EXAM #2 Flashcards
(136 cards)
1
Q
Cardiovascular disease prevention
A
-No smoking or alcohol
-Prenatal care
-Folic acid
-Family hx of defects
2
Q
What are indicators of cardiac dysfunction?
A
-Poor feeding
-Tachypnea/cardia
-Failure to thrive/poor weight gain/activity intolerance
-Developmental delays
-Family and prenatal history
3
Q
Definition of a shunt:
A
Blood flow through an opening between two structures or vessels of the heart
4
Q
Definition of Murmur:
A
A sound heard when listening to the heart; reflects flow of blood within the heart
-Normal during periods of rapid growth
5
Q
What is CHF?
A
Inability of the heart to perform its function of pumping blood forward
6
Q
What are the s/s of congestive heart failure?
A
-Poor feeding and growth
-Irritability
-SOB
-Excessive sweating
-Hepatomeagly
-Edema
-Exercise intolerance
-Acities (older kids)
-Puffy eyelids
-Buldging fontanelles
7
Q
How to diagnose CHF:
A
-Hx & physical
-B-type natriuretic peptide
-Chest x-ray
-Exercise test
-Echocardiogram: looks at direction of blood flow
-MRI
-Cardiac cath
8
Q
Nursing care for CHF:
A
-Comfort care
-Oxygenation
-Skin care
-Continious V/S monitoring
9
Q
Medications for CHF management:
A
-Cardiac Glycoside (Digoxin)
-Loop Diuretic (Furosemide)
10
Q
What HR should we hold Digoxin for a new born?
A
less than 100
11
Q
What HR should we hold Digoxin for a child?
A
Less than 70
12
Q
What HR should we hold Digoxin for an adolescent?
A
Less than 60
13
Q
What foods should be consumed when on loop diuretics
A
Foods high in potassium (banana, broccoli, grapefruit)
14
Q
What is cardiac catheterization used for?
A
Diagnosis and repair for CHF
15
Q
Nursing management for Cardiac Cath:
A
-Pressure dressing
-Monitor V/S
-Check for pulse distally
-Immobilization of patient
-Bedrest for 6 hours afterwards
-Quiet play for 24 hours
16
Q
What medications do we give for any congenital heart defect?
A
-Angiotensin Converting Enzymes (ACE) inhibitor (Captopril)
-Cardiac glycoside (Digoxin)
-Loop Diuretic (Furosemide)
17
Q
Does pulmonary blood flow increase or decrease with acyanotic CHD?
A
Increase
18
Q
Does pulmonary blood flow increase or decrease with cyanotic CHD?
A
Decrease
19
Q
ANY CHD that starts with a T or H is considered an _______ defect
A
Cyanotic defect. If it doesn’t start with T or H, is is acyanotic.
5 Ts and H (hypoplastic Left sided heart defect)
20
Q
What is the Increased pulmonary blood flow defect? What are the types?
A
An abnormal connection between two sides of the heart.
-Atrial Septal Defect
-Ventricular Septal Defect
-Patent Ductus Arteriosus
21
Q
How is blood flow affected in the Increased pulmonary blood flow defects?
A
-Increased pulmonary blood flow
-Decreased systemic blood flow
22
Q
What is an Atrial Septal Defect?
A
Simple defect of the atria
23
Q
Clinical manifestations for Atrial Septal Defect:
A
-Possible Murmur or Thrill
-Possible right atrium enlargement
-Hepatomeagly (fluid overload)
-SOB
-Respiratory distress
-Periorbital edema
-Failure to thrive
-Increased risk for respiratory infection
-Increased risk for stroke
24
Q
What is a Ventricular Septal Defect?
A
Defect in the ventricular septum.
25
Clinical Manifestations for Ventricular Septal Defect:
-Asymptomatic
-SOB
-Feeding difficulties
-Poor growth
-Easy fatiguability
-Recurrent respiratory infections
-Murmur
-Harsh murmur or thrill
26
Nursing care for Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD):
-Monitor V/S until stable
-CHF management: Digoxin & Lasix
Monitor for complications:
-Chest pain, palpitations, sudden hypotension, dehydration or anemia.
27
Medical management for Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD):
-May spontaneously close by itself.
-Surgical repair or closure device.
28
Postoperative mangement for Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD):
-Limit exposure & cluster care
-Prophylatic antibiotics
-Offer small, frequent meals
-Suction secretions
-Keep warm and relaxed
-Monitor I & Os (limit fluids as ordered)
-Monitor K level
-Change position Q2 hrs
-Give oxygen
29
What is Patent Ductus Arteriosus?
Blood flows from the Aorta to the pulmonary artery through abnormal connection (normal in fetus).
30
Clinical Manifestations of Patent Ductus Arteriosus:
-Harsh Murmur
-Frequent colds
-Susceptible to RSV
-Fatigue
-Poor feeding & growth pattern
-Wide pluse pressure
-Bounding pulse
31
Nursing care for Patent Ductus Arteriosus (PDA):
-Monitor V/S
-Wound-care (RITA)
-Allow time to close
-Ventilatory support
-Fluid restrictions and Diuretics
-Indomethacin (closes defect)
-Ibuprofen or NSAID
-Incubator or radiant warmer
32
Medical management for Patent Ductus Arteriosus (PDA):
-Thoracotomy
-VATS if medical mangement fails
-Coils and super glue
33
What is Coarctation of the aorta?
Narrowing or stricture of the descending aorta distal to the carotid arteries (2 links of sausage)
34
Clinical manifestations of Coarctation of the aorta:
-Murmur
-CHF signs
-Pain in the legs or cyanotic lower extremities due to lack of blood flow
-Increased pressure to head and upper extremities
35
Nursing care for Coarctation of the aorta:
-Monitor upper and lower blood pressures
-May have postsurgical rebound hypertension = HTN (give antihypertensive agents for 6-12mths)
36
Medical management for Coarctation of the aorta:
-Cardiac Cath-baloon angioplasty & vulvuloplasty
-Give Captopril (Capoten) or enalapril (Vasotec) as well as Digoxin and Lasix
37
What is Tetralogy of Fallot?
Four associated defects:
-Pulmonary stenosis
-Right Ventricular Hypertrophy
-Overriding Aorta
-Ventral Septal Defect
38
Clinical Manifestations for Tetralogy of Fallot:
-Tachypnea
-Dyspnea on Exertion
-Growth failure
-Cyanosis
-Harsh Murmur
-Rt ventricular hypertrophy.
39
What are TET spells? What helps prevent them?
-Cyanotic event that is exacerbated by excitement or crying.
-Pre-oxygenate, knee-chest position, and morphine.
40
What is transposition of great vessels?
Switching of the aorta and pulmonary artery
41
Clinical Manifestations of transposition of great vessels:
-Cyanosis
-SOB
-Poor feeding
-Clubbing of fingers and toes
-Murmur (sometimes)
42
Surgical interventions for transposition of great vessels:
Arterial switch operation
43
What is hypoplastic left heart syndrome?
-Ventricle is small or hypoplastic and unable to maintain CO. Right ventricle must work quickly as the main pumping mechanism.
-Poor outcomes.
44
Nursing & surgical mangement for hypoplatic left heart syndrome:
-Prostaglandin given to keep PDA open
-Norwood procedure
-BT Shunt
-Glenn procedure
-Fontan procedure
-Pallative or End-of-Life care in severe cases.
45
What labs should be monitored in cyanotic heart disease?
Hbg & Hct
46
Important things to remember when giving Digoxin:
-Assess Apical pulse for one min
-Give consistently
-DO NOT administer if child throws it up
47
How often should you palpate the liver for R sided HF?
Q 4-12 hours
48
Pathophysiology of Kawasaki's Disease:
Acute systematic vaculitis of unknown cause with increased risk of coronary artery aneurysm.
-May progess to myocarditis or rhythm disturbances
-May form scars
49
Clinical Manifestations of Kawasaki's Disease:
-Skin Rash
-Cervical lymphadenopathy unilateral
-Strawberry tongue and cracking lips
-Conjunctivitis without exxudate
-High fever
50
Nursing care/education for Kawasaki's Disease:
-Support if they have aneurysm repair
-Medication
-Follow up appointments
-May be placed on anticoagulant therapy, blood testing and monitoring
-Activity restrictions
51
Pharmacological treatment/management for Kawasaki's Disease
-IV immunoglobulin/ gammaglobulin
-NSAIDs-Salicylates (Aspirin)
-Digoxin
-Angiorensin enzyme inhibitiors-reduces the after load on the heart
-Lasix
52
What is Rheumatic Fever/Disease?
RF: self limiting (3mths)
-From Group A B-hemolytic streptococcal pharyngitis
Acute phase: Connective tissue inflammation (joints, brain, serous surfaces & heart)
Proliferative phase: Heart valves are damaged leading to stenosis & regurgitation
53
How to Dx Rheumatic disease:
JONES (major) PEACE (minor) Critera
*Joints polyarthritis (hot, swollen joints)
*Heart (carditis, valve damage)
*Nodules (subcutaneous)
*Erythema marginatum (painless rash)
*Syndenham chorea (flinching movement)
*Previous rheumatic fever
*ECG and PR prolongation
*Arthragias
*CRP and ESR elevated
*Elevated temperature
Presence of 2 major or 1 major & 2 minor criteria.
54
Clinical manifestations of Rheumatic Fever/Disease
-Carditis & valvulitis
-Polyarthritis
-Erythema marginatum
-Subcu nodules
-Arthragia
-Fever elevated ESR or C-reactive protein
-Prolonged PR interval
55
Pharmacological treatment for Rheumatic Disease:
-Penicillin
-NSAIDs-Salicylates (Aspirin)
56
Are newborns obligatory nose breathers?
Yes. Newborns tend to have non-productive coughs which makes them more susceptible to respiratory infections
57
Clinical manifestations of respiratory dysfunction
*Respiratory distress: grunting, nasal flaring, retractions, cyanosis, tachypnea
Associated symptoms:
-Fever
-Anorexia
-Vomiting
-Nasal blockage & drainage
-Agitation/ excessive fussiness
58
Cystic fibrosis pathophysiology:
Exocrine galdn dysfunction that involves the respiratory, GI, and reproductive systems.
-Thick mucus accumulates in glands and ducts
-Mechanical obstruction
-Pancreas ducts are blocked which prohibits that secretion of pancreatic enzymes that aid in digestion. May lead to diabetes
-Constant/increased respiratory infections
59
Diagnostic testing for cystic fibrosis:
-Sweat chloride test: + 60
-Chest X-ray: consolidation & atelectasis
-Pulmonary function test: lowers over time
-Stool fat and enzyme analysis: Decrease in Fat soluble vitamins (ADEK)
60
Signs and symptoms of cystic fibrosis:
-Wheezing/crackles
-Diminished breath sounds
-Generalized obstructive emphysema
-Patchy atelectasis
-Clubbing of fingers and toes
-Bronchitis & pneumonia
-Meconium ileus
-Steaorrhea
-Tachypnea, hypoxia and cyanosis
-Salty skin/tears (hyponatremia & hypochloremic)
-Hypoalbuminemia
-Distal intestinal obstruction syndrome
-Dehydration
-Sterility in males
61
CF: Compression of pulmonary blood vessels leads to...
Pulmonary hypertension, respiratory failure, and death.
62
Medical care for cystic fibrosis:
-CPT (chest physiotherapy) b/f meals 2/3 times per day
-Bronchodialator meds
-IS
-Antibiotics
-Chest tube insertion
-Steroids & NSAIDS
-Transplant
- Enzyme replacement with meals
-Salt supplementation
63
What kind of meals should be implemented with cystic fibrosis?
High protein and high calorie
-Vitamin supplementation
64
Education/discharge instructions for CF:
-CPT at home and then suction
-Do not eat before PT
-Monitor child's weight
65
Nursing interventions for CF:
-Wash hands
-Monitor temp q 4 hours, report temp over 101.3 or three temps greater than 100 in 24 hr
-Assess for s/s of infection
-Monitor CBC, protein, albumin, and cultures
66
Etiology of pharyngitis:
Adenovirus and Group A Beta-hemolytic streptococci
67
How to diagnose pharyngitis:
Throat culture with rapid step test.
68
Signs and symptoms of pharyngitis:
-Abrupt onset
-Fever
-Sore throat
-Difficulty swallowing
-HA
-Abdominal pain
-Inflammed, red, and enlarged pharynx, often covered with exudate
-Anterior cervical lymphadenopathy
-Petechiae on the palate
69
How to prevent pharyngitis & tonsillitis:
Hand washing, cover cough and avoid second-hand smoke
70
Nursing management for pharyngitis:
Viral
-Supportive care
-Acetaminophen or ibuprofen
Bacterial
-Penicillin (amoxicillin) 10 days
71
Education/discharge instructions for pharyngitis:
-Give full and all doses for antibiotics
-No school for 24 hrs until fever free
-Acetaminophen or ibuprofen
-New toothbrush
72
Pathophysiology & etiology for tonsillitis:
Inflammation & infection of the tonsils by virus or Group A strep
73
Signs and symptom for tonsillitis:
-Enlarged tonsils
-Dysphagia
-HA
-Malaise
-Halitosis
74
What is a potential complication of tonsillitis?
Peritonsillar abscess
75
Medical care for tonsillitis:
Tonsillectomy for chronic tonstillitis
-6 weeks after infection is resolved
-3 treated infections in one yr indicate need for surgery.
76
Aftercare for tonsillectomy:
-Pain medications
-Keep patient on lateral side
-Avoid coughing, clearing of the throat and blowing the nose.
-Give ice packs
-Give water, ice chips and ice pop (do not give brown or red pops)
-Give gelatin foods, cooked fruit, sherbert, soup mashed potatoes if liquids are tolerated well
-Avoid milk and dairy
77
Education and discharge instructions for tonsillectomy:
Avoid highly seasoned foods and aggressive brushing/garggling
78
What may indicate that the child is bleeding after a tonsillectomy?
Continious swallowing, restlessness, increased HR, and pallor.
79
Croup etiology:
-Parainfluenza virus or RSV
-Less often Group A, S
pnuemoniae, S aureus
Affects the larynx, trachea, and bronchi
80
Signs and symptoms of Croup:
-Hoarseness
-“barking” cough
-inspiratory stridor
-Varying degrees of respiratory distress
81
Medical mangement for Croup:
Corticosteriods, Nebulized epinephrine.
82
Acute Epiglottitis Pathophysiology & Etiology
-Acute inflammation of the epiglottis
-Haemophilus influenzae type b (HiB)
83
Acute epiglottitis Clinical Manifestations:
* Rapid onset
* Tripod positioning
* Drooling, protruding tongue
* Dysphagia
* Muffled Speech
* Retractions
* Inspiratory stridor
* High Fever 105
84
Prevention of Acute epiglottitis:
Haemophilus influenzae type b (Hib) vaccine
85
Diagnostic testing for Acute epiglottitis:
* Steeple Sign (airway x-ray)
* Thumb Sign (lateral airway x-ray)
86
Nursing interventions for acute epigottitis:
* Antibiotics
* Cool mist humidification
* Oxygen
* IV fluids
* Do not examine the throat due to risk of laryngospasm (emergency)
* Monitor for drooling and tripod positioning (leaning forward) as these are signs of airway obstruction and warrant immediate attention
* Trach/endotracheal tube available
87
Acute Laryngotracheobronchitis (LTB) Etiology:
* S. aureus, RSV, parainfluenza virus
88
Clinical Manifestations of Acute Laryngotracheobronchitis (LTB):
* Inspiratory stridor
* Suprasternal retractions
* Barking or “seal-like” cough
* Increasing respiratory distress and hypoxia
* Purulent sputum
* High Fever
89
Therapeutic Management for Acute Laryngotracheobronchitis (LTB):
* Airway management: high flow nasal canula
* Maintain hydration, I/O’s (orally or intravenously)
* High humidity with cool mist
* Nebulizer treatments, racemic epinephrine, steroids
90
Pathophysiology & Etiology of Otitis externa (swimmer's ear):
* persistent excessive moisture causes an inflammatory reaction in canal, pinna, & TM.
* Worse in warm climates and summertime
* Long time submerged in water
* Pseudomonas, Candida, & Aspergillus
* Digital trauma, foreign body
91
Clinical Manifestations of otitis externa (swimmer's ear):
* Feeling of pressure/fullness
* Redness and edema of ear canal
* Itching
* Pain with chewing or when pinna or tragus is manipulated
* No fever
* Otorrhea
92
Nursing Management for otitis externa (swimmer's ear):
* Focus on prevention
* Keep canal dry
* Warm compresses can help manage pain
93
Medications for otitis externa (swimmer's ear):
* Ear drops (antibiotic/antifungal)
* Glucocorticosteroids (prednisone)
* Antipyretics/Analgesics
* NSAIDS
94
Etiology of otitis media:
* Streptococcus pneumoniae, H. influenza &
Moraxella catarrhalis are the most common bacteria
* Passive smoke increase risk
* URI, allergic rhinitis or hypertrophic adenoids
* Breastfeeding babies have a lower risk both horizontal positioning and immature
structure/function of the eustachian tubes predispose small children
95
Clinical Manifestations for otitis media:
* Ear Pain
* Fever
* Purulent discolored effusion and a bulging,
red, immobile tympanic membrane
* Irritability and ear pulling is the initial signs
for infants who are non-verbal
96
Pharmacologic management for otitis media
* Antibiotic x 10-14 days
* Acetaminophen or ibuprofen for pain management
* Ear drops
97
Patient education for otitis media:
* Antibiotic administration
* Hold child upright when feeding
* Do not prop bottle
* No Q-tips
* No second hand smoke exposure
98
Surgical management for tympanostomy:
* Child may have temporary hearing loss
* Keep bath water out of ear, keep out of lakes, no swimming for 2 weeks
* No nose blowing for 7-10 days
* Keep ears dry (earplugs or cotton balls)
99
Pathophysiology of Bronchiolitis /Respiratory Syncytial Virus:
The bronchiole mucosa swell and lumina are filled with mucus and exudate
100
Diagnostic Testing for Bronchiolitis /Respiratory Syncytial Virus:
* ELISA-enzyme-linked immunosorbent assay
* X-ray
101
Clinical Manifestations for Bronchiolitis /Respiratory Syncytial Virus
* URI, rhinorrhea
* Fever
* Non-productive cough, paroxysmal
* Apnea
* Intercostal retractions is a hallmark sign of this diagnosis
102
Therapeutic Management for Bronchiolitis /Respiratory Syncytial Virus
* Contact precautions
* Monitor oxygenation, cool mist/hood/tent
* Bronchodilator therapy
* Hydration / IV therapy
* Use of bulb syringe, saline drops to nares prior to all feeds (infants are nose breathers)
* Continue to breast feed or pump if infant wont feed
103
Etiology of Pertussis (Whooping Cough):
* Caused by Bordetella pertussis
* Children who have not been
immunized/incomplete
* Highest incidence in spring and summer
104
Prevention of Pertussis (Whooping Cough):
* Prevention Vaccines are available
* DTaP is the childhood vaccine
* Tdap booster vaccine for preteens, teens,
and adults
105
Clinical Manifestations of Pertussis (Whooping Cough):
* Paroxysmal cough
* Inspiratory whoop
* Cyanosis
* Red face/protruding tongue with cough
* Vomiting
* Conjunctival hemorrhage/facial petechiae
106
Pertussis (Whooping Cough) Therapeutic Management:
* Maximize nutrition
* Provide adequate hydration
* Rest and recovery
* Antibiotics as prescribed
* Keep open airway
* Monitor oxygen saturation
107
Pharmacological Management and isolation type of Pertussis (Whooping Cough):
* Antibiotics (erythromycin or
trimethoprim/sulfamethoxazole)
* Isolation: droplet and contact
108
Clinical Manifestations of Influenza:
Rapid onset of high fever, myalgia, headache, sore throat,
nonproductive cough
109
What medication is given for influenza?
Tamiflu
110
Nursing implications for Tamiflu
Start within 1st 48 hours
111
Isolation type and Nursing care for Influenza:
*Droplet and contact
* Supportive (antipyretics,
rest, hydration)
* Isolated until signs/symptoms subside
* No aspirin
112
Foreign Body Aspiration /Obstruction s/s:
Airway
* Inability to speak, drooling, cyanosis, syncope, stridor
Ear
* Drainage, hearing loss, pain, cerumen impaction
Nose
* Drainage, warped sense of smell, frequent blowing of nose or “sniffing,” mouth
breathing
113
Therapeutic Management of foreign body aspiration/obstruction:
* Retrieve foreign object
* Educate on prevention!
* Appropriate toys according to developmental age
* Supervise children at all times
* Be very diligent about toys or items that contain small piece
114
Asthma Pathophysiology & Causes:
* Inflammation and edema of the mucous membranes, accumulation of tenacious secretions from mucous glands, and spasms or the smooth muscle of the bronchi and bronchioles which decrease the caliber of the
bronchioles
* IgE mediated response
* Extrinsic/environmental
115
Clinical Manifestations of asthma:
* Wheezing
* Tachypnea
* Non-productive cough
* Chest tightness
* Prolonged expiratory phase
116
Asthma preventative measures & diagnostic testing:
* Identify triggers
* Allergy testing to determine sensitivities
* Pulmonary function tests
* Skin testing for allergens
117
Complications of Asthma:
* Status Asthmaticus; asthma attack not controlled by inhaled medication
* Respiratory distress continues despite vigorous therapeutic measures
* Emergency treatment: epinephrine 0.01 ml/kg subcutaneously (maximum dose 0.3 ml)
* Emergency: silent chest (absence of wheezing in a previously wheezing patient
118
Patient Education for asthma:
* Symptom recognition
* Allergen control or avoidance of precipitating activities or substances
* Using a peak flow meter; monitor function with peak flow meter
* Asthma action plan
* Oral hygiene when using inhalers
119
Pharmacological Therapy for asthma (long-term and short-term):
Short Term
* Short acting beta-agonists-Albuterol (#1)
* This is your rescue inhaler for symptomatic treatment
Long Term/Preventative
* Corticosteroids (The inhaled form is the anti-inflammatory drug of choice for persistent asthma.)
* Mast cell stabilizers (anti-inflammatory drugs)
* Long-acting beta-agonists (bronchodilators often used along with an anti inflammatory drug)
* Theophylline (a bronchodilator used along with an anti-inflammatory drug to prevent nighttime symptoms)
* Leukotriene modifiers (an alternative to steroids and mast cell stabilizers)
* Xolair (an injectable asthma medication used when inhaled steroids for asthma failed to control asthma symptoms in people with moderate to severe asthma who also have allergies)
120
Bronchopulmonary Dysplasia Pathophysiology & Prevention:
* long term O2 use causes dependence, damages tissue, causes fibrosis
w/ decreased compliance.
Prevention
* Keep 02 at the lowest possible concentrations in newborns
121
Diagnostics for Bronchopulmonary Dysplasia:
CXR will show cyst formation, increased density, and hyperinflation of the lungs
122
Therapeutic and Phamacological Management for Bronchopulmonary Dysplasia:
* Wean newborn's off O2 ASAP
Pharmacological:
* Bronchodilators (Albuterol)
* Anticholinergic (Ipratropium)
* Xanthine (Theophylline)
* Inhaled Glucocorticoids (Fluticasone)
123
Esophageal Atresia and Tracheoesophageal Fistula
Pathophysiology:
The esophagus ends in a blind pouch. Sometimes body naturally creates a fistula
connecting to the trachea.
124
Esophageal Atresia and Tracheoesophageal Fistula
Clinical Manifestations:
* Excessive drooling/secretions/frothing
* Cyanosis
* Respiratory distress/coughing
* Choking with attempted feeds
* Inability to pass NG/OG tubes
125
Diagnostic Testing for Esophageal Atresia and
Tracheoesophageal Fistula:
* Prenatal sonogram
* CXR
126
Therapeutic Management for Esophageal Atresia and
Tracheoesophageal Fistula:
* Maintain patent airway
* NPO immediately, high aspiration risk
* Positioning
*No NG tube
* Surgical correction
***Obtain consent***
127
A 4 year old on aspirn therapy has rheumatic fever what should you monitor for:
Gastric alternation
128
A child with a cyanotic heart disorder is going to have their teeth cleaned, what med should the nurse anticipate?
Amoxicillin
129
What medication does the nurse anticipate for a child with hyperplastic heart defect?
Prostaglandins, keeps defect open
130
What is Reye's syndrome?
encephalitis-like illness that occurs when taking aspirn with a viral disease.
Watch out for N/V, lethargy, indifference, delirum and rapid breathing.
131
What pathogen causes epigoltitis?
Hib
132
Do not give fluids to a child who is drooling. T or F
True
133
Do we give bronchodilators before or after chest physiotherapy?
before
134
Which vaccine is not a live one?
Hep B
135
What tool is used to determine the size of the VSD?
Echocardiogram
136
What foods have good potassium?
Green leafy vegetables, grapefruit, oranges
