Exam 3 Flashcards

Question

Client educations for Peptic Ulcer Disease

Answer 1

- Hand hygiene - Cook food completely - Use all recommended cautions when taking pain relievers, Taking as low a dose over as short a length of time as possible, take with food. - Avoid excessive alcohol intake - Avoid smoking - Avoid chewing tobacco - Follow healthcare provider’s instructions and report if their are continuing symptoms, worsening symptoms, or more serious symptoms occur.

Answer 2

- Stomach acid flow back to esophagus - It irritate the lining of the esophagus - Esophageal strictures: The ulcers will swell and obstruct causing narrowing of the esophagus. - Esophageal ulcers - Symptoms: laryngitis, chronic dry cough, hoarseness, asthma, feeling as if there is a lump in the throat, sudden increase in saliva, bad breath, earahces, and/or chest pain.

Answer 3

- Factors that increase the chances of developing GERD: - Obesity - Hiatal hernia - Pregnancy - Smoking (weakens esophageal sphincter) - Dry mouth - Asthma - Diabetes - Delayed stomach emptying - Connective tissue disorders, such as scleroderma - Alcohol consumption (weakens esophageal sphincter)

Answer 4

- Abdominal pain - Factors that precipitate pain or make it worse - Description and location of pain - Other symptoms such as nausea, vomiting, diarrhea, constipation, gas, fever, weight loss. - Recent weight gain or loss

Answer 5

-Past: -Abdominal surgery, trauma, injury, medications -Abdominal pain and treatment -Lab work or gastrointestinal studies -Family: Stomach, colon, liver cancer Abdominal pain, appendicitis, colitis, bleeding, hemorrhoids Nutritional habits in family

Answer 6

- Smoking: Do you smoke, how much? - Alcohol use: Do you drink, how much and how often? - Diet: What types of food and how much do you consume daily? - Antacid - Medications - Fluid intake - Exercise: Do you exercise? - Stress: What kind of stress do you have in your life?

Answer 7

- Empty the bladder. - Remove clothes and put on a gown. - Lie supine with the arms folded across the chest or resting by the sides. - Drape the client. - Breathe through the mouth; take slow, deep breaths.

Answer 8

- Coloration of the skin: Abdominal skin may be paler. - Aortic pulsations. - Peristaltic waves: Normally not seen, may be visible in very thin people. - Vascularity of abdominal skin: Scattered fine veins may be visible. - Striae: New striae are pink or bluish, old striae are silvery, white, linear, and uneven stretch marks. - Scars: Pale, smooth, minimally raised. - Umbilicus - abdominal contour, - abdominal movements when client breathes - Lesions and rashes. - Abdominal symmetry.

Answer 9

- Flat - Rounded - Scaphoid (may be abnormal) - Distended/Protuberant (Usually abnormal)

Answer 10

- Auscultate for Bowel Sounds - Start in RLQ - Auscultate clockwise for one minute in each quadrant - Bowel sounds occur every 5-15 seconds, gargling or clicks - If you do not hear any sounds you must listen for 5 minutes before you document (or ask someone else to listen) - Hyperactive bowel sounds referred to as “borborygmus” may also be heard. These are the loud, prolonged gurgles characteristic of one’s “stomach growling.”

Answer 11

- Percussing for tone over the abdomen allows the examiner to hear different sounds over hollow vs solid organs. - Tympany is heard over most of the abdomen due to the air in the stomach and intestines. - Dullness is heard over the liver and spleen. - Do it during a focus assessment - Tympany- where there is air in inner structure - Dullness- full organ with no air inside

Answer 12

- Perform light palpation. - Deeply palpate all quadrants to delineate abdominal organs and detect subtle masses. - Palpate for masses. - Palpate the umbilicus and surrounding area for swellings, bulges, or masses. - Light: 1cm or less - Deep: 5-6cm

Answer 13

- Aorta - Liver - Spleen - Kidneys - Urinary bladder - aorta- two fingers, thumb and first finger - Umbilical- see if you feel masses - Liver- not palpated usually, on right side below 11th or 12th rib palpate deep and up to patients head (will fell if enlarged) - Spleen- not usually palpated, have patient lay on right side and palpate with both hands - Urinary bladder- wont palpate if its empty

Answer 14

- Rebound Tenderness (Blumberg Sign) - Used to diagnose appendicitis - Deeply palpate at 90 degrees into abdomen, LLQ, one half way between umbilicus and inferior iliac crest and quickly release pressure. - Patient will feel pain when you let it go (Sharp, stabbing)

Answer 15

- Have patient laying on left side and hyper extend leg -patient will have pain in RLQ when leg is hyperextended

Answer 16

-RUQ pain or tenderness -Murphy sign -Deeply palpate on RUQ and pain will be when pressure is applied Pain elicited when pressure is applied under the liver boarder at the right costal margin and client inhales deeply.

Answer 17

- Types of pain: - Visceral- hollow organs become distended or contract. (Dull, aching, burning, cramping, or colicky.) - Parietal-peritoneum is inflamed (appendicitis, peritonitis) - Referred- distant to places innervated at the same levels. this pain travels from the primary site and becomes highly localized at the distant site.

Answer 18

- Pregnancy (normal) - Fat: Obesity accounts for most uniformly protuberant abdomens. The abdominal wall is thick, and tympany is the percussion tone elicited. The umbilicus usually appears sunken. - Feces: Hard stools in the colon appear as a localized distention. Percussion over the area discloses dullness. - Fibroids and other masses: A large ovarian cyst or fibroid tumor appears as generalized distention in the lower abdomen. The mass displaces bowel, thus the percussion tone over the distended area is dullness, with tympany at the periphery. The umbilicus may be everted. - Flatus: The abdomen distended with gas may appear as a generalized protuberance (as shown), or it may appear more localized. Tympany is the percussion tone over the area. - Ascitic fluid: Fluid in the abdomen causes generalized protuberance, bulging flanks, and an everted umbilicus. Percussion reveals dullness over fluid (bottom of abdomen and flanks) and tympany over intestines (top of abdomen).

Answer 19

- Umbilical Hernia: An umbilical hernia results from the bowel protruding through a weakness in the umbilical ring. This condition occurs more frequently in infants, but also occurs in adults. - Epigastric Hernia: An epigastric hernia occurs when the bowel protrudes through a weakness in the linea alba. The small bulge appears midline between the xiphoid process and the umbilicus. It may be discovered only on palpation. - Diastasis Recti: Diastasis recti occurs when the bowel protrudes through a separation between the two rectus abdominis muscles. It appears as a midline ridge. The bulge may appear only when the client raises the head or coughs. The condition is of little significance. - Incisional Hernia: An incisional hernia occurs when the bowel protrudes through a defect or weakness resulting from a surgical incision. It appears as a bulge near a surgical scar on the abdomen.

Answer 20

- Enlarged liver: An enlarged liver (hepatomegaly) is defined as a span greater than 12 cm at the midclavicular line (MCL) and greater than 8 cm at the midsternal line (MSL). An enlarged nontender liver suggests cirrhosis. An enlarged tender liver suggests congestive heart failure, acute hepatitis, or abscess. - Enlarged nodular liver: An enlarged firm, hard, nodular liver suggests cancer. Other causes may be late cirrhosis or syphilis. - Liver higher than normal: A liver that is in a higher position than normal span may be caused by an abdominal mass, ascites, or a paralyzed diaphragm. - Enlarged spleen: An enlarged spleen (splenomegaly) is defined by an area of dullness exceeding 7 cm. When enlarged, the spleen progresses downward and toward the midline. - Aortic aneurysm: A prominent, laterally pulsating mass above the umbilicus strongly suggests an aortic aneurysm. It is accompanied by a bruit and a wide, bounding pulse. - Enlarged kidney: An enlarged kidney may be due to a cyst, tumor, or hydronephrosis. It may be differentiated from an enlarged spleen by its smooth rather than sharp edge, the absence of a notch, and tympany on percussion. - Enlarged gallbladder: An extremely tender, enlarged gallbladder suggests acute cholecystitis. A positive finding is Murphy sign (sharp pain that causes the client to hold the breath).

Answer 21

- Have dilated superficial capillaries without a pattern may be seen. - Move visible to sunlight - Have acute abdominal conditions as sensitivity of pain decreases - GI tract problems- take a lot of medications - Appetite may decrease - Have dentures or have problems chewing (assess gums) - Complications with diarrhea, such as fluid volume deficit, dehydration, and electrolyte and acid-base imblances because of a higher fat-to-lean muscle ratio. - Prone to UTIS because protective bacteria in the urinary tract declines with date.

Answer 22

- The size of a clenched fist - Hollow, muscular organ - Located in mediastinum - Four chambers: left atrium and ventricle, right atrium and ventricle - Two atrioventricular valves - Two semilunar valves - Three layers: - Epicardium: membrane covering the outer surface of the heart. - Myocardium: The middle layer of the heart, made of cardiac cells - Endocardium: The inner layer of the heart. - Surrounded by a sac called the pericardium. - Precordium: The anterior chest area that overlies the heart and great vessels.

Answer 23

Very Important: The right atrium receives the blood from the body, the atrium sends it to the right ventricle, the ventricle sends it to the lungs by the pulmonary artery to be oxygenated, the oxygenated blood from the lungs returns to the left atrium by the left pulmonary vein, blood comes to the left ventricle and is pumped to the rest of the body. - The right side of the heart pumps blood to the lungs for gas exchange (Pulmonary circulation) - The left side of the heart pumps blood to all other parts of the body (Systemic circulation)

Answer 24

2 atrioventricular (AV) - Tricuspid- Three flaps, located between right atrium and right ventricle. S1 when it closes - Bicuspid (mitral)- wo flaps, located between left atrium and left ventricle.

Answer 25

2 semilunar: Each valve has 3 cusps that look like half moons - Aortic: Located at the entrance of the ascending aorta as it exits the left ventricle. Closure of S2 - Pulmonary: Entrance of the pulmonary artery as it exits the right ventricle. Closure of S2

Answer 26

- Aortic Area: Not exactly the aortic valve, second intercostal space at the right sternal boarder. - Pulmonic Area: Left of the sternal boarder on the second intercostal space. - Erb Point: Left of the sternal boarder on the third intercostal space. - Mitral: Left of the sternal boarder on the fifth intercostal space. In the midclavicular line of the left sternal boarder, we will find the apical pulse or point of maximum impulse. - Point of Maximum Impulse: Is where the heartbeat feels the strongest on the mitral valve area. - Tricuspid Area: Left of the sternal boarder on the fourth intercostal space.

Answer 27

Aortic: Closure of semilunar valves Pulmonic: Closure of semilunar valves Erb: Closure of Atrioventricular valves Mitral: Closure of atrioventricular valves Tricuspid: Closure of atrioventricular valves

Answer 28

Cardiac cycle- Filling and emptying of heart chambers. Two phases diastole and systole - Electrical Activities of the heart can be recorded in the form of electrocardiogram, ECG or EKG. - Depolarization: The conduction that triggers the contraction - Repolarization: The conduction that triggers the relaxation

Answer 29

-Narrowed or blocked blood vessels -Can lead to: Heart attack Chest pain Stroke

Answer 30

- 65 years old or older - Gender (male) - Heredity (African American: Double the risk of heart disease, native Hawaiian, Mexican American, Native american and some asian)

Answer 31

-Smoking -High blood cholesterol -Hypertension -Physical inactivity -Obesity/overweight diabetes

Answer 32

- P wave: Atrial depolarization; conduction of the impulse throughout the atria. PR interval: Time from the beginning of the atrial depolarization to the beginning of ventricular depolarization, that is, from the beginning of the P wave to the beginning of the QRS complex. - QRS complex: Ventricular depolarization (also atrial repolarization); conduction of the impulse throughout the ventricles, which then triggers contraction of the ventricles; measured from the beginning of the Q wave to the end of the S wave. - ST segment: Period between ventricular depolarization and the beginning of ventricular repolarization. - T wave: Ventricular repolarization; the ventricles return to a resting state. - QT interval: Total time for ventricular depolarization and repolarization, that is, from the beginning of the Q wave to the end of the T wave; the QT interval varies with HR. - U wave: May or may not be present; if present, it follows the T wave and represents the final phase of ventricular repolarization.

Answer 33

- African Americans have higher HDL levels, but paradoxically they have significantly higher rates (nearly double) of cardiovascular than white Americans - African Americans have the world’s highest rates of hypertension, which predisposes to stroke, and CHD - Hypertension in African Americans has a higher incidence, earlier onset, and higher mortality than in Caucasian Americans

Answer 34

- Stress - Alcohol - Diet and nutrition - Diabetes - Smoking

Answer 35

- History of present health concern: Do they have chest pain, palpitations, what brought them to do the office, do they take medications to sleep at night? - Past health history: Do they have heart disease or high blood pressure? - Family history: : Diabetes, high blood pressure, obesity? - Lifestyle and health practices: Do they exercise, smoke, type of diet, drink alcohol, who cooks at home? Does the wife cook with a lot of salt or fat foods or wife doesn’t cook. That affects the patient.

Answer 36

- Briefing on physical examination - Preparing the client: Explain they need to move around. Explain that we will be exposing parts of the body. - Explain the procedures. - Client must assume different positions. - Equipment - Physical assessment

Answer 37

-Stethoscope with a bell and diaphragm -Small pillow -Penlight -Watch with second hand Sphygmomanometer (BP cuff) -Centimeter rulers (two)

Answer 38

- Pulsations - Neck vessels - Color: he skin to make sure they don’t have any bumps or rashes, redness, bruises.

Answer 39

- Apical impulse: in the midclavicular line in the mitral area on the fifth intercostal space at the midclavicular line. If patient is too large we won’t be able to palpate. - Abnormal pulsations: Shouldn't feel any pulsations, you will feel a thrill if they have a grade 4 murmur. - Skin temperature: Warm bilaterally

Answer 40

- heart rate: 60-100 and rhythm: regular - If you detect an irregular rhythm, auscultate for a pulse rate deficit: can check radial pulse and find the irregular beats. - identify S1 and S2. - extra heart sounds. - murmurs. - Have client assuming other positions. - For apical pulse: have patient lay on left side to hear better.

Answer 41

- Produced by valve closure - Normal heart sounds: “lub dub” (S1 and S2) - Extra heart sounds (S3 and S4) - Murmurs

Answer 42

Closure of the AV valves, begins in systole. If it has two sound it is a split S1. Heard best on the apex of the heart. Apex is on the lower part, base is on the upper part. Louder at the apex of the heart. Lub will be louder.

Answer 43

Closure of semilunar valves, at the beginning of diastole, if there is two sounds it is split valves are having a difficult time closing. Heard better during inspiration and on the base of the heart. Louder at the base of the heart. Dub is louder.

Answer 44

Diastole filling sounds, vibration on the ventricular because it is filling to rapidly. You will be able to hear it better on the lateral position on the left side with the bell of the stethoscope. S3: Lub Dub Ta, could be due to fluid overload or heart failure. S4: Ta Lub Dub, could be hypertrophic left ventricle (resistance)

Answer 45

Blowing or swishing noise caused by turbulent blood flow Grade 1- hard to hear Grade 2- faint but heard Grade 3- easy to hear Grade4- loud with a thrill Grade 5- very loud (can hear when whole chest piece off the chest) Grade 6- loudest (can hear when whole chest piece off chest)

Answer 46

- Diaphragm- high pitched sound, chest s1 and s2, and murmurs aortic and pulmonic regurgitation - Bell- low pitched sounds, s3, s4 and mitral synosis murmurs All Patients Take Medicine

Answer 47

- Increased blood velocity - Structural valve defects - Valve malfunction - Abnormal chamber openings (septal difect)

Answer 48

Inspection: -Observe the jugular venous pulse: When patient is laying at 45 degrees. Will indicate if patient has a fluid overload. -Evaluate jugular venous pressure (done on ICU only). Auscultation and palpation: -Auscultate the carotid arteries. -Palpate the carotid arteries.

Answer 49

- Carotid artery: - Pulse - Vessel elasticity - Thrills - Jugular venous pulse/distention

Answer 50

- Be cautious with older clients because atherosclerosis may have caused obstruction, and compression may easily block circulation. - In older clients, the apical impulse may be difficult to palpate because of increased anteroposterior chest diameter.

Answer 51

- Validating and documenting findings - Diagnostic reasoning - Collaborative problems

Answer 52

- Carry oxygenated, nutrient-rich blood from the heart to the capillaries - Major arteries of arm: - brachial: Major artery that supplies the arm. Brachial pulse is found above the bend of the elbow. - radial: Extending down the thumb side of the arm. - ulnar: Extending down the little-finder side of the arm. - Major arteries of the leg: - femoral: Major supplier of blood to the legs. Travels down the front of the thigh then crossess to the back. - popliteal: The back of the thigh, pulse found behind the knee. - dorsalis pedis: Top of the foot, pulse found on the great toe side. - posterior tibial: Palpated behind the medial malleolus of the ankle.

Answer 53

- Carry deoxygenated, nutrient-depleted, waste-laden blood from the tissues back to the heart - Three types of veins: - deep veins: Account for 90% of venous return from the lower extremities. - superficial veins: Great Saphenous vein is the longest of all veins. - perforator (communicator) veins: Connect the superficial veins with the deep veins. - Femoral, popliteal, saphenous (superficial) veins - Veins differ from arteries in that there is no force that propels forward blood flow.

Answer 54

-Lymphatic capillaries, -lymphatic vessels -lymph nodes: : Function as a filter that destroys the microorganism protecting the immune system. -Capillaries: small veins that exchange fluid from the lymphatic tissue back to veins -Small blood vessels -Form the connection between the arterioles and venules -Allow the circulatory system to maintain vital equilibrium Main Function: : Drain excess fluid and plasma protein from the tissues back to venous system, filter through the lymph nodes, absorbs fats or lipids from the small intestine into the bloodstream.

Answer 55

Peripheral Artery Disease Venous Stasis Deep Vein Thrombosis

Answer 56

- Narrowing blood vessels, Can be because of the loss of elasticity of the arteries and the blood vessels narrow. - Atherosclerosis: Formation or build up of plaque or fat in the arteries that will be blocking the blood flow. - Very common

Answer 57

- Age younger than 50 in people who have diabetes and one additional risk factor, such as smoking, dyslipidemia, hypertension, or hyperhomocysteinemia : High levels of homocysteine in the blood cause form a vitamin B deficiency, can cause damage on the arteries and cause blood clotting. - Ages 50 to 64 in people with a history of smoking or diabetes - Age 65 or older - Leg symptoms with exertion (suggesting claudication) or ischemic rest pain - Atherosclerotic Disese (coronary, carotid, or renal artery) - Smoking, or history of smoking - Diabetes - Obesity - High blood pressure - High cholesterol - Family history of peripheral artery disease, heart disease, or stroke - Excess levels of homocysteine - African American

Answer 58

- Blood flows slow in the veins - Most common in the legs - Risk factor for DVT

Answer 59

- Long periods of inactivity - Lack of muscular activity - Varicose (tortuous and dilated) veins

Answer 60

- Blood clot (thrombus) - One or more of the deep veins - Usually in the legs

Answer 61

- Reduced mobility - Dehydration - Increased viscosity of the blood - Venous stasis

Answer 62

- Quit smoking - Maintain blood sugar under control. - Exercise regularly - Lower your cholesterol levels - Lower your blood pressure levels - Eat a healthy diet (low fat) - Maintain a healthy weight. - Regular screening

Answer 63

- Skin changes - Leg pain, heaviness, or aching - Leg veins - Leg sores or open wounds - Swelling in legs or feet - Men: sexual activity changes - Swollen glands or nodules

Answer 64

- Tobacco use - Regular exercise - Oral contraceptives use - Degree of stress - Peripheral vascular problems interfering with ADLs - Medications to improve circulation or control blood pressure - Support hose

Answer 65

- Size, presence of edema, venous patterning - Skin color - Fingertips for clubbing

Answer 66

- Fingers, hands, and arms for temperature - Capillary refill time (Less than 2 seconds) - Radial, ulnar, and brachial pulses - Epitrochlear lymph nodes - Allen test: (blood returns within 3-5 sec) Done when patient has a procedure such as cardiac cath, don't do it unless on cardiac cath.

Answer 67

- Skin color - Distribution of hair - Lesions or ulcers - Edema - Everything you do on one side of the body you want to do on the opposite side - Edema: Graded from 1+ to 4+. 1+ is the least severe.

Answer 68

-Temperature: If venous disease temperature is warm it is a venous problem/disease If arterial disease the temp is cold it is the problem is an arterial problem. -Superficial inguinal lymph nodes (fixed indicate malignancy) -Femoral pulse, listening for bruits -Popliteal, dorsalis pedis, posterior tibial pulses -Edema (1+ to 4+) -Stages of Lymphedema (box 22-1) pg 485 -Pulses are graded: 0=dead, no pulse to 4+= bounding, unable to obliterate the pulse, strong pulse. -regular pulse is 2+

Answer 69

- Pain: intermittent claudication to sharp, unrelenting, constant - Pulses: diminished or absent - Skin characteristics: dependent rubor - Cold, pale, clammy skin on the extremities and thin, shiny skin with loss of hair over the lower legs is associated with arterial insufficiency

Answer 70

- Pain: aching, cramping - Pulses: present, but may be difficult to palpate through edema - Warm skin, edema and brown pigmentation around the ankles are associated with venous insufficiency

Answer 71

- Hair loss on the lower extremities occurs with aging and is, therefore, not an absolute sign of arterial insufficiency in the older client. - With aging, lymphatic tissue is lost, resulting in smaller and fewer lymph nodes. - Varicosities are common in the older client.

Answer 72

- Health promotion diagnoses - Risk diagnoses - Actual diagnoses - Collaborative problems - Medical problems

Answer 73

percussion

Answer 74

if they are absent

Answer 75

constipation or surgery

Answer 76

palpate after percussion

Answer 77

start in RLQ and go clockwise

Answer 78

light: 1cm, tenderness and superficila masses deep: 5-6cm, dilenatees abdomen organs and detect subtle masses

Answer 79

extra fluid, right or left sides heart failure, edema

Answer 80

the patient could pass out

Answer 81

in young people, athletes, and pregnant women

Answer 82

0 Absent 1+ Weak, diminished (easy to obliterate) 2+ Normal (obliterate with moderate pressure) 3+ Strong (obliterate with firm pressure) 4+ Bounding (unable to obliterate)

Answer 83

GI bleed ulcers

Answer 84

Grade - Depth - Rebound time 1 - 2mm depression, barely visible- immediate 2 - 3-4 mm depression, a slight indentation - 15 seconds or less 3 - 5-6 mm depression - 10-30 seconds 4 - 8 mm depression, or a very deep indentation - more than 20 seconds

Answer 85

- throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh - swelling in 1 leg (rarely both legs) - warm skin around the painful area - red or darkened skin around the painful area - swollen veins that are hard or sore when you touch them

Answer 86

Warm skin, edema and brown pigmentation around the ankles

Answer 87

Cold, pale, clammy skin on the extremities and thin, shiny skin with loss of hair, especially over the lower legs

Answer 88

Refers to the filling and emptying of the heart’s chambers. Triggers the contraction and relaxation of the heart. -Has two phases: Diastole: The relaxation of ventricles (Filling) and Systole: The contraction of the ventricles (emptying). -Closure of the AV valves produces the first heart sound (S1), which is the beginning of systole. -Semilunar valves closing produces the second heart sound: (S2), which signals the end of systole.

Answer 89

Records Depolarization: The conduction that triggers the contraction and Repolarization: The conduction that triggers the relaxation

Answer 90

Located in the right atrium in the entrance of the superior vena cava, natural pacemaker of the heart, it initiates all heartbeat and determines heart rate, electrical impulses form the SA node spread throughout both atria and stimulate them to contract.

Answer 91

Located on the other side of the right atrium near the AV valve, serves as an electrical gateway to the ventricles, delays the passages of electrical impulses to the ventricles, this delay is to ensure that the atria have projected all the blood into the ventricles before the ventricles contract. The AV node receives signals from the SA node and passess them to the AV bundle, this AV bundle is then divided into right and left bundle branches which conduct the impulses to the apex of the heart, the signals are then passed onto purkinje fibers turning upward and spinning out of the ventricular myocardium

Answer 92

Inspect the jugular venous pulse by standing on the right side of the client. The client should be in a supine position with the torso elevated 30–45 degrees. Make sure the head and torso are on the same plane. Ask the client to turn the head slightly to the left. Shine a tangential light source onto the neck to increase visualization of pulsations as well as shadows.

Answer 93

: Evaluate jugular venous pressure by watching for distention of the jugular vein. It is normal for the jugular veins to be visible when the client is supine. To evaluate jugular vein distention, position the client in a supine position with the head of the bed elevated 30, 45, 60, and 90 degrees. At each increase of the elevation, have the client’s head turned slightly away from the side being evaluated. Using tangential lighting, observe for distention, protrusion, or bulging.

Exam 3 Flashcards

(119 cards)