pain or pressure </li></ul><ul><li>Shortness of breath </li></ul><ul><li>Edema and weight gain </li></ul><ul><li>Palpitations </li></ul><ul><li>Fatigue </li></ul><ul><li>Dizziness or loss of consciousness </li></ul>
Heart Sounds (see video) <ul><li>S 1 and S 2 </li></ul><ul><li>S 3 and S 4 </li></ul><ul><li>Gallop sounds </li></ul><ul><li>Snaps and clicks </li></ul><ul><li>Murmurs </li></ul><ul><li>Friction Rub </li></ul>
<ul><li>Aorta & arteries tend to become less distensible </li></ul><ul><li>Heart becomes less responsive to catecholamines </li></ul><ul><li>Maximal exercise heart rate declines </li></ul><ul><li>Decreased rate of diastolic relaxation ( ↑in BP is more pronounced for systolic BP than diastolic BP) </li></ul><ul><ul><li>Note that hypertension is NOT a normal age-related process </li></ul></ul><ul><li>Compensatory mechanism are delayed/insufficient = orthostatic hypotension is common </li></ul><ul><li>Thickness of LV wall may increase with age due to blood vessel changes </li></ul>http://nursinglectures.blogspot.com
General Nursing Measures <ul><li>For cardiac function </li></ul><ul><li>ﾟ Hemodynamics monitoring </li></ul><ul><li>ﾟ O2 therapy </li></ul><ul><li>ﾟ Drug therapy </li></ul><ul><li>ﾟ Hydration </li></ul><ul><li>ﾟ Prevention of infection </li></ul><ul><li>ﾟ Prevention of complications </li></ul><ul><li>ﾟ Prevention of psychosocial problems </li></ul><ul><li>ﾟ Rehabilitation </li></ul>
<ul><li>Oxygen carrying capacity of the blood </li></ul><ul><li>ﾟ Blood component replacement </li></ul><ul><li>ﾟ O2 therapy </li></ul><ul><li>ﾟ Drug therapy </li></ul><ul><li>ﾟ Hydration </li></ul><ul><li>ﾟ Prevention of infection </li></ul><ul><li>ﾟ Prevention of complications </li></ul><ul><li>ﾟ Prevention of psychosocial problems </li></ul><ul><li>ﾟ Rehabilitation </li></ul>