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126 Cards in this Set

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What are some risk factors for cleft lip or palate?
Family hx
Mom who took anticonvulsants or steroids during pregnancy
Maternal infection (rubella) in pregnancy
True or False: Cleft lip or palate can be unilateral or bilateral and the diagnosis is based on the appearance at birth.
True
Babies with cleft lip/ palate may have problems with f_____ and complications such as more ____ infections and _____ issues.
feeding (vomitting, milk comes out nose, tire easily- use a lot of energy to eat)
ear
speech
A team approach is taken in managing a child with cleft lip or palate, which includes surgeons, nurses, geneticists, psychologists, ENTs, and orthodontists. Around Age 2, they see a _____ _______ to help with learning to pronounce words correctly. What does the orthodontist and psychologist help with?
Speech Therapist
May see an orthodontist to make an appliance to help baby eat, plugs the hole in roof of mouth.
Psychologist helps with reinforcing healthy personality, self esteem. (nurses job too)
The 1st intervention for a baby with cleft lip or palate is to modify _____ techniques by using unique ______ and _____.
feeding
nipples
feeders
________ is plastic surgery of the cleft lip. The child may need cosmetic modification at age 4-5.
chelioplasty
True or False: Cleft palate repair can be done between 6-24 months. It is recommended to repair by 1 year of age.
true
It is very important for child with repair of cleft lip or palate not to rub the incision area, may need _____ to keep from rubbing.
restraints (splints)
Nursing implications for the postop baby after repair of cleft lip or palate needs lots of reinforcement of post-op appearance. Teach about the use and purpose of splints. Can the baby can breastfeed? What are some things the child needs to avoid after surgery?
Yes, baby can breastfeed.
No straws or pacifiers for 7-10 days postop.
True or False: Post op care for a baby who has had surgery on a cleft lip or palate includes analgesics, sedatives, and antibiotic ointment.
True
Esophageal atresia and tracheoesophageal fistula are both failures of the esophagus to develop as a continuous passage to the stomach. What are the clinical manifestations?
Coughing, choking, cyanosis,
Salivation (excessive, difficulty with secretions)
Apnea
Vomiting
Abdominal distention
Respiratory distress
(CCC + SAVAR)
Diagnosis for esophageal atresia or tracheoesophageal fistula is suspected if there is a history of maternal _______ and if baby is unable to pass NG tube ___ cm beyond gum line.
polyhydramnios
10
Dx of esophageal atresia and tracheoesophageal fistula
abdominal x-ray
bronchoscopy
endoscopy
A baby with esophageal atresia or tracheoesophageal fistula needs close monitoring for distress, such as a______. HOB should be ______. Aspirate the NG TUB every __ to ___ minutes. Child should be ____ before surgery and should have an IV. After surgical repair, needs a ___ tube for feedings and family needs teaching.
A baby with esophageal atresia or tracheoesophageal fistula needs close monitoring for distress, such as ASPIRATION. HOB should be ELEVATED. Aspirate the NG TUB every 5 to 10 minutes. Child should be NPO before surgery is indicated and should have an IV. After surgical repair, needs a Gastrostomy (G) tube for feedings and family needs teaching.
Post Op for child with surgery for esophageal atresia or tracheoesophageal fistula needs frequent assessments, check on G tube, oral feedings are slow/fast, pain meds and possible __________, strict I & O. Can a pacifier be used?
Post Op for child with surgery for esophageal atresia or tracheoesophageal fistula needs frequent assessments, check on G tube, oral feedings are slow/fast, pain meds and possible antibiotics, strict I & O. A pacifier can be used.
Post Op for child with surgery for esophageal atresia or tracheoesophageal fistula needs to be monitored for what 3 problems? What systems are you looking at in your focused assessment?
atelectasis, pneumonia, GT site infection

GI & respiratory
An upper gastrointestinal hernia is a protrusion of a portion of an organ or organs. It can be ______ in which it becomes trapped and cannot be reduced easily, or _______ in which there is decreased blood supply and lots of pain.
incarcerated

strangulated
ture or false: Remember to read about upper gastrointestinal hernias on our own...
true :(
A _____ hernia is where a portion of the stomach protrudes throught the esophageal hiatus of the diaphragm. The symptoms are similar to a child with ____ and include vomiting, coughing, and short periods of apnea. Does it heal on its own?
hiatal

reflux

Need surgical repair
A congenital diaphragmatic hernia is where there is an ______ of the diaphragm through which _____ contents enter the ____.
opening
abdominal
chest
A congenital diaphragmatic hernia is fatal 80% of the time. If it is small or diagnosed early, surgery can be done in utero or immediately after birth. How many lungs will the child end up with?
Just one.
True or False: lungs develop faster than intestines in utero.
false, intestines develop faster.
READ ABOUT imperforate anus, gastroschisis, omphalocele, umbilical hernia, there will definitely be a ....
question on the test.
______ is when the intestines are on the outside of the body.
gastroschisis
Tx for gastroschisis includes expanders in abdomen, _____ to keep moist, wrap in ____and a little is put back in at a time, sometimes a small amount of bowel is ___. There may be a temporary ______.
saline
plastic
cut
colostomy
True or False: In omphalocele, abdominal viscera herniates into base of umbilicus (everything is outside). The prognosis is poor.
true
Every culture has its own idea of how to fix an _____ hernia.
umbilical
_____ is the regurgitation of gastric contents into the esophagus
GER- gastroesophageal reflux
GER is linked with _______ impairment and an immature ______ esophageal _______. Medications often prescribed include _____ and _____.
neurologic
lower esophageal sphincter (LES)

caffeine and theophylline
What are the 3 types of GER? Explain each type.
Physiologic-
occasional emesis, rarely occurs with sleep
Functional- painless, frequent emesis. usually asymptomatic by 18 months
Pathologic- aspiration PNA,
apnea, coughing, choking, frequent emesis, failure to thrive
Clinical manifestations of GER

(way too many... theres' 13)
vomitting/ spitting up
weight loss
gagging
choking
apnea
aspiration
hematemesis (blood emesis)
melena (black/tarry stools)
anemia
heartburn
aspiration PNA
esophagitis
irritability
Children at risk for GER
preterm infants
esophageal atresia
tracheoesophageal fistula
scoliosis
cystic fibrosis
asthma
neurological impairment

(PET SCAN)
Diagnostic Tests for GER include a ______ esophagram, esophaeal ______, and a 24 hour intraesophageal ___ monitoring. However, it's usually diagnosed based on _____.
barium
manometry
pH
symptoms
Therapeutic management for infants with GER include burping with every _____ of feeding, thicken feedings with 1 TBSP of ___ _____ per __ oz of formula, don't over____, and do small, frequent feedings. Baby should be upright for ___ minutes after feedings, raise HOB ___ degrees, and infants with severe GER need continuous/intermittent NG feedings especially if they have failure to ____.
Therapeutic management for infants with GER include burping with every ounce of feeding, thicken feedings with 1 TBSP of rice cereal per 2 oz of formula, don't overfeed and do small, frequent feedings. Baby should be upright for 30 minutes after feedings, raise HOB 30 degrees, and infants with severe GER need continuous NG feedings especially if they have failure to thrive.
A child or adult with FER should avoid foods that can cause reflux such as... (4) Avoid eating ___ hours before bedtime, weight reduction is important if child is _____ and they should avoid second-hand _____. Raise HOB __ inches.
A child or adult with FER should avoid foods that can cause reflux such as chocolate, caffeine, fatty foods, spicy foods. Avoid eating 2 hours before bedtime, weight reduction is important if child is overweight, and they should avoid second-hand smoke. Raise HOB 6 inches.
Medications for GERD include ____ for symptomatic relief. Climetidine (Tagemet) can be used to decrease ____ _____. Sucralfate is a mucosal _______. Omeprazole (Prilosec) can suppress gastric acid ______. Metoclopramide (Reglan) can _______ gastric emptying.
Medications for GERD include antacids for symptomatic relief. Climetidine (Tagemet) can be used to decrease acid secretion. Sucralfate is a mucosal protectant. Omeprazole (Prilosec) can suppress gastric acid secretion. Metoclopramide (Reglan) can accelerate gastric emptying.
Page 13
constipation and encopresis
Infrequent passage of firm or hard stools or small hard masses is known as ________.
constipation
Constipation is also defined as more than ___ days without a stool or _____ in expulsion of stools. Sometimes there are stools streaked with _____ or ______ discomfort. Headache, nausea, and ______ may also occur with constipation.
3
difficulty
blood
abdominal
vomitng
True or False: Constipation in children may occur during potty training when the child realizes he has control over his or her bowels.
True
What is the name of the term for fecal incontinence? Is it voluntary or involuntary? When and why does it occur? This child may have soiled clothing and a ____ odor.
Encopresis
Involuntary and repeated
Child is usually over 4 years old and is constipated, a small amount of stool leaks out and you will see a tiny bit of stool in their underwear. It's caused by recurrent fecal impaction and enlarged rectum. (Some of it has to get out eventually)
Child may have a fecal odor.
Constipation is caused by changes in _____ or _____, lack of _______, and if the child is experiencing s____ at school or at home. It can also be caused by other substances such as excess Vitamin ___, ____ supplements, exposure to _____, and medications that have a drying effect such as ____, ____, and ____.
Constipation is caused by changes in diet or routine, lack of exercise, and stress. It can also be caused by other substances such as excess Vitamin D, iron supplements, exposure to lead, and medications that have a drying effect such as opiods, antihistamines, and diuretics.
Therapeutic management for constipation includes what 3 things for disimpaction? To prevent constipation, it can be helpful to use ______ oil with juice, l______, make ______ changes, and get plenty of ____.
mineral
lactulose
dietary
exercise
True or False: Stool softeners and laxatives both cause dependence.
False, laxatives are habit forming, cause dependence. Stool softeners do not.
In helping children change their retention habit (constipation), use positive reinforcement such as a behavior chart with rewards, avoid negative feedback, and have the child sit on the commode for ___ to ____ minutes approximately ____ to ____ minutes after meals.
5-10
20-30
Irritable Bowel Syndrome (IBS) is described as increased/decreased intestinal motility with s_____ and p_____.
increased
spasm, pain
True or False: The cause of IBS is unknown, but stress and emotional factors seem to play a role.
true
Manifestations of IBS include abdominal pain related/unrelated to meals or activity. There are alternating episodes of _______ and _______. In diagnosing IBS it may be helpful to rule out Ulcerative Colitis and Crohns.
unrelated
diarrhea, constipation
There is no definitve treatment for IBS. It is usually ____ -limiting and intermittent. To decrease symptoms, try to include a healthy well balanced ____ and exercise.
self
diet

(Yeah but I thought it's unrelated to diet and activity... maybe poor diet and inactivity would just make it worse.)
A peptic ulcer is ______ related to _____ exposure of mucosal lining related to ____, H. _____, and medications like _____ and _____.
A peptic ulcer is erosion related to acid exposure of mucosal lining related to stress, H. Pylori, and medications like aspirin, NSAIDs.
What are the 2 types of peptic ulcers?
gastric (stomach)
duodenal (duodenum or pylorus)
The causes of peptic ulcers include excessive ____ secretion, ___ salts, lack of _______ to protect, and _____ factors and the bacteria H. _____. Physical ____ from another chronic illness as well as psychological factors and concurrent problems such as b____ and h______ play a role in the etiology of peptic ulcers. Medications such as ____ can irritate the ulcer
...
Manifestations of peptic ulcers include poor ____, vomiting (including ______), _____ spells after eating, tarry stools- _______ (blood in stool), pain, and waking up at night crying in pain
Manifestations of peptic ulcers include poor eating, vomiting (including hematemesis)crying spells after eating, tarry stools- melena (blood in stool), pain, and waking up at night crying in pain.
What are some medications used in treating peptic ulcers?
antacids after meals, H2 receptor antagonists (anti-secretion agents) and one of the following: Cemetidine (Tagamet), Rantidine (Zantac, or Famotidine (Pepcid). If the peptic ulcer is caused by H. Pylori, the medications include Bismuth (Pepto-Bismol), Tetracycline and 1 other antibiotic (usually amoxicillin), and Omeprazole (Prilosec). Give all 4 of these medications.
How long is the treatment for H. Pylori?
2-4 weeks
There is no evidence that foods directly cause ulcers, however they can irritate them. What are some foods or drinks to avoid?
colas, chocolate, tea
True or False: never give aspirin with a bacterial infection
False. Never give aspirin with a viral infection (can cause Reye’s syndrome).
Nursing considerations for peptic ulcers include teaching about dietary changes which are the same as with ____, avoiding chocolate, fatty foods, and spicy foods. Give appropriate medications and assess for complications such as a GI _____.
GERD, bleed
Infectious Gastroenteritis is caused by ingestion of _________ water or food, and is also spread _____ to ______.
contaminated, person to person
What are the most common GI pathogens?
giardia & rotavirus
Manifestations of Infectious Gastroenteritis include what 3?
diarrhea, vomiting, and abdominal pain
_______ is contracted when water is contaminated by feces of infected animals or humans. A person can get it when they’re camping and drink the water from a stream or river. Symptoms include nausea, vomiting, bloating, gas, fatigue, and weight loss.
giardia
True or False: Giardia symptoms appear 7-10 days after encountering the organism. Infected people with Giardia can pass it around for months.
True
Therapeutic management for infectious gastroenteritis includes replacing ______, correcting ______ disturbances, and if giardia, give ________
fluids, electrolyte, antibiotics.
To prevent dehydration when a patient has infectious gastroenteritis, what do we suggest ( in regards to each episode of diarrhea)?
drink a glass of water with each episode of diarrhea
The pathophysiology of appendicitis is _______leads to ischemia, causing______ of the epithelial lining, _______ invasion, then necrosis, perforation or ______ with _____ or ______ contamination of peritoneal cavity, causing _______, possible small bowel _______, electrolyte _______ and sh____.
The pathophysiology of appendicitis is obstruction leads to ischemia, causing ulceration of the epithelial lining, bacterial invasion, then necrosis, perforation or rupture with fecal or bacterial contamination of peritoneal cavity, causing peritonitis, possible small bowel obstruction, electrolyte imbalance and shock.
Signs and symptoms of appendicitis include _______ pain radiating to _____, pain with ______, positive ______ test, anorexia and ______ , and possibly an elevated ____ count.
Signs and symptoms of appendicitis include periumbilical pain radiating to RLQ, pain with movement positive McBurney test, anorexia and vomiting , and possibly an elevated WBC count.
True or False: Diagnostic tests for appendicitis include CBC, X-ray, and a CT scan.
False. Diagnostic tests for appendicitis include CBC, Ultrasound, and CT scan.
Therapeutic Management for appendicitis includes an appendectomy which is abbreviated: _____, ______ and _______ replacement as needed, and if the appendix is ruptured, we do IV ______, an ___ tube, and open the wound with _____.
Therapeutic Management for appendicitis includes an appendectomy which is abbreviated: appy, and fluid and electrolyte replacement as needed, and if the appendix is ruptured, we do IV antibiotics, an BG tube, and open the wound with penrose.
Hypertropic Pyloric Stenosis is an ________ of pyloric sphincter by hypertrophy of circular muscle of pylorus.
obstruction
Manifestations of hypertrophic pyloric stenosis include colicky ______ pain, abdominal ________, possible ____ shaped mass to the _____ of the umbilicus, a feeling of _____, and weight ____. There will be visible ______. There is definitely ______ vomiting, and there is often constipation, d______, and possibly shock, ____, and RDS.
Manifestations of pyloric stenosis include colicky abdominal pain, abdominal distention, possible olive shaped mass to the right of the umbilicus, a feeling of hunger, and weight loss. There will be visible peristalsis. There is definitely projectile vomiting, and there is often constipation, dehydration, and possibly shock, sepsis, and RDS.
What are the 3 main manifestations of hypertrophic pyloric stenosis?
Possible olive shaped mass to the right of umbilicus, projectile vomiting, and visible peristalsis.
A diagnostic evaluation for pyloric stenosis includes an ultrasound, the ____ GI series. Lab values will reflect metabolic/respiratory acidosis/alkalosis due to an elevated ___ and _____. There will be high/low Na, K, an Cl.
upper, metabolic alkalosis, elevated pH and bicarb, low Na, K, Cl
The therapeutic management for pyloric stenosis includes one of two surgeries, what are they?
pylorotomy or pyloromyotomy
Preoperatively and postoperatively (pyloric stenosis surgery) the HOB is ________.
elevated
Postop after surgery for pyloric stenosis, feedings include ____ and ___ strength formula, advance to regular formula or ____ milk.
Pedialyte, ½ , breast milk
Intussusception is invagination of a section of the intestine into the proximal/distal bowel that causes bowel _____. It is also described as a _______ing of the _____ bowel or portion of intestine into another portion, usually the _______ valve.
distal, obstruction, telescoping, small, ileocecal
Signs and symptoms of intussuception include currant ____ stool, increased/decreased ability to pass stool which causes ______ and _____ with the stool. There is also ______ pain and the patient feels ______.
jelly, decreased, mucous & blood, abdominal pain, lethargic.
The diagnosis of intussuception is often based on ________ and also may include a ______ enema and an ____ to check for free air.
symptoms, barium, x-ray
Sometimes the weight of the barium used in diagnosing intussuception can cause the bowel to ____
unfold
Therapeutic management includes attempts to reduce with either barium or air enema. If unsuccessful, abdominal ______ or _______ can be done.
surgery, laparoscopy
If distention is present preoperatively (for surgery for intussuception) a __ ____ may be placed to decompress.
NG tube
Post-op for surgery for intussuception includes ____ status, ___ tube, an IV, and ____ medication.
NPO, NG, pain
A _______ is a twisting of the bowel which causes bowel obstruction.
volvulus.
A volvulus is caused by a defect in ____ development
fetal
How is a volvulus treated?
surgically
Nursing care for a volvulus is similar to that of _______
intussusceptions.
True or False: symptoms are always present at birth
False. They may not show up until the kid is older depending on how bad it is.
_______ ______ is a congenital aganglionic megacolon in which there are increased/decreased ganglion cells to the __ tract, usually the ___ and part of the small/large intestine. It may not be diagnosed until late infancy or childhood.
Hirschprung Disease, decreased, GI, rectum large
Symptoms of Hirschprung Disease are ___ related.
age
In a newborn with Hirschprung Disease, symptoms include failure to pass ______, _____ing up, abdominal ______, and reluctance to ingest _____.
meconium, spitting up, distention, fluids
In an infant with Hirschprung Disease, symptoms include ___, c_________, abdominal ________, d_______ and v_______
FTT, constipation, abdominal distention, diarrhea, vomiting
In a child with Hirschprung Disease, there will be c________, abdominal distention with _____ peristalsis. What will the stool look like?
constipation, visible peristalsis, Stool will be pelletlike or ribbon-like and very foul smelling.
Diagnostic tests for Hirschprung Disease include a ______ enea, a _____ exam and biopsy ( to check if there are nerves), and an ________ manometry.
barium, rectal, anorectal.
The purpose of medical management in preparation for surgery is to stabilize the bowels. The patient is ____ status, enemas are done until _____, the patient is on ___ and ____ IV.
NPO, clear, TPN, antibiotics.
Surgery for Hirschprung Disease is usually 2 or 3 stages and may include a temporary ______. The surgery is a “permanent ____ ___ “ procedure and the child must weigh at least ____ lbs at time of surgery. Later the temporary _______ is closed.
colostomy, “permanent pull through,” 20, colostomy
Preop care for a patient having surgery for Hirschprung Disease includes stabilization, teaching, IV antibiotics, colonic ______s with antibiotics, an ___ tube, and a measurement of the ______ ______ (to assess for bleeding after surgery), also it is important to watch for signs of infection such as _______.
irrigations, NG tube, abdominal girth, enterocolitis.
Postop care for a patient having surgery for Hirschprung Disease includes _____ care, teaching, NPO until ____ _____ are present, NG tube to decrease _______, and discharge instructions for care. It’s important to tell patients to turn, cough, and deep breathe as well as perform ROM exercises.
stoma, bowel sounds, distention.
Place baby on the ______ side if he or she has pyloric stenosis
right
Lactose intolerance is the inability to tolerate lactose (the sugar found in dairy products) and may cause water to be drawn in, leading to ______.
diarrhea
Manifestations of lactose intolerance include_______ pain and cramping, excessive ______, and _____.
abdominal, flatus, diarrhea.
True or False: Symptoms of lactose intolerance are usually present at birth.
False. Usually not seen until after age 3 when lactase activity begins to decrease.
Therapeutic Management for lactose intolerance include a lactose free diet and lactase preparations such as _______.
Lactaid.
True or False: Lactose intolerance tends to run in families.
True
Celiac disease involves an inability to fully digest the _____ part of wheat, barley, rye, and oats.
protein
True or False: Celiac disease is an autoimmune disease and has varying degrees from mild to severe.
True
In celiac disease, the intestinal ____ become inflamed; everything they eat just goes right through them.
villi
The first symptoms of celiac disease include failure to _____ and _____. Other symptoms include s________ (oily, fatty stool), behavioral changes such as being f______, and a GI problem ______.
thrive, diarrhea
streatorrhea
fretful
vomiting
Diagnosis of celiac disease is usually based on _____ or based on blood tests such as ____ and ____, which detect damage to intestines. These levels are elevated in almost 100% of cases. A biopsy of the jejunum can also be done which will show atrophic changes of the small intestine, but isn't done much anymore.
symptoms
AGA & tTG

AGA (Anti-gliadin antibodies both IgA and IgG)
tTG (tissue transglutaminase)
True or False: Management of celiac disease includes a diet free of wheat products. Corn and rice are ok.
true
People with celiac disease may be l_______ i______ until healing has occurred in the GI tract.
lactose intolerant
A person with celiac disease needs to strictly follow the prescribed diet This can help avoid _______, a serious disease that people with celiac are at risk for.
lymphoma
True or False: People with celiac disease have adequate nutrition and don't need supplements.
False, vitamin supplements are important.
Acute hepatitis is viral and can be caused by c________, E___-_____, and h_____ ______.
cytomegalovirus, Epstein-Barr, herpes simplex
Type __ hepatitis is spread from oral and fecal contact. ____ ____ing is very important for prevention.
A
hand washing
Type ___ hepatitis is spread through the _____ and other ____ ____.
B
blood
bodily fluids
Type __ hepatitis is _____ related (p______). Usually this person already has hepatitis type ___. Symptoms include pain in the upper ___ quadrant of the abdomen, nausea & vomiting, anorexia, jaundice, fatigue, and itching. People at risk are those who share ______ and ____-___ workers.
Type C hepatitis is transfusion related (parenteral). Usually this person already has hepatitis type B. Symptoms include pain in the upper right quadrant of the abdomen, nausea & vomiting, anorexia, jaundice, fatigue, and itching.
People at risk are those who share needles and health-care workers.
Hepatitis Type ____ is known as the "dangerous duo." It needs type ___ to replicate. People at risk include _______ and __ ___ users.
Hepatitis Type D is known as the "dangerous duo." It needs type B to replicate. People at risk include hemophiliacs and IV drug users.
Hepatitis __ is in contaminated water in underdeveloped countries. (It's non A/B)
E
Hepatitis ___ is bloodborn, and has a connection with tattoos, especially tattoo shops in foreign countries.
G
If you're going to get a type of hepatitis, get Hepatitis ___ because it's the mildest. You will feel like you have the flu for a few days and you can pass it around. You might not even turn yellow.
A
Diagnosis of different types of hepatitis include liver _____ and liver function tests such as ____ and _____. Also look for hepatitis a______ and a_____. A history & physical is done along with a liver ____.
enzymes
AST & ALT
antibodies, antigens
biopsy
Manifestations for hepatitis include what 3 phases? Describe each phase.
Anicteric phase 5-7 days
nausea, vomiting, anorexia, fatigue, slight fever seems like the flu (all types have this phase)

Icteric Phase- 3-4 weeks
jaundice, darkening of urine, light colored stool, urticaria (skin rash), itching due to bilirubin (this phase is types BCDE)

Recovery Phase- 1-3 months
Therapeutic management for hepatitis includes the activity restriction: b_____, anti____'s like ____/_______. _____ lotion, and _____ baths can help with symptoms.
bedrest
antivirals
acyclovir/Zovirax
Calamine & Aveeno
In teaching about hepatitis, there should be emphasis placed on _______.
prevention
Which types of hepatis have vaccines?
A & B- vaccine series
C- None
D- protect from getting B
E- no vaccine, under animal trial