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Cardiovascular, Immune, and Lymphatic Systems and Blood

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1 Cardiovascular, Immune, and Lymphatic Systems and Blood
Chapter 10 Cardiovascular, Immune, and Lymphatic Systems and Blood Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2 Chapter 10 Lesson 10.1 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10-2

3 Objectives Identify organs and structures of the cardiovascular and lymphatic systems and blood; and the function of the immune system. Define and spell the word parts related to the cardiovascular and lymphatic systems and blood. Define, pronounce and spell disease and disorder terms related to the cardiovascular and lymphatic systems and blood. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

4 Function of the Cardiovascular System
Pumps and transports blood throughout the body. It consists of the heart and a closed network of blood vessels made up of arteries, capillaries and vein. The heart pumps blood containing oxygen and nutrients to body tissues through the arteries. The exchange of gases, nutrients and waste between the blood and body tissue takes place in the capillaries. The blood carrying carbon dioxide and waste is carried from the tissues through veins to organs of excretion. What structures comprise the cardiovascular system? How does the cardiovascular system work in conjunction with the respiratory system studied earlier in this text? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

5 Interior of the Heart Have the students note the various structures of the heart and their names. Which of the listed terms are combining forms? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

6 Types of Blood Vessels Do veins branch out from arteries, or are they separate? What is the function of the capillaries? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

7 Cardiovascular System
heart: muscular cone-shaped organ the size of a closed fist, located behind the breast bone and between the lungs. The pumping action circulates blood throughout the body. upper chambers: right and left atria lower chambers: right and left ventricles Why is the heart referred to as a muscular organ? Where is another septum in the body? (nose) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

8 Cardiovascular System (cont’d.)
tricuspid valve: located between right atrium and right ventricle mitral valve: located between the left atrium and left ventricle pericardium: two layer sac which facilitates movement of the heart myocardium: middle, thick, muscular layer endocardium: inner lining of the heart Why do all the layers of the heart contain the suffix -cardium? What are the layers of the heart? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

9 Cardiovascular System (cont’d.)
blood vessels: tubelike structures that carry blood throughout the body arteries: carry blood containing oxygen & other nutrients away from the heart to the body cells except for the pulmonary artery, which carries carbon dioxide and other waste products to the lungs arterioles: smallest arteries aorta: largest artery in the body What is the word root for arteries and arterioles? To what does the word root pulm/o refer? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

10 Cardiovascular System (cont’d.)
veins: carry blood containing carbon dioxide and other waste products back to the heart except for the pulmonary vein, which carries oxygenated blood from the lungs to the heart venules: smallest veins in the body venae cavae: largest veins in the body capillaries: connect arterioles with venules; exchange of gases takes place in capillaries Do veins carry blood away from the heart or to the heart? What is the origin of the term venae cavae? Since veins don’t have a “pump” behind them (the heart), what structural difference (from arteries) allows the veins to maintain the one-way flow? The lymph system also relies on valves to keep the flow of fluid going in one direction. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

11 Function of Blood Maintains internal balance in the body. Activities of the blood include transportation such as transporting nutrients, waste, oxygen, carbon dioxide, and hormones, protection provided by certain cells that protect the body against microorganisms and regulation by controlling temperature and maintaining fluid and electrolyte balance. What is the function of blood? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

12 Blood plasma: liquid portion of blood in which cells are suspended
cells: formed elements erythrocytes: red blood cells that carry oxygen leukocytes: white blood cells that combat infection thrombocytes (platelets): responsible for aiding in the clotting process What is the name of a disease referring to excessive white blood cells? Is coagulation a combining form? What word parts make up the terms erythrocyte and leukocyte? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

13 Function of the Lymphatic System
Returns excessive tissue fluid to the blood Absorbs fats and fats soluble vitamins from the small intestine and transports them to the blood. Provides defense against infection Lymphatic vessels . . . . similar to veins, lymphatic vessels transport lymph from body tissues to the chest where it enters the cardiovascular system. What does the word root lymph mean? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

14 Lymphatic System Note the distribution of the lymphatic system throughout the body. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

15 Lymphatic System (cont’d.)
lymph: transparent, colorless, tissue fluid lymph nodes: small, spherical bodies made up of lymphoid tissue; act as filters in keeping substances such as bacteria from the blood Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

16 Lymphatic System (cont’d.)
spleen: located in the left side of the abdominal cavity between the stomach and the diaphragm; largest lymphatic organ in the body thymus gland: located anterior to the ascending aorta and posterior to the sternum between the lungs; plays an important role in the development of the body’s immune system Most people do not know that the spleen is actually a lymph organ. Where does the old expression “vent your spleen” come from? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

17 Function of the Immune System
protects the body against pathogens (bacteria fungus, and viruses) foreign agents that cause allergic reactions (peanuts) or toxins (insect bites), and abnormal body cells (cancer). has three lines of defense; the first is the prevention of foreign substances from entering the body. Unbroken skin and mucous membranes act as mechanical barriers. Ear wax and saliva act as chemical barriers. How do bacteria, fungi, and viruses differ? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

18 Three lines of defense…
Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

19 Combining Forms of the Cardiovascular Immune, and Lymphatic Systems and Blood
angi/o aort/o arteri/o atri/o cardi/o lymphaden/o lymph/o myel/o phleb/o plasm/o What does the combining form angi/o mean? What is the combining form for “vein”? What is the other combining form for “vein”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

20 splen/o thym/o valv/o, valvul/o ven/o ventricul/o
Combining Forms of the Immune, Cardiovascular, and Lymphatic Systems (cont’d.) splen/o thym/o valv/o, valvul/o ven/o ventricul/o Ventricle is derived from Latin venter, meaning “little belly.” What does the combining form thym/o mean? What is the combining form for “ventricle”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

21 Combining Forms Used with Cardiovascular and Lymphatic Systems
ather/o ech/o electr/o isch/o therm/o thromb/o What does the combining form ather/o mean? What is the combining form for a “deficiency” or “blockage”? What is the combining form for “clot”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22 Prefix brady- What does the prefix brady- mean?
Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

23 Suffixes -ac -apheresis -graph -dynia -penia -poiesis -sclerosis
What does the suffix -apheresis mean? What is the suffix for “pain”? What is another suffix for “pain”? What does the suffix -poiesis mean? What is the suffix for “hardening”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

24 Similar Suffixes Used in Diagnostic Terms
Suffix Meaning Chapter -gram record, radiographic image -graph instrument used to record; record -graphy process of recording, radiographic imaging What are the differences among electrocardiograms, electrocardiographs, and electrocardiography Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

25 Clicker Question Which of the following means vein? arteri/o phleb/o
valv/o Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

26 Disease and Disorder Terms Built from Word Parts
Cardiovascular System angioma angiostenosis aortic stenosis arteriosclerosis atherosclerosis bradycardia cardiodynia Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

27 Disease and Disorder Terms Built from Word Parts (cont’d.)
Cardiovascular System cardiomegaly cardiomyopathy cardiovalvulitis endocarditis ischemia myocarditis pericarditis phebitis polyarteritis tachycardia thrombophlebitis What does the term cardiomegaly mean? What is the term for “inflammation of the heart valves”? What might be the physical result of ischemia? What is the term for “an inflammation of the heart muscle”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

28 Disease and Disorder Terms Built from Word Parts (cont’d.)
Blood hematoma pancytopenia thrombosis thrombus What does hematoma mean? What is the medical term for “an abnormal reduction of all blood cells”? An embolus can circulate in the bloodstream until it becomes lodged in a particular vessel. A thrombus is attached to a vessel’s interior wall; when it breaks away and enters the bloodstream, it becomes an embolus. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

29 Disease and Disorder Terms Built from Word Parts
Lymphatic System lymphadenitis lymphadenopathy lymphoma splenomegaly thymoma Lymphadenopathy is associated with infection or malignancy. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

30 Clicker Question Which of the following is analyzed correctly?
cardi/o/dynia cardi/odynia card/i/odynia Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

31 Disease and Disorder Terms Not Built from Word Parts
Cardiovascular System acute coronary syndrome (ACS) aneurysm angina pectoris arrhythmia atrial fibrillation cardiac arrest cardiac tamponade coarctation of the aorta congenital heart disease congestive heart failure (CHF) coronary artery disease coronary occlusion Acute coronary syndrome is a general term used when a patient with symptoms of acute angina or myocardial infarction seeks emergent treatment. Ancients believed angina pectoris was a disorder of the breast. The term is derived from the Latin angere, meaning “to choke,” and pectus, meaning “breast.” Coronary is derived from the Latin coronalis, meaning “crown or wreath.” It is used to describe the arteries that circle the heart. What is the term for an “obstruction of an artery of the heart”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

32 Aortic Stenosis This illustration shows a normal valve (top) and a valve with stenosis (bottom). Have the class note how the valve has narrowed. What would be the physical effect of aortic stenosis? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

33 Atrial Fibrillation Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

34 Aneurysm Have the class note the balloon-like appearance of the aneurysm. What would be the physical symptoms of a coronary aneurysm? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

35 Coarctation of the Aorta
What is the most recognizable symptom of coarctation? This is a congenital disorder. What does that mean? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

36 Disease and Disorder Terms Not Built from Word Parts (Cont’d.)
Cardiovascular system deep vein thrombosis (DVT) hypertensive heart disease (HHD) intermittent claudication mitral valve stenosis myocardial infarction peripheral arterial disease rheumatic heart disease varicose veins Common symptoms of peripheral atheroscelosis is intermittent claudication. What does rheumatic fever mean? What is the term for a “heart attack,” and what does it really mean? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

37 Disease and Disorder Terms Not Built from Word Parts (Cont’d.)
Blood anemia embolus (pl. emboli) hemophilia leukemia What does the term anemia mean? Name some types of anemia. What is the plural form of embolus? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

38 Disease and Disorder Terms Not Built from Word Parts (con’t)
Lymphatic System Hodgkin disease infectious mononucleosis Hodgkin disease is named after Thomas Hodgkin, who first described the disease in It was originally Hodgkin’s disease and only recently has the apostrophe been removed from this and other eponyms. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

39 Chapter 10 Lesson 10.2 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

40 Objectives Define, pronounce and spell surgical terms related to the cardiovascular lymphatic system and blood. Define, pronounce and spell diagnostic terms related to the cardiovascular system. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

41 Surgical Terms Built from Word Parts
Cardiovascular system angioplasty atherectomy endarterectomy pericardiocentesis phlebectomy phlebotomy valvuloplasty Lymphatic System splenectomy splenopexy thymectomy What is an endarterectomy? What is the most common location for an endarterectomy? What is the term for a “surgical puncture used to aspirate fluid from the outer sac of the heart”? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

42 Surgical Terms Not Built from Word Parts
Cardiovascular system aneurysmectomy bone marrow transplant cardiac pacemaker coronary artery bypass graft (CABG) coronary stent embolectomy femoropopliteal bypass implantable cardiac defibrillator intracoronary thrombolytic therapy coronary angioplasty (PTCA) percutaneous transluminal coronary angioplasty What does aneurysmectomy mean? How are a coronary stent and CABG related? What does percutaneous transluminal coronary angioplasty mean? When is an implantable cardiac defibrillator used? What would be the benefits of laser angioplasty compared with traditional angioplasty? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

43 Coronary Artery Bypass Graft
Have the class note the location of the bypass vessel. What is the arch-shaped vessel? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

44 Coronary Stent A B C Stent at site of plaque formation
The stent is a stiff cylinder or mold, fashioned to anchor a graft. Stent is not related to the term stenosis. Stent at site of plaque formation Inflated balloon and expanded stent Implanted stent Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

45 Implantable Cardiac Defibrillator
Describe how defibrillator paddles are placed on either side of the heart on the chest. Where else might you find defibrillators other than in a medical facility? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

46 Clicker Question Which of the following is performed to remove
fatty plaque from an artery? angioplasty aneurysectomy atherectomy Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

47 Surgical Terms Not Built from Word Parts
Blood bone marrow aspiration bone marrow biopsy bone marrow transplant What condition might be treated by a bone marrow transplant? What is the difference between a bone marrow biopsy and a bone marrow transplant? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

48 Bone Marrow Aspiration
Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

49 Placement of Defibrillator Paddles
Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

50 Diagnostic Terms Built from Word Parts
Cardiovascular System Diagnostic imaging angiography angioscope angioscopy aortogram arteriogram venogram venography What does the term angiography mean? Discuss the many types of angiography. What would an aortogram be used for? What is venography? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

51 Diagnostic Terms Built from Word Parts (cont’d.)
Cardiovascular System Cardiovascular diagnostic procedures echocardiogram (ECHO) electrocardiogram (ECG, EKG) electrocardiograph electrocardiography What is the difference between an echocardiogram and an electrocardiogram? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

52 What word is formed by the word parts listed on the slide
What word is formed by the word parts listed on the slide? (electrocardiogram) electrocardiogram Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

53 Diagnostic Terms Not Built from Word Parts
Cardiovascular System Diagnostic imaging digital subtraction angiography (DSA) Doppler ultrasound exercise stress test computed tomography (SBECT) single-photon emission thallium test transesophageal echocardiogram (TEE) How does digital subtracting angiography work? What is a Doppler ultrasound? What equipment does a person taking an exercise stress test use? What does a thallium test show? A transesophageal echocardiogram uses an ultrasound probe placed in the pharynx and esophagus. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

54 Diagnostic Terms Not Built from Word Parts (con’t)
Cardiovascular System Cardiovascular Studies cardiac catheterization impedance plethysmography (IPC) Is cardiac catheterization a type of angioplasty? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

55 Diagnostic Terms Not Built from Word Parts (cont’d.)
Cardiovascular System Other diagnostic terms auscultation blood pressure percussion pulse sphygmomanometer stethoscope c-reactive protein creatine phosphokinase homocysteine lipid profile troponin What does a sphygmomanometer measure? A stethoscope is used for auscultation and blood pressure measurement. What would a physician use percussion for? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

56 Measurement of blood pressure
Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

57 Clicker Question Which measures the number of times per
minute the heart beat is felt on the arterial wall? auscultation blood pressure pulse Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

58 Diagnostic Terms Not Built from Word Parts (cont’d.)
Blood Laboratory coagulation time complete blood count and differential count (CBC and Diff) hematocrit hemoglobin (Hgb) prothrombin time (PT) What is hemoglobin? What is coagulation time? What does prothrombin time show? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

59 Chapter 10 Lesson 10.3 Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

60 Objectives Define, pronounce and spell complementary terms related to the cardiovascular, and immune systems and blood. Interpret the meaning of abbreviations presented in the chapter. Interpret, read and comprehend medical language in simulated medical statements and documents. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

61 Complementary Terms Built from Word Parts
Cardiovascular system atrioventricular (AV) cardiac cardiogenic cardiologist cardiology hypothermia intravenous phlebologist phlebology What is a phlebologist? What would he or she treat? What is hypothermia? Would hypothermia ever be induced on purpose? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

62 Complementary Terms Built from Word Parts (cont’d.)
Blood hematologist hematology hematopoiesis hemolysis hemostasis myeloporesis plasmapheresis thrombolysis What is the term for the “dissolution of a clot”? What is the term for “stoppage of bleeding”? What does hematopoiesis mean? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

63 Clicker Question A patient diagnosed with leukemia would seek
treatment from a hematologist cardiologist phebologist Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

64 Complementary Terms Not Built from Word Parts
Cardiovascular system cardiopulmonary resuscitation (CPR) diastole extracorporeal extravasation fibrillation heart murmur hypercholesterolemia hyperlipidemia hypertriglyceridemia lipids What does diastole mean? Would a heart murmur be dangerous? Why do dentists make patients with heart murmurs take antibiotics before undergoing dental work? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

65 Complementary Terms Not Built from Word Parts (cont’d.)
Cardiovascular system hypertension hypotension lumen occlude systole vasoconstrictor vasodilator venipuncture Is hypotension high or low blood pressure? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

66 Complementary Terms Not Built from Word Parts (cont’d.)
Blood anticoagulant dyscrasial hemorrhage What would an anticoagulant be used for? What is a hemorrhage? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

67 Complementary Terms Not Built from Word Parts, Immune System
allergen allergist anaphylaxis antibodies antibiotic antigen autoimmune disease immune immunodeficiency immunologist immunology infection phagocytosis vaccine Name two autoimmune diseases. What are three types of immunity? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

68 Abbreviations ACS CPR AFib CRP AV CPK BP DSA CABG DVT CAD ECG, EKG CBC
CCU CHF CPR CRP CPK DSA DVT ECG, EKG ECHO HCT What does ACS stand for? What does CABG mean? What does CBC mean? Where would a CCU be located? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

69 Abbreviations (cont’d.)
Hgb HHD ICD IV MI PAD PT RBC SPECT TEE WBC What does Hgb mean? What does SPECT mean? Why do both ECG and EKG mean electrocardiogram? What does HHD mean? What does TEE mean? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

70 Read Medical Terms In Use
A 55-year-old man presented to his doctor with pain in the calf and swelling in the left foot and ankle. Five days before, the patient had traveled by air across the country, spending several hours in a sitting position. He has a history of varicose veins. No previous history of hypertension or thrombophlebitis existed. Physical examination revealed an edematous left lower extremity and a tender calf. The pedal pulse was intact. A Doppler ultrasound was obtained, which revealed deep vein thrombosis. The patient was hospitalized and subcutaneous low molecular weight heparin was begun. Concurrently, Coumadin was started and will continue for 6 months. The oral anticoagulant therapy will be monitored monthly by prothrombin time. Why is a history of varicose veins recorded? What type of diagnostic procedure was used? Did the patient have a history of high blood pressure? Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.


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