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Clinical Nursing May Exam > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

what is the purpose of RVCS professional code of conduct for vet nurses?

A

sets out nurses professional responsibilities and standards of practice

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2
Q

list the 5 principles of practice according to the RCVS code of conduct

A 
professional competence
honesty and integrity
independence and impartiality
client confidentiality and trust
professional accountability
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3
Q

list some nursing interventions that can be done to help encourage inappetant patients to eat

A 
avoid lots of food in kennel
avoid unpalatable prescription diets
anti-emetics
appetite stimulants
analgesia
provide options for different foods
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4
Q

when are feeding tubes placed in patients?

A

anorexic for 48 hours
anticipate anorexia after a procedure
head, neck, mouth trauma
provide oral rehydration and medication if AKI

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5
Q

list equipment needed to place NO tube

A 
surgical stapler
feeding tube
syringes
LA
sterile lube
gloves
sterile water
tape
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6
Q

describe how NO tubes are placed

A

measure tube from 7th rib in cats and 9th in dogs to end of snout and mark on tube
give LA to one nares
apply sterile lube to end of tube and hold against muzzle
direct tube in medio-ventral-caudal direction and quickly insert up to the mark
patient should swallow when at pharynx so goes to oesophagus
check negative pressure with syringe
administer 10mls water slowly and check no respiratory distress
tape to nares and face and place collar

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7
Q

describe the process of feeding through NO or oesophageal feeding tube

A

draw food into syringe and leave in warm water bath
check for negative pressure
preflush 10ml water
feed over 10-15 minutes watching for nausea or regurgitation
follow with 10ml flush

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8
Q

what are considerations when feeding through NO tube?

A

keep face clean

tempt with food before tube feeding

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9
Q

how long can NO tubes be left in?

A

7 days

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10
Q

how are NO tubes removed?

A

gently pulling out of nose

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11
Q

when are NO tubes contraindicated?

A 
cat flu
congestion
epistaxis 
head trauma
oesophageal disease
vomiting
impaired gastric outflow
comatose patients, no gag reflex
need support longer than 7 days
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12
Q

list complications of NO tube

A 
removal by patient
displacement
infection
irritation preventing eating
aspiration
blockage
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13
Q

list advantages of NO tube

A

no GA
easy to place and remove
well tolerated

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14
Q

list disadvantages of NO tubes

A

short term
aspiration risk
not secured inside patient
time consuming feeds

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15
Q

list equipment for oesophageal feeding tube

A 
sterile and non-sterile gloves
curved artery forceps
surgical prep equipment
scalpel
bandage material
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16
Q

what is nursing care for oesophageal tube?

A

check stoma site 2x daily
tempt food before feeding
no neck collar or lead
give medication through tube when possible

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17
Q

how is oesophageal tube stoma site checked?

A 
remove dressing
clean with 1:10 iodine
assess if normal appearance
check negative pressure
flush with water
redress
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18
Q

how long can oesophageal feeding tubes be left in place?

A

months

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19
Q

how are oesophageal feeding tubes removed?

A

cut suture holding in place
gently pull out
dressing over stoma site

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20
Q

list contraindications for placing oesophageal feeding tube

A

persistent vomiting
impaired gastric outflow
patients at risk of aspiration
oesophageal disease

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21
Q

list complications of oesophageal tubes

A

infection
displacement
suture failure
blockage

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22
Q

state advantages of oesophageal feeding tubes

A

larger volumes and medications can be given easier

can be managed at home

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23
Q

list disadvantages of oesophageal feeding tube

A

GA needed
infection at stoma site
time consuming feeds

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24
Q

list equipment needed for percutaneous endoscopic gastrotomy/PEG tube

A 
PEG tube kit
endoscope
endoscope forceps
suture material
surgical prep equipment
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25
describe how PEG tubes are placed?
clip in right lateral from costal arch, lateral edges of transverse processes to ventral 13th rib use light from endoscope in stomach to see where to place needle through to stomach introduce guide wire through needle put loop of PEG tube through guide wire feed through mushroom tip through PEG tube guidewire pulled away so mushroom tip against stomach wall peg tube secured
26
how do you feed through PEG tube?
``` wait 24 hours after placement preheat food in syringe aspirate stomach contents through tube, measure volume and replace feed over 20-25 minutes give medication flush with 10ml water ```
27
what are nursing considerations for patients with PEG tubes?
check stoma site 2x daily | tempt to eat before tube feeding
28
what are advantages of PEG tube?
large lumen for admin can leave for months owner can manage
29
list disadvantages of PEG tube
GA needed needs to be in at least 7 days cant use first 24 hours
30
describe how much patients are fed when feeding tube placed
24hrs- 1/3 RER 48hrs- 2/3RER 72hrs- full RER
31
what is the veterinary poisons information service?
24 hour helpline to give guidance regarding treatment of poisons
32
what is the benefit of the tox box service?
contains antibodies for uncommon poisons around the country so vets dont have to keep in stock when rarely used
33
what suggests intoxication?
acute onset signs usually towards an organ system | known or suspected accidental or rarely malicious exposure
34
list what is included in phone triage for poison victims
what when dose current BW call VIPS if asymptomatic, unknown poison or low risk bring for immediate vet attention if symptomatic or known high risk ingestion bring label and or sample if dermal prevent self grooming and other contact with pet
35
how can you prepare for triaging poison patients?
``` inform vet hospital sheet IV catheter IVFT oxygen sample tubes decontaminants emetics ```
36
what history should be taken for poison patients?
``` patient signalment pre-existing conditions onset of problem progression of signs information of toxin signed consent ```
37
what is included in primary survey of poison patients?
``` respiratory rate, effort, lung sounds MM CRT pulses temperature mentation neuro exam bladder size pain haemorrhage trauma ```
38
what is initial care for poison patients after primary survey?
``` oxygen airway IVFT treat any cardiac abnormalities manage neuro issues secondary head to toe exam ```
39
how is poisoning diagnosed in patients?
history of exposure acute onset signs toxin panel potentially
40
what are the ways of managing intoxications?
remove toxin reduce ongoing absorption dilute toxin
41
what does inducing emesis in poison patients do?
empties 50% gastric contents
42
when is induced emesis indicated in poison patients?
2-3 hours after oral ingestion of non-corrosive intoxicant
43
when is induced emesis contraindicated in poison patients?
corrosive intoxicant | pre-existing aspiration risk
44
what emetics can be used for poison patients?
dogs- apomorphine | cats- xylazine
45
when is gastric lavage considered in poison patients?
intoxication within an hour | contraindicated to induce emesis
46
what are complications of gastric lavage in poison patients?
anaesthesia aspiration GO perforation or trauma
47
how is gastric lavage performed?
``` anaesthetised and intubated, placed in lateral measure nares to last rib lavage with 10-30ml water kink tube before removal suction oropharynx before recovery extubate after swallow reflex ```
48
how can you cutaneously decontaminate patients?
PPE clip long haired patients in area warm water and mild shampoo
49
what is haemodialysis used for for poison patients?
renal replacement toxin removal rarely used due to expense and availability
50
what is the purpose of enteric adsorbents in poison patients?
reduce absorption | facilitate excretion of toxin
51
name an example of an enteric adsorbent
activated charcoal
52
what is intralipid enteric adsorbent used for?
lipophilic toxins | when other treatment failed
53
what are complications of intralipid enteric adsorbents?
fat embolism | pancreatitis
54
state some supportive management for intoxication patients
``` antidote specific therapy organ care hydration and nutrition analgesia anti-emetics recumbency care eye lube ```
55
what are the effects of nephrotoxins?
AKI causing azotaemia, olig, an, polyuria
56
list clinical signs of nephrotoxication
``` sudden onset inappetence lethargy vomiting diarrhoea signs related to AKI ```
57
how is nephrotoxicity diagnosed?
azotaemia submaximally concentrated urine specific findings
58
list common nephrotoxins
NSAIDs lillies in cats grapes and raisins in dogs ethylene glycol
59
how is nephrotoxicity managed?
decontamination by emesis, activated charcoal, dermal | specific antidotes
60
list nursing considerations for nephrotoxicity
maintain euhydration and euvolaemia anti-emetics analgesia monitor for hypertension
61
what is prognosis for nephrotoxicity?
depends on toxin and extent of injury
62
list signs of neurotoxicity
``` hyper-excitability agitation tachycardia arrhythmia muscle tremor seizure coma low mentation ```
63
list common neurotoxins
``` theobromine, chocolate permethrin on cats metaldehyde, slug pellets tremorgenic mycotoxins cannabis ```
64
how are neurotoxins managed?
``` GI decontamination dermal decontamination muscle relaxants anti-epileptic therapy intralipids ```
65
list nursing considerations for neurotoxin patients
recumbency care manage seizures monitor respiration if lack gag reflex IVFT, feeding tubes etc
66
list common hepatotoxins
``` xylitol mushrooms blue green algae alfatoxins penobarbitone paracetamol doxycycline ```
67
list general considerations for hepatotoxins
``` antioxidant support give lactulose if encephalopathic monitor electrolytes manage glucose levels plasma if coagulopathic ```
68
what is the effects of xylitol on pets?
stimulates endogenous insulin release | lethargic, weak, seizures
69
how is xylitol intoxication managed?
emesis activated charcoal manage hypoglycaemia feed little and often of high fibre complex carbs
70
how do anticoagulant rodenticides affect the body when ingested?
prevent activation of clotting factors in the liver
71
how does anticoagulant rodenticide poisoning present?
``` symptoms after 2-5 days severe coagulopathy haemoabdomen haemothorax collapse hypovolaemic anaemia ```
72
what is advice for patients ingested who have anticoagulant rodenticides but are pre-symptomatic?
emesis activated charcoal measure clotting times at presentation and 48 hours after decontamination, base for diagnosis treat with vitamin K if abnormal clotting times
73
what is advice for symptomatic cases of anticoagulant rodenticide poisoning?
urgent vet care coagulopathic so care with blood sampling vitamin K therapy plasma if life threatening bleeding
74
what is the effect of paracetamol toxicity in cats and dogs?
cats- methaemoglobinemia | dogs- hepatic injury
75
what causes methaemoglobinemia?
RBC oxidative damage causes Fe3+, Hb can only bind to Fe2+
76
what are signs and diagnosis of methaemoglobinemia?
chocolate, dark cyanotic MM | diagnosed by drop of blood with brown discoloration
77
why are cats susceptible to paracetamol toxicity?
lack pathways for its metabolism | accumulate high oxidative metabolites
78
what is the effect of methaemoglobinemia?
``` reduced oxygen delivery shock CV distress neuro signs death oedema ```
79
how is paracetamol toxicity treated?
induce emesis activated charcoal anti-oxidants
80
what is prognosis for paracetamol toxicity?
guarded as highly toxic
81
what effects does adder venom have?
cytotoxic cytolytic CV effects
82
list clinical signs of adder bites
``` usually within 2 hours puncture wounds swelling to bite depression panting pyrexia cardiac arrhythmia ```
83
how are adder bites treated?
``` keep calm and quiet leave area alone to not distribute toxins further antivenom analgesia IVFT ```
84
what is prognosis for adder bites?
good with treatment
85
list examples of caustic substances
alkali batteries benzalkonium chloride washing tablets
86
list clinical signs of caustic substance intoxication
``` oral, oesophageal, gastric ulceration pain hypersalivation anorexia regurgitation vomiting dermal alopecia, burns, ulcers ```
87
how is caustic intoxication treated?
dermal decontamination with warm water analgesia IVFT tube feeding
88
what is prognosis for caustic intoxication?
depends on burn severity
89
what is respiratory arrest?
apnoea
90
what is cardiac arrest?
no CO
91
what is CPA?
no CO and apnoea
92
list risks for CPA
``` trauma systemic illness paediatrics geriatrics iatrogenic causes recent arrest ```
93
what are the aims of CPCR?
prefusion of heart lungs and brain | return of spontaneous circulation
94
how should you be prepared for CPCR?
regular training | crash box ready and accessible
95
what is considered basic life support?
CPCR | oxygen
96
what is considered advanced life support?
drugs IVFT cardioversion
97
list examples of the equipment in each drawer of the crash trolley
airway access IV and IO access ventilation drugs
98
what drugs are included in the crash trolley?
``` adrenaline atropine 50% dextrose propofol naloxone ```
99
what equipment other than standard for life support can be used in CPCR?
``` capnography crash record chart ECG defib pulse oximetry BP monitor ```
100
what are the 2 types of compressions?
cardiac pump directly over heart in cats and small dogs | thoracic pump at widest part of thorax in large dogs
101
how are compressions carried out?
100-120/min at least 50% depth of thorax can do interthoracic direct compressions
102
when and how is IPPV done in CPCR?
as soon as suspect respiratory arrest | 20brpm inflating thorax normal amount
103
what should happen after CPCR?
monitor for rearrest treat underlying cause consult owner debrief
104
list blood products available for dogs
``` whole blood packed RBC fresh frozen or frozen plasma cyroprecipitate cyroprecipitate poor plasma ```
105
how do cats get access to blood?
local donation as no blood banks
106
who is whole blood broken down?
spun to produce packed RBC and fresh frozen plasma
107
how is cryoprecipitate produced?
partially thawing and spinning fresh frozen plasma
108
what are the components of fresh whole blood?
physiological concentrations of RBC, platelets, proteins, coagulation factors
109
what is meant by stored whole blood?
over 8 hours post collection up to 21 days at 2-6 degrees | no functional platelets, lots of clotting factors
110
how are packed RBC stored and what is its composition?
same as whole blood up to 42 days | PCV 70-80%
111
what is fresh frozen plasma?
stored less than a year at -18 | contains coagulation factors and plasma proteins
112
what is frozen plasma?
FFP thawed and refrozen or over 1 year, up to 5 years | stable coagulation factors only
113
what is the composition of cyroprecipitate?
rich in fibrinogen. VII and vWF
114
state some diseases that can be treated with blood products
hypovolaemic anaemia euvolemic anaemia coagulopathy thrombocytopenia
115
what are clinical signs that help determine whether to use blood to treat anaemia?
``` acute onset PCV weakness tachycardia tachypnoea high blood lactate ```
116
what is the best way to give blood products?
replace with whats most similar to whats missing
117
what determines blood type?
antigens on RBC surface
118
what causes transfusion reactions?
naturally occurring antibodies in recipients blood against donor antibodies
119
list signs of transfusion reaction
``` fever tachycardia dyspnoea muscle tremors vomiting collapse hemoglobinemia haemoglobinuria death ```
120
what as the most antigenic DEA?
DEA 1 | no naturally occurring antibodies for DEA 1
121
why should dalmations only be give blood from other dalmations?
they are Dal negative but most other dogs are Dal positive
122
what blood can you give to dogs that are DEA 1 neg, DEA 1 pos?
neg- only DEA 1 neg | pos- DEA 1 neg or pos
123
why can you give the first transfusion in dogs untyped?
no naturally occurring antibodies so unlikely to get transfusion reaction
124
what blood should be given to dogs in emergency?
DEA 1 neg
125
what is the effect of DEA 1 neg being exposed to pos blood?
produce antibodies against DEA 1 antigens so future exposure will cause transfusion reaction
126
what are the blood types on cats?
A B AB
127
why do cats have to be typed and cross matched for blood transfusions?
have naturally occurring antibodies in plasma
128
what are the levels of antibodies in plasma of A and B blood in cats?
A- few anti-B antibodies | B- lots of anti-A antibodies
129
what blood type should be given in cats?
own blood type | if AB and cant because rare give A as low numbers of antibodies
130
how is cross matching of blood carried out?
determine serological compatibility, incompatible if agglutination recipient serum and donor RBC for major cross match as most severe reactions from this recipient RBC and donor serum for minor cross match
131
when is blood cross matching done?
``` recieved transfusion over 4 days ago history of transfusion reaction transfusion history unknown previously pregnant all females dalmatians ```
132
how are blood products obtained?
canine blood banks | local donors
133
what makes a pet a suitable donor for blood?
``` healthy 1-8 years old no travel history routine healthcare never received transfusion clear health screening good jugular veins large dogs over 25kg large cats over 4.5kg ```
134
what needs to be done to patients before donating blood?
``` clinical history full physical exam PVC TS haematology biochemistry blood typing infectious disease screening ```
135
describe the process of blood donation
place catheter for IVFT clip and prepare jugular vein and apply EMLA sedate if needed anticoagulant at correct ratio to blood
136
what are the maximum amounts of blood that animals can donate?
15ml/kg for dogs | 10-12ml/kg for cats
137
how are animals cared for after blood donation?
IVFT, volume of blood taken over 1-2 hours give food and water restrict activity for 24 hours
138
what are negatives to open blood donation?
more sites of bacterial contamination | need anticoagulant
139
what are negatives to closed blood donation?
only use for large dogs | need anticoagulant
140
what are benefits to closed blood donation?
needle uncapping is only exposure for contamination so has longer shelf life
141
what needs to be done before giving blood products?
inspect bag for contamination and abnormalities thaw frozen products to body temperature record and monitor patient
142
how is blood given to patients?
IV blood giving set 10-20ml/kg given 1ml/kg over 20 minutes monitoring for reactions, rest over 4-6 hours
143
what is monitored for recipients of blood?
``` mentation temperature PR RR MM CRT plasma and urine colour PVC and TS ```
144
when do blood recipients need to be monitored?
every 15-30 minutes during transfusion | 1, 12 and 24 hours after transfusion
145
what are signs of antigen-antibody sensitivity reactions in blood transfusion?
``` fever tachycardia dyspnoea muscle tremors weakness haemolysis ```
146
list immunologic reactions to blood products
antigen-antibody sensitivity reaction cytokines and leukocytes allergic reaction
147
what are signs of allergic reaction to blood products?
``` pruritus erythema urticaria angioedema vomiting dyspnoea anaphylaxis ```
148
list examples of non-immunologic transfusion reactions
``` volume overload citrate intoxications coagulopathy ammonia intoxication bacterial contamination pre-transfusion haemolysis ```
149
what are signs of volume overload reaction to blood?
pulmonary oedema jugular distention chemosis effusions
150
what is sign of citrate intoxication from blood?
hypocalcaemia
151
list signs of coagulopathy as a reaction to blood
petechia ecchymoses bruising thrombocytopenia
152
list signs of blood infection
fever distributive shock vomiting haemolysis
153
how do you manage transfusion reactions?
``` stop transfusion fluid resus for distributive shock antibiotics for contamination oxygen for dyspnoea monitor haemolysis, renal function slow infusion if volume overload ```
154
what causes periodontal disease?
inflammatory response to plaque | gingivitis left untreated progressing to periodontitis
155
describe the aetiology of periodontal disease
accumulation of plaque
156
what is plaque?
biofilm on all mouth surfaces | made up of mucopolysaccharides, glycoproteins, bacteria, oral debris
157
what is calculus?
mineralised plaque covered in plaque
158
what is gingivitis?
reversible plaque induced inflammation limited to gingiva
159
list clinical signs of gingivitis
inflammation reddening bleeding gums halitosis
160
define halitosis
bad breath
161
what is mild, grade 1 gingivitis?
redness swelling no bleeding on probing
162
what is moderate, grade 2 gingivitis?
grade 1 with bleeding on probing
163
what is grade 3 severe gingivitis?
grade 2 with ulceration and spontaneous bleeding
164
how is gingivitis treated?
removal of calculus improve oral hygiene daily oral hygiene
165
what is periodontitis?
inflammation involving gingiva and surrounding periodontal ligament, alveolar bones and cementum
166
how does periodontitis develop?
untreated gingivitis
167
what are clinical signs of periodontitis?
``` dental deposits halitosis mucosal and glossal ulcers gingiva recession bleeding dysphagia pain teeth falling out ```
168
what are components of clinical dental exam?
``` halitosis dysphagia hypersalivation gingival health number of teeth GA exam of head, occlusions, individual teeth, oral cavity ```
169
how are patients prepped for dental exam under GA?
``` GA prep throat pack to prevent aspiration IVFT temperature regulation analgesia ```
170
what is the modified tridan system?
used on dental charts to number teeth with first number quadrant and second and third is tooth position
171
state normal number of adult teeth in dogs and cats
dogs- 42 | cats- 30
172
what is examined in dental exam under GA?
calculus score gingivitis score periodontal probe depth sulcus
173
define sulcus
gap between tooth and gingiva
174
what are causes of dental attachment loss?
periodontal pockets gingival rescission furcation exposure tooth motility
175
what is dental caries?
softening and loss of enamel resulting in formation of pit in tooth
176
how is dental caries managed?
filling | extractions
177
what teeth are most commonly affected by crown fractures?
canines carnassials incisors
178
how are crown fractures managed?
polishing small chips | extraction
179
what is crown attrition?
wearing of crown leading to exposed pulp or fracture of tooth
180
how is crown attrition treated?
usually extraction
181
what are feline dental neck lesions?
pits affecting enamel, dentine and cementum | active destruction of unknown cause
182
how are feline dental neck lesions treated?
extractions
183
which deciduous teeth are most commonly retained?
incisors | upper canines
184
why do retained deciduous teeth need to be extracted?
malerruption and malocclusion of retained teeth
185
what is the problem of malocclusion?
abnormal wear | injury to mouth
186
how is malocclusion treated?
conservative management extraction orthodontics
187
what is the purpose of scaling teeth?
removal of plaque and calculus from tooth above and below gingival margin
188
what are the types of tooth scalers available?
manual ultrasonic sonic
189
what are considerations for ultrasonic scalers?
use flat surface on tooth, never tip maximum each tooth 15 seconds at a time water flowing before contact
190
why are sonic and rotosonic scales less commonly used for dentals?
potentially damage teeth and adjacent structures
191
describe the process of scaling teeth
``` remove gross deposits of calculus irrigate mouth examine teeth remove loose teeth probe sulcus remove calculus below gingival surface polish after scaling ```
192
what is the purpose of polishing after scaling teeth?
damage from scaling allows faster build up of calculus so polishing prevents this
193
list instruments used for dental surgery
``` curettes scalers periodontal probe extraction forceps dental mirror root elevators ```
194
what are indications for tooth extractions?
``` advanced periodontal disease caries or feline neck lesions retained deciduous teeth tooth trauma with exposed pulp malocclusion damaging soft tissues ```
195
list instruments for dental exam
``` mouth mirror periodontal probe mouth props gags retractors ```
196
list equipment for calculus removal
calculus removing forceps subgingival curette hand scaler polishing cups and paste
197
list aftercare for dental surgery
``` tooth brushing once healed mouth washes soft food while healing no hard chews soft toys ```
198
how can owners be educated to prevent dental disease?
promote dental care from first visit tooth brushing daily advised nurse clinics or consults focused on prevention
199
list examples of conditions affecting pinnae
trauma aural haematoma neoplasia
200
what increases risk of aural neoplasia?
sun exposure white fur hairless unpigmented skin
201
how is aural haematoma caused?
head shaking damages capillaries so bleed into ear
202
what causes otitis externa?
immune mediated parasites poor aeration obstruction by fur, neoplasia, inflammation
203
what are common neoplasias of the ear?
squamous cell carcinoma ceruminous gland adenoma melanoma basal cell carcinoma
204
what causes otitis media?
chronic otitis externa
205
list middle ear diseases
bacterial otitis media tympanic membrane trauma allowing bacterial infection tumours polyps
206
how is pinnae trauma treated?
``` treat underlying cause clip pinnae place in lateral bandage buster collar consider contamination ```
207
how is aural haematoma treated?
``` drainage stitches to limit swelling massage flushing prevent further accumulation ```
208
what can pinnectomy be used for?
removal of invasive tumours
209
what is lateral wall resection?
removal of secretory epithelium, lateral cartilage of vertical ear canal
210
what is the purpose of lateral wall resection?
increase drainage and ventilation of ear
211
how is lateral wall resection prepared for?
clip whole pinnae and side of head flush ear to remove debris lateral with head elevated
212
what are indications for lateral wall resection?
non responsive to other treatment | external ear canal disease
213
what is vertical canal ablation?
excision of whole auricular cartilage | formation of stoma at level of horizontal canal
214
what are indications for vertical canal ablation?
disease affecting whole vertical canal | neoplasia
215
how do you prep for vertical canal ablation?
same as LWR | prep histology samples
216
what is total ear canal ablation and lateral bulla osteotomy?
removal of all epithelial lining and vertical and horizontal canal cartilage
217
what is the purpose of total ear canal ablation and lateral bulla osteotomy?
salvage procedure for chronic otitis externa, trauma and neoplasia
218
list potential complications for total ear canal ablation and lateral bulla osteotomy
``` hearing and facial nerve paralysis infection cosmetic affects haemorrhage vestibular issues trauma to deep structures fistula formation ```
219
describe prep for total ear canal ablation and lateral bulla osteotomy
clip whole pinnae, caudal border of eyelid, lateral neck | prep whole pinnae
220
when is ventral bulla osteotomy performed?
cats with middle ear disease | middle ear polyps
221
list complications for ventral bulla osteotomy
vestibular disease haemorrhage infection

Clinical Nursing May Exam (22 decks)

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