Pedi Exam 2

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Pedi Exam 2
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2012-11-20 00:44:29
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Brittany Pedi exam
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Chapters 10, 14, 23, 24, 25
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  1. Hep A: Fecal oral route
    How?
    Manditory?
    How many shots?
    What age?
    • IM
    • Not manditory
    • 2 round series
    • @ least 1yr old
  2. Hep B;
    How
    manditory
    how many
    if mom b+
    • IM
    • 3 dose
    • yes
    • start within 24hrs
  3. Diphtheria, Pertusses, Tetanus: DTaP
    How
    manditory
    how many
    how many years for booster, what if step on rusty nail
    • IM
    • yes
    • 5 rounds
    • boost every 10 years, but if step on rusty nail and its been longer than 5 years since boost, give just a tetnus booster
  4. Polio
    How
    how many
    manditory
    • IM inactivated
    • 3
    • yes
  5. Measles, mump and rubella
    How
    How many
    SE
    who do we not give it to?
    • Sub Q
    • AFTER 1 year of age
    • 2 rounds
    • It burns, give last!
    • <12 months, pregnant, immunocomprimised.
  6. Hib
    how many
    manditory
    what does it protect from
    • 3
    • not manditory
    • hepatititis, menigitis
  7. Prevnar: pneumonococcal vaccine
    how many
    manditory
    protects from what
    • 4 rounds
    • not manditory
    • otitis media, pnmonia, sinitis
  8. Influenza
    how often
    earliest age
    how
    • yearly
    • 6 months
    • injection, nasal
    • *asthma is written in the notes, look up what it means*
  9. HPV:
    How many
    ages
    manitory
    protects against
    • 3 part
    • 9-26 yrs old
    • not manitory
    • 4 typs of hpv, 6,11,16,18 cervical cancer and gential warts
  10. Rotovirus
    ages
    how many
    how
    all by what age
    • 2,4,6 months
    • 3 dose series
    • all by 32 weeks (8 months) of age
    • oral
    • decreases severity
  11. Meningococcal vaccine
    Age
    prevents
    • 11 years
    • menigitis
    • optiona
  12. Administration of vaccine will include what 5 things?
    • documentaion
    • date
    • manufacturer/lot #
    • Title adsignature of person givinG vaccine
    • caccine information statement
  13. Contradictions for adminstration of vaccines
    • Childern who are
    • immunocompromised- chemo, steriod use
    • really ill
    • allerigies (food and vaccine componets)
    • Severe reatctions to a previous injection
    • pregnancy
  14. Contradiction to polio vaccine
    neomycin or streptomycin
  15. Contradictions to MMR
    <12 months or pregnant
  16. Contradictions to Hep B vaccine
    baker's yeast
  17. time between administration of mmr and varciella
    at least one month between
  18. Chicken pox
    agent
    source
    transmission
    contagious
    s&S
    • varicella-zoster virus
    • primary secretios of respiratory tract and skin lesions
    • direct contact, airborn, contaminated objects
    • One day before eruption of slesions until all vesicles are crusted over
    • Papual-vesical-pop-crust over
  19. Diptheria
    agent
    source
    incubation
    Treatment
    S&S
    • corynebacterium diphtheriae- bacteria
    • discharges form mucous membrans of nose, nasoharynx, skin and other lesions of infected person
    • Period of 2-5 days
    • penicillian erythromycen- 3 neg cultures in a row neg
    • "bulls neck"
  20. Erythema infectiosum- fifth disease
    agent
    s&S
    transmitted
    treatment
    • Human parvovirus
    • 3 stage rash-
    • 1. slapped face appearence desapperars by 1-4 days
    • 2. maculopapular rash on extremities; last 7 days or more
    • 3. Rash subsides but reappears if skin irritated or traumatized by heat, cold, friction, etc
    • Keep pregnant people away!!
    • Respiratory secretion
    • rest fluids tylonol ibprofen
  21. Roseola
    Agent
    incubation
    s&s
    usually infects what aged children
    • Human herpes virus type 6
    • 5-15 days
    • Persistant fever for 3-4 days, otherwise apears well,
    • after fever subsides, rash appears,
    • rash first on trunk, then face and extemities
    • <3yrs of age, 6-15months of age
  22. Rubeola (measles)
    agent
    source
    incubation peiord
    S&S
    • Virus
    • secretions; droplet transmision
    • 10-20 days; communicability from 4 days before to 5 days after apperance of rash
    • Fever-maliaise-cough-kolik's spots- rash
    • kopliks spots appear 2 days before rash
    • (buccal mucosa, red with white tops)
  23. Mumps
    agent
    transmitted
    incubation
    s&s
    may cause what
    • Paramysovirus
    • droplet or contact
    • 14-21 day incubation
    • fever, headache, malaise, followed by parotitis (earache)
    • may cause orchitis and menigoecephaliits
  24. Pertussis (whooping cough)
    agent
    transmission
    incubation
     s&s
    Complications
    • Bordetella pertussis
    • droplet or direct contact
    • 6-20 days
    • short rapid coughs followed by crowing or "whoop" sound
    • complications pneumonia (usual cause of death)
    • rds on rebound always rule out
  25. Polio
    agent
    types
    manifested in what 3 ways
    source
    transmission
    • Enterovirus
    • Type 1- paralysis- gets better
    • Type 2- least freqeuent associated with paralysis
    • Type 3- second most frequeently assocatied with parlysis
    • abortive or inpapparent- fever uneasieness, sore throat, headache, lasts a few hours to days
    • Nonparalytic- same manifestations as abortive but more severe with pain and stiffness in neck pain and legs
    • Paralytic- Intital course similar to nonpar type followed by recovery and then signs of central nervous system paralysis
    • Feces and oropharygea secretions
    • Direct contact
  26. Rubella (German Measles)
    Agent
    Transmission
    incubation
    complications
    S&S
    • rubella Virus
    • direct contact or indirect contant with article freshly contaminated with nasopharyngeal secretions, blood, stool, or urine
    • 14-21 days
    • complications are rare; greatest dangert is teratogenic effect on fetus
    • occasionally low-grade fever, headache, maliase, lymphaenopathy, rash that appears one day after these symptoms subside. rash first appears on face and spreads down and disappears in the same order it began and usually gone by third day
  27. Scarlet Fever
    Agent
    Transmission
    incubation
    complications
    Always do what
    How to treat
    S&S
    • Group a hemolytic steptococci
    • droplet or direct contact
    • 1-7 days incubation
    • crditis, perionsillar abcess, glomerulonephiritis
    • Rapid test
    • some kind of penicillian
    • abrupt heigh fever, tonsils enlarge, white strawberry tongue and then red strawberry tonge, rash 12 hours after prodromal stage (fever) red pinhead sized lessions rapidly becaome generalized but are absent on face, more promident on fold of joints, sloughing on palms and soles of hands and feet
  28. Isotonic dehydration
    electrolyte and water equally lost
  29. Hypotonic dehydration
    electrolyte loss is greater than water loss
  30. hypertonic dehydration
    water loss is greater than electrolyte loss
  31. Sudden increase of diarrhea that test positive for infectious pathogen and last less than 14 days
    acute infectious diarrhea
  32. Diarrhea lasts longer thatn 14 days and cannot find pathogens, gone in a couple of months
    lactose intolerance
    Chronic diaherra
  33. Intractable diarrhea of infancy
    • More than 14 days
    • no pathogens
    • gone in a couple of months
  34. Chronic nonspecific diarrhea (CNSD)
    • 6 months -54 months
    • loose stool for more than 2 weeks with no malnutrition.
    • Baby verision of IBS
  35. Diagnostic evaluations for diarrhea
    stool sample from one source
  36. Therapeutic management of diarrhea
    reintroduce fluids IV= po feedings asap
  37. Rotovirus- most significant nosocomial pathogen
    most severe at what ages
    what are comon isolated baterial pathogens
    • 3-24months
    • salmonella, shigella, camplobacter organisms
  38. An alteration in frequency, consistancy, or eas of passage of school
    3= days without pooping
    constipation
  39. idiopathic (functional) constipation
    no known cause
  40. Chronic constipation
    may be due to enviromental or psychosocial factors control!
  41. First mconium should be passed when
    24-36 hours of life
  42. If mecomium is not passed within 36hours what should you assess for?
    • Hirschsprung disease, hypothyroidism
    • Meconium plug, meconium ileaus (CF)
  43. Interventions for constipation for infancy
    • iron formula
    • prune or apple juice
    • stimulate rectal thermometer
  44. Encopresis
    inappropriate passage of feces, often with soiling
  45. Hirschsprung disease aka Congenital aganglionic megacolon
    • accumulation of stool with distention
    • failure of internal anal sphincter to relax
    • enterocolitis may occur
  46. Diagnostic evaluation of hirschsprung disease
    • xray barium enema
    • anorectal manometric exam
    • confirm diagnosis with rectal biopsy- looking for ganglioin cells
  47. Thrapeutic Management hirschsprung disease
    • Surgery- cut out area missing the cells and colostomy for the distended part
    • 2stages
    • 1. Tempory ostomy - 1st year of life
    • 2. Pull-through procedure - reattach
  48. Home management for Hischsprung disase
    • send home with white baton to dialate the rectum
    • turn it everytime they change diaper
    • once pull through change the diaper immediatelty as patent is high risk for impaired skin integrity
  49. What makes gastroesophageal reflux abnormal since it happens to all of us
    frequency and persistency
  50. Gerd
    the damage from ger
  51. Diagnositics for GER
    • Acute life threatening event, failure to thrive
    • Upper gi- barium- take pic when swallow (1 time shot)
    • Ph probe- lower esophageal monitor 24hr recording would mark down on chart when baby is feeding or crying
  52. Therapeutic management for Ger
    • Less amount and up the frequency
    • Burp frequently
    • hold up right after eating for 20 min
  53. Nusring considerations for ger
    education thicken feeds, zantac, reglan ( increases the emptying of stomach)
  54. Which comes first closure of a cleft lip or palate?
    Lip defect precedes correction of the palate
  55. What minimizes the retraction of scar of CL
    Z-plasty
  56. What should you protect suture line with for cl
    Logan bow or other methods
  57. When will CP be corrected?
    typically 12-18 months of age
  58. Biggest issue for cleft lip and palate
    • Feedings, latching and sucking
    • Use elongated nipple with larger slit for suction problems (frequent burping)
    • Breastfeedig- infants head upright mostion with nipple use pump to bring milk down
  59. Clinical manifestations for Esophageal atresia and tracheosepohageal fistula (TEF)
    • Excessive drooling and salvation
    • 3 "c's" coughing, choking, cyanosis
    • apnea
    • increased respiratory distress after feeding
    • abdominal distention
  60. Management of TEF
    • Surgical interveintions
    • good prognosis
  61. Tracheomalacia
    • Associated with TEF
    • Trachea compresses as they breath
  62. Hypertrophic pyloric stenosis
    constriction of pyloric sphincter with obstruction of gastric outlet
  63. Diagnostic evaulation of Pyloric stenosis
    • Failure to thrive
    • History
    • Ultrasound
    • Projectile vomiting that occurs 30-60 minutes after feeding
    • Can feel olive like mass
  64. Theraputic management of pyloric stenosis
    • pyloromytotomy- RUQ incison
    • feeding begun with 4-6 hours postop
    • small frequent feedings of glucose water or electolyte solu then move to formula and bm
  65. Intussusception
    • telescoping or invagination of one portion of intestine into another
    • occasionally due to intestinal lesions
  66. Ages for intussusception
    • below 5 years of age
    • 3-9 months are peak age
  67. Diagnostic for intussusception
    barum enema (usualy diagnosis and coreects it)
  68. Celiac disease
    • aka gluten induced enteropathy and celiac sprue
    • Immune response to gluten
  69. 4 characterisitcs to celiac disease
    • steatorrhea -fatty stool
    • general malnutrition
    • abdominal distention
    • secondary vitamin deficiencies
  70. Patho of celiac disease
    • Patient allergic to gluten
    • Mucous rsponce in gi ( allergic responce)
    • impaired growth
    • diahrrea
    • poor appitite
  71. Diagnosis of Celiac disease
    • biopsy
    • changes in mucosal
  72. Thereaputic management of celiac disease
    • gluten free diet
    • lifetime change
    • dietary consult
  73. Short bowel sydrome (sbs)
    • a malabsorptive disorder
    • results form decreased mucosal surface area, usually as a result of small bowel resection
    • (trauma, nec, gastroesis- bowel outside body)
    • goal is to preserve as much intestin as possible
  74. Therapeutic management of short bowel syndrome
    • early diagnosis
    • may be on po and po & tpn
    • small frequent amounts otherwise dumping syndrome
  75. Necrotizing enterocolitis
    • acute inflammatory disease of the bowel occurring in preterm and high risk infants
    • can cause short bowel syndrome
  76. factors predisposing developing nec
    • prematurity
    • ischemia
    • colonization of bacteria
  77. diagnostic evalutation of of nec
    • assessment
    • xray
    • labs
  78. theraputic management of nec
    • npo 24-48 hours
    • breast milk preferred for feeds (contains iga, macrophages and lysozymes)
    • Ng for decompression
    • iv antibiotics TPN
    • bowel resection if perforation occurs
  79. Nursing interventions for gi disyfunctions
    • assessment of f&E
    • rehydration
    • mainenance of fluid therapy
    • reintrouction of adequeate diet
    • isoalation precautions
    • education
    • history of bowel patterns, medications and diet
    • dietary modification (age appropriate0
    • pre op care
    • post op care
    • discharge care
  80. upper respiratory tract
    • nose
    • pharynx
  81. lower respiratory tract
    bronchi and bronchioles
  82. croup syndromes
    infections of epiglottis and larynx
  83. most common season for respirtatory infections
    winter and spring
  84. mycoplasma pnemoina infections occur in what seasons most
    fall and winter
  85. asthmatic bronchitis more frequent in what weather
    cold weather
  86. rsv seasons?
    winter and spring
  87. generalized signs and symptons and local manifestations for respiratory tract infections
    • fever
    • anorexia
    • vomiting
    • diarrhea
    • abdominal pain
    • cough
    • sore throat
    • nasal blockage or discharge
    • respiratory sounds - wheezing rhonci crackles
  88. Nursing interventions of resp probles
    • ease respiratoty effort - o2 resp treatments
    • promote rest and comfort
    • infection control
    • promote hydratio and nutrition
    • family support and teaching
    • fever management
  89. Nusring interventions for tosnilectomy
    • pain medication/ ice collar
    • use a cool mist vaporizer
    • monitor for bleeding
    • strict monitoring of intake and output
    • provide comfort
    • monitor o2 sats, resp treatments
    • assess assess asses
  90. Nasopharyngitis
    common cold
  91. nasopharyngitis
    cause
    s&s
    • rsv, rhinovirus, adenovirus influenza, and parainflueza virus
    • fever
  92. Pharyngits cause and risks
    • bacterial or viral
    • culture should be taken to rule out GABHS
  93. Clinical manifestations of pharyngitis
  94. Therapeutic management of pharyngitis
    if gabhs
    • oral penicillian
    • azithromycin, clarithromycin, oral cephalosporins amoxicillian
  95. Tonsillitis pathophysilogy and etiology
    filter and protect
  96. Clinical manifestations of tonsillitis
    • fever
    • malaise
    • difficulty swallowing
  97. Theraputic management of tonsilitis
    penicillian derivitive
  98. What would warrent a consult for a tonsillectomy
    more than 3 infections in a year after medication and no improvement
  99. after tonsillectomy when is biggest risk for bleeding
    10 days post op
  100. Nursing interventions post tonsillectomy
    • drink post op- nothinig red and no straws
    • pain medication q4hrs while awake for base level;
  101. Patho and etiology for otitis media
    • toddlers and babies
    • viral
    • 3 types of bacteria
  102. What increases risk for otitis media for child
    • passive smile
    • pacifier
    • daycare
    • increased amount of people
    • not breastfed
  103. theraputic management for OM
    pharmacologic- amocicillian 10days follow up in 2 weeks
  104. Croup syndroms characterized by what
    • hoarseness,
    • barking cough
    • inspiratory stridor
    • varying degrees of resp distress
  105. Croup syndromes affect what?
    • Larynx- laryngitis
    • Bronchi- ltb- laryngotracheobronchitis
    • Trachea- tracheitis
  106. Acute epliglottitis - hib vaccine
    Clinical manifestations
    • sore throat
    • pain
    • tripod positioning
    • retractions
    • inspiratory stridor
    • mild hypoxia
    • distress 
    • DO NOT STICK A TONGUE DEPRESSOR!
    • HAVE EQUIPMENT FOR INTABATION
  107. Acute laryngitis
    age most common
    cause
    chief complaint
    treatment
    • self-limiting
    • older children and adolescents
    • virus
    • hoarseness
    • symptomatic
  108. Acute LTB- laryngotracheobronchitis
    most common of the croup syndromes
    ages affected
    cause
    • less than 5 years old
    • rsv, parainfluenza virus, mycoplasma pneumoniae, influenza A&B
  109. Acute LTB
    clinical manifestations
    can lead to what
    • fever
    • inflammation of the mucosal
    • inspiratory stridor
    • suprasternal retractions
    • barking or seal like cough
    • increasing respriatroy distress and hypoxia that can lead to respiratory acidosis, respiratory failure and death
  110. Theraputic management for Acute LTB
    • airway management
    • maintain hydration po or iv
    • high humidity with cool mist
    • nebulizer treatments - epinephrine and steriods
  111. Acute spasmodic laryngitis aka
    spasmodic croup
    midnight croup

    when
    inflammation
    age
    therapeutic management
    • paroxysmal attacts of laryngeal obstruction
    • occurs cheifely at night
    • inflammation: mild or absent
    • most often affects children 1-3
    • cool mist vapor
  112. Bacterial tracheitis
    • infectionof the mucosa of the upper trachea
    • distinct entiti with features of croup and epiglottisis
    • clinical manifestations similiar to ltb may be complication of ltb
  113. Bacterial tracheitis
    clinical manifestation
    THICK purulent secretions result in respiratory distress
  114. Bacterial tracheitis
    therapeutic management
    • o2
    • humidified oxygen
    • antipyretics
    • antibiotics
    • may require intubation
  115. Infections of the lower airways
    • considered the reactive portion of the lower respriatory tract
    • includeds bronchi and bronchiles
    • cartilaginous support not fully develped until adolescence
    • constriction of the airways
  116. RSV= respiratory syncytial viruls
    Bronchioles fill swell and fill with exudate THICK mucus
  117. Patho rsv
    • bronchiolar mucosa swessl and lumina are fulled with mucus and exudate.
    • Lumina are frequently obstucted on expiration
    • produce partial obstruction and patchy areas of actlectasis
    • narrow passages on expiration prevents air from leaving lungs and thus progresses to overinflation (emphysema)
  118. Clinical manifestations of rsv
    • rhinorrhea
    • pharyngitis
    • coughing, sneezing
    • wheezing
    • possible ear or eye drainage
    • increased coughing and weezing
    • tachypna and retractions
    • cyanosis
  119. Diagnostics for rsv
    • rapid testing  dfa
    • elisa for rsv antigen
  120. Therapeutic management of RSV
    • Humidified o2
    • periodic nasal secretions
    • oral hydration unless listless and tachypnea
    • suction prior to feedings
    • avoid passive smoke exposure
    • ribavirin MAY be given aerosol  12-20 hours daily
  121. Prophylaxis RSV
    • Nov-March monthly IM inj
    • Babies born before 32 weeks
    • Babies less than 6 months of age
  122. Asthma
    • chronic inflammatoroy disorder of airways
    • Bronchial hyper resonsiveness -mornings and evenings
    • episodic
    • limited airflow or obstruction that reverses spontaneously or with treatment
  123. Asthma severity classes which one is least and which is most
    • Steps I-IV
    • I being the most mild about 2 times a week
    • IV is severe, persistent asthma
  124. Diagnosis of asthma
    • Reactive Airway Disease @ first
    • PFT
    • Allergy test
  125. Theraputic management of asthma
    Long term control meds everyday
  126. Nursing considerations for asthma
    • how to prevent the allergins
    • no carpet, curtains, low humidity
    • plastic sheets
    • dust and vacuum daily
  127. Drug therapy for asthma
    • lt control meds
    • quick relief meds
    • mdi
    • corticosterioids -not usually daily, prn
    • cromolyn sodium
    • albuterol, metaproterenol, terbutaline
    • MDI
  128. Status astmaticus
    • respiratory distress continues despite vigorous therapeutic measures
    • emergency treatment- epinephrin 0.01 mL/kg SQ (max dose is 0.3mL)
    • concurrent infection in some cases
  129. Goals of asthma management
    • avoid exacerbatio
    • avoid allergens
    • relieve asthmatic episodes promptly
    • releive bronchospasm
    • monitor function with peak flow meter @home
    • self-management of inhalers, devices, activity regulation
    • some will outgrow but teach
  130. Cystic fibrosis
    • genetic recessive gene - mom and dad are carriers 25% will have it, 50% carry it 25% normal
    •  exocrine gland dysfunction that produces multi-system involvement
    • Most common lethal GENETIC illness among white children
    • Approximately 3% of us caucasioan population are symptom free carriers
  131. Patho of CF
    • Characterized by several unrealted clinical features
    • increased viscosity of mucous gland secretion
    • results in mechanical obstruction
    • thick inspissated mucoprotein accumulates, dialates, precipitates, coagulates to form concretions in glands and ducts
    • respiratory tract and pancreas are predominately affected
  132. Most reliable diagnostic procedure for CF
    • sweat chloride test
    • sodium and chloride will be 2-5 times greater than normal
  133. order of the heart
    venacava-> rt atrium-> tricuspid->rt ventricle->pulmonary artery ->lungs-> left atrium--> mitral valve--> left ventricle--> aorta--> system
  134. risks of cardiac cath
    • acute hemorrage rt or left femmoral watch for bleeding
    • infection
    • low grade fever
    • trasient dysrythmias
    • n&v
  135. two types of cardiac defects
    • cogenital - anatomic > abnormal function
    • Acquired- disease process- infection, autoimmune enviromental, familial tendencies
  136. What 2 things give their baby a 50% chance of having chd
    • fetal alcohol syndrome
    • Rubella in 1st 7 weeks of pregnancy
  137. most common anomaly for CHD
    vsd
  138. CHD
    incidence
    • 5-8 per 1000 live births
    • about 2-3 of these are symptomatic in the first year
    • major cause of death in the first year
    • 28% with chd have another recognized anomaly
  139. Hemoodynamic characteristics of chd
    • increases pulmonary blood flow
    • decreased pulmonary blood flow
    • obstrution of blood flow out of the heart
    • mixed blood flow
  140. Nursing interventions for cardiac cath
    • apply emla cream to both femoral arteries
    • obtain accurate weight and height
    • obtain blood work
    • education
    • consult child life
  141. Nursing interventions for post cardiac cath
    • check pulses for equality/ symmetry
    • check temp and color of affected limb
    • monitor bp
    • monitor dressing for bleeding
    • monitor i&os
    • monitor for s&s of infection - low grade ok at first
  142. Increased pulmonary blood flow defects
    What is it?
    Increased blood flow on ____ side
    ________ pulmonary blood flow
    ________ systemic blood flow
    • Abnormal connection between two sides of the heart
    • Either the septum ore the great vessels
    • Right
    • Increased
    • Decreased
  143. Increased  pulmonary blood flow defects
    This allow blood to flow from _______ pressure to _____ pressure ( ____ to _____ shunting)
    This patient may develop s/s of ____
    • higher to lower
    • left to righ
    • CHF
  144. Three major defects associated with pulmonary blood flow defects
    • atrial septal defect
    • ventricular septal defect
    • patent ductus arteriosus
  145. Artial septal defect
    • Hole between the atrium
    • Left pressure higher than the right
    • may close with cardiac cath procedure
    • right atrium becomes disteneded
  146. Ventricular septal defect
    • hole between ventrilce
    • characteristic murmer, chf is common , risk of bacterial endocarditis
    • r ventricle hypertrophy
    • cardiac cath repair or surgery with bipass
  147. Signs and symptoms of PDA
    • large PDA: CHF with tachypnea, dyspnea, hoarse cry
    • bounding peripheral pulse, widening pulse pressure , macherinery murmer, echo for diagnosis

    indomethicin to close pdas
  148. Obstructive defects
    • blood exciting the heart meets an area of anatomic narrowing (stenosis) causing obstructed blood flow
    • preassure is increased before the obstructio adn decreased beyond.
  149. 3 examples of obstructive defects
    • coartation of aorta
    • aortic stenosis
    • pulmonic stenosis
  150. Coartation of aorta
    • increase pressure proximal to the defect
    • risk of rupture
    • Causes high BP and bounding pulses in arems and weak or absent femoral pulses and cool lower extrimities with low bp
    • balloon angioplasty

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