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301 Cards in this Set
- Front
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Any pregnancy, regardless of duration, including present pregnancy
|
Gravida
|
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Birth after 20 weeks gestation regardless of whether the infant is born alive or dead
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Para
|
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The number of weeks since the first day of the last menstrual period
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Gestation
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The normal duration of pregnancy
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Term
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Second or any subsequent pregnancy
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Multigravida
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Period during which a woman is pregant
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Antepartum
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From the onset of labor until birth of the baby and placenta
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Intrapartum
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From birth until the woman's body return to a prepregnant condition. Approx. 6 weeks
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Postpartum
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G, T, P, A, L
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Gravada
Number of term Number or pre-term Abortions Living |
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What must you consider for gestational age
|
1)last menstrual period
2)menstrual history (interval and duration) 3)contraceptive use |
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What is Nagele's Rule
|
LMP + 7 -3 months = EDC
|
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What are ancillary dating methods used for pregnancy testing
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Detects presence of Beta hCG
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When can Beta hCG be detected in normal pregnancy
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as early as 6-9 days following ovulation
|
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When does the level of Beta hCG rise after conception
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During the first 3-4 weeks and then levels off eventually to decline
|
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What do low levels of hCG indicate
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Ectopic, or impending SAB
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What can higher levels of hCG indicate
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Twins
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When are heart tones first audible?
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Doppler 10-12 weeks
Fetoscope 17-20 weeks |
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The fundus reaches the umbilicus at approximately how many weeks
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20
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Between how many weeks gestation is the fundal hight in cms equal to the G.A in weeks
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20-31
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When measuring fundal height, where do you measure the top
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Fetal pole in fundus
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When does quickening usually occur
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between 17-20 weeks
|
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What is the general rule regarding ultasound dating
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the earlier teh estimate of the age, the more accurate it is
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What is the new cornerstone of dating
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Ultrasound
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What is the most common used method for figuring out the gestational age with an unknown LMP, irregular menses, and contraceptive use
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Ultrasound
|
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Good dates
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-reliable LMP
-Documented positive pregnancy test by 6 weeks -1st exam before 12 weeks, S=D -FHT's by doptone @10 weeks |
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Poor Dates
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-unknown LMP
-1st exam after 30 weeks -U/S after 30 weeks -size < or > dates |
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What signs are these:
nauseated breastes are tender tiredness -Cessation of menses -increased urination -Elevated BBT -Quickening -Skin changes |
Presumptive signs
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What signs are these:
-Enlargement of the abdomen -Enlargement and change in shape of uterus -Palpation of fetal outline -Palpation of UC's -Positive pregnancy test |
Probable Signs
|
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What signs are these
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-Fetal Movement
-FHT's -Ultrasound |
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When can the gestational sac be seen with an ultrasound
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4-6 weeks
|
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What are dark brown splotchy areas over the face
|
Chloasma
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What is Palmar Erythremia
|
Redness of the palms of the hands due to high estrogen levels
|
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What are stretch marks called
|
Striae Gravidarum
|
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What are breast changes during pregnancy
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-Breast enlargement and fullness
-Tingling and tenderness -Areola darkening -Montgomery tubercles become prominent -Colostrum |
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When pregnant stomach tone and motility ___
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Decrease
|
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When pregant small intestine motility ____
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Decrease
|
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When pregnant Colon motility _____
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Decrease
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When pregnant what happens to the bladders tone
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Decrease
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When pregnant what happens to retention capacity
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It's reduced
|
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When pregnant what happens to the kidneys and ureter
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Dilation
|
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What happens to the Tubules during pregnancy
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unable to reabsrob all filtered substances causing spillage of glucose
|
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What are women at risk for
|
UTI's
|
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What respiratory change occur in pregnancy is not normal
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Breathing from the diaphragm
|
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When pregnantion what occurs as the tidal volume increases to blow off excessive CO2 coming from fetus
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hyperventilation
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What happens to oxygen consumption when pregnant
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It increases
|
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Breathing is what during pregnancy
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Thoracic, rib cage flares
|
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When is the diaphragm displaced when pregnant
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upward, SOB
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How much does Blood volume increase during pregnancy
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45%
|
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How much increase in plasma volume during pregnancy?
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50%
|
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How much is cardiac output increased?
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30-50%
|
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Pulse rate increase by
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10-15 BPM
|
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What are some iron rich foods
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Lean Beef
Spinach Baked Beans |
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Pregnant Hemoglobin
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> 11
|
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Pregnant Hematocrit
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>33 (Normal 37-47)
|
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Pregnant Anemia
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Hgb <10
Hct<35% |
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Anemia in non-pregnant
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<12
|
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What are changes in the uterus
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size increases by stretching
thinner and softer increase in muscle fibers increase in contractility |
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What is the Chadwick's sign
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Bluish Hue of the cervix when a woman is pregnant
|
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What are changes in the cervix
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more vascular and edematous
Chadwick's sign Goodell's sign Increase in mucus production |
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What is the Goodell's sign
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Softening of the uterus
|
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What changes happen in the vagina during pregnancy
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Hypertrophy and hyperplasia
-thickened vaginal mucosa -Increase in lenght of vault -Increase in white vaginal discharge |
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when do food cravings common
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Second trimester
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When is constipation common
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Second trimester
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When are pigmentation change common
|
Second trimester
|
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When are varicose veins common
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Second trimester
|
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When are round ligament pain common
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Second trimester
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When is supine hypotension common
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Second trimester
|
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When are Braxton Hicks UC's common
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Third
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When is Dependent Edema common
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Third Trimester
|
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When is Insomnia common
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Thrid Trimester
|
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When is Urinary Frequency common
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Thrid trimester
|
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What are signs of pregnancy induced hypertension
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headache, blurry vision
seeing spots before eyes |
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When is absence of fetal movement a danger sign
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After 20 weeks
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What are some danger signs
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Sudden gush in fluid
-Vaginal bleeding -Abdominal pain -Temp and chills -Sever H/A, blurred vision, spots -Dysuria |
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when should someone be referred for genetic consultation
|
Hx of 2 or more miscarriages
Mother 35> Hx of family member with defect -Exposure -Mother's health condition -Couple is first cousin or other close blood relative |
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What test is removal of a small tissue specimen from the fetal portion of the placental
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Chorionic Villus Sampling
|
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When is Chorionic Villus Sample taken
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10-12 weeks
|
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When should chorionic Villus not be done
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Before 10 weeks
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What does MSAFP stand for
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Maternal Serum Alpha-fetoprotein
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This test is recommended for all pregnant women
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MSAFP
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What does MSAFP detect
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Neural Tube defects and open abdominal wall defects
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Where is AFP produced
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by the fetal liver
|
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WHen is AFP detected in the serum
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From 14-34 weeks
|
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What do lower levels of AFP possibly mean
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Down Syndrome and other autosomal trisomies
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When is the triple-marker test performed
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16-18 weeks
|
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What does the triple-marker test test?
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Three maternal serum markers:
MSAFP unconjugated estriol Human chorionic gonadotropin |
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Using a triple-marker test, what will a baby with down syndrome test
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MSAFP and unconjugated estriol levels are low, and hCG level is elevated
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MSAFP is what?
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Only a screening test, not diagnostic
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What happens if the MSAFP is positive
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An U/S is ordered, Refered to genetics who will order amniocentesis
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What is one example of a Genetic Diagnostic test
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Chorionic Villi Sampling
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What is CVS?
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Chorionic Villi Sampling, analysis of chorionic villi for chromosome analysis
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When is a CVS ordered
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(Chorionic Villi Sampling) Between 9-11 weeks
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What is an example of a genetic diagnostic test
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withdrawal of amniotic fluid
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What is both a screening and diagnostic test
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Ultrasound
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What is the most widely applied technique for antepartum evaluation of the fetus
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Nonstress test
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Describe the nonstress test:
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seated in a reclining chair
slight left or right tilt FHR is recorded with a Doppler and a codynamometer is appled to detect uterine contractions. -may take 20-30 minutes -Baby has to be awakened |
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What are accepted criteria for Non-stress tests
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Two or more accelerations of 15 beats/min lasting for 15 seconds over a 20 min period
-Normal baseline rate -Moderate variability |
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What can provide earlier warning of fetal compromise thant the NST and with fewere false-positive results
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CST (Contraction stress test)
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IS the CST Contraction stress test used often
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NO
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How does the contraction stress test work
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Two methods: nipple-stimulated contraction test and the oxytocin-stimulated contraction test
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Interpretation of CST Contraction Stress Test
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If no late deceleration are observed with the contraction the findings are considered negative
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What are three fetal well-being tests
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NST-non stress test
CST- contraction stress test BPP-biophysical profile |
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What is the Biophysical Profile
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noninvasive- Includes AFV (amniotic fluid volume)
FBMs (fetal breathing movements) Fetal movements FHR *considered a physical examination of the fetus |
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Breasts
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1-1.5
|
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Blood
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3-4.5
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Extra water
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4-6
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Uterus
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2.5-3
|
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Placenta
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1.5-2
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Amniotic fluid
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2-3.5
|
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Baby
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7-8
|
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stores of fat
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4-6.5
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When the expectant father adjusts to the reality of the pregnancy, what phase is this
|
Moratorium
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stores of fat
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4-6.5
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When the expectant father adjusts to the reality of the pregnancy, what phase is this
|
Moratorium
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What enzyme is present in the fetal liver in amounts less than those required after birth
|
glucuronyl transferase
|
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How long does it take for the fetus to produce vitamin K
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several days
|
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What is the most critical alveolar surfactant required for postnatal lung expansion
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Lecithin
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What is used to determine the fetal lung maturity
|
L/S ratio, Sphingomyelin is also produced in the lungs but is constant, Lecithin increases at 21-24 weeks.
|
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When are the lungs considered to be mature
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When L/S reaches 2:1
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When are the lungs usually mature by
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35 weeks
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What can retard fetal lung maturity
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gestational diabetes and chronic glomerulonephritis
|
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What babies have more respiratory difficulty?
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Cesarean because the fluid is not sqeezed out
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Is the GFR high or low in a term baby
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Low
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When sould newborns void
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within 24 hours of birth
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When does the neural tube form
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during the 4th week
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What can cause fetal hiccups
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cold solution placed into the amniotic fluid
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What is the name for a large fetus
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macrosomic fetus
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What is it called with infants secret fluid from engorged breasts
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Witch's Milk
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What is the cheesy material that protects the skin of the fetus
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Vernix caseosa
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What is the very fine hairs called
|
Lanugo
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What is the only immunoglobulin that crosses the placenta
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IgG
|
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What is an immunoglobulin that is not produced by the baby
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IgA
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What does colostrum contain
|
large amounts of IgA
|
|
Two zygoes
|
Dizygotic twins- two placenta that may fuse
"Fraternal" |
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Identical twins
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Monozygotic twins
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A woman who has never been pregnant
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nulligravida
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A woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks
|
nullipara
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A pregnancy that goes beyond 42 weeks
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Postdate or posterm
|
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A pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation
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preterm
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A woman who is preganant for the first time
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Primigravida
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A pregancy from the beginning of 38 weeds to the end of 42 weeks
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term
|
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capacity to live outside the uterus; abotu 22-25 weeks
|
viability
|
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gravidity
|
pregnancy
|
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What pregancy test can detect the beta subunit of hCG
|
RIA radioimmunoassy; performed in the labratory
|
|
What can cause false-positive tests
|
anticonvulsants
|
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What causes false negatives
|
diuretics and promethazine
|
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What does the uterus look like during the second trimester
|
spherical or globular
|
|
When does the pregnancy show?
|
14th week
|
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What is it called when the fetus begins to descend and engage in the pelvis
|
lightening
|
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When does lightening occur in the nullipara
|
about 2 weeks before the onset of labor
|
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When does lightening occur in the multipara
|
Start of labor
|
|
at 6 weeks gestation, softening and compressibility of the lower uterine segment occur
|
Hegar Sign
|
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When do Braxton Hicks start
|
Fourth month
|
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What is the sound made by blood in the uterine arteries that is synchronous with the maternal pulse
|
uterine souffle
|
|
Sound made by blood rushing through the umbilical vessels and synchronous with the fetal hearth rate
|
Funic souffle
|
|
Softening of the cervical tip
|
Goodell Sign
|
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Passive movement of the unengaged fetus
|
ballottement (bouncing it gently)
|
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First sign
|
Quickening
|
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Violet-bluish color of the vaginal mucosa and cervix
|
Chadwick, (6-8th week)
|
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White or slightly gray mucoid discharge with a faint musty odor
|
Leukorrhea
|
|
formation of the mucous plug
|
operculum
|
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Is the vaginal secretions more acidic or basic
|
acid
|
|
What is a pregnant more prone to
|
yeast infections
|
|
What are sebaceous oil glands embedded in the primary areolae
|
Montgomery tubercles
|
|
viscous secretory material can be found in the acini cells by the third month of gestation
|
Precolostrum
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Creamy, white-to-yellowish-toorange premilk fluid may be expressed from the nipples as early as 16 weeks
|
Colostrum
|
|
When does the apical impulse and PMI shift
|
Upward and laterally about 1-1.5 cm
|
|
Does systolic blood pressure change
|
usually remains the same
|
|
Does diastolic blood pressur echange
|
begins to decrease in the first trimester, continues to drop until 24-32 weeks, then gradually increases and retuns to prepregnancy levels by term
|
|
Drop of more than 30mm in systolic bp. bradycardia is noted,feels faint
|
Supine hypotensive syndrome
|
|
hemodilution is referred to as
|
physiologic anemia
|
|
When does the Total white cell count increase
|
second, and peaks during the 3rd
|
|
What causes the lung expansion to relax
|
Estrogen
|
|
What does estrogen cause
|
more vascularity
|
|
What happens to BMR
|
increases
|
|
What side do the urters ususally dialate more on
|
Right
|
|
Why is their urinary frequency
|
Initially from increased bladder sensitivity and later from compression
|
|
What happens to bladder tone
|
may decrease which increases the bladder capacity to 1500ml
|
|
What happens to the GFR early in pregnancy
|
increased
|
|
Does physiologic edema or dpendent edema require treatment
|
no
|
|
Tubular reabsorption of what is impaired
|
Glucose
|
|
glucosuria occurs when maternal glucose levels are lower than
|
160 (Normal 160-180)
|
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Does proteinuria usually occur during pregnancy
|
No, except during labor or afterbirth. 1+ protein or less than 300 mg per 24 hr are acceptable
|
|
Facial melasma is called
|
chloasma
|
|
What might cause stretchmarks
|
adrenocorticoisteroids
|
|
In multipara in addition to the striae of the present pregancy glistening silvery lines appear on...
|
light skined women, purplish lines on dark skined
|
|
Whats antoher word for vascular spiders
|
Angiomas
|
|
Where are vascular spiders normally found
|
neck, thorax, face, and arms, usually disappear
|
|
Palmar Erythema
|
Pinkish-red, diffuse mottling or well-defined blotches on the palms of the hands
|
|
What is the most common cause of pruritic rash
|
Cholestasis of pregnancy
|
|
Gingival granuloma gravidarum, red, raised nodule on the gums that bleeds easily
|
Epulis
|
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Separation of the abdominal muscles
|
diastasis recti abdominis, gradually regain tone
|
|
When is carpal tunnel synderome common
|
last trimester
|
|
What causes carpal tunnel syndrome
|
Edema involving the peripheral nerves
|
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Numbness and tingling of the hands
|
Acroesthesia
|
|
When does lightheadedness commonly occur
|
during early pregnancy
|
|
When does morning sickness usually appear
|
4-6 weeks
|
|
Excessive salivation
|
ptyalism
|
|
Are peptic ulcers common
|
No- estrogen decreases production of hydrochloric acid
|
|
What causes acid indigestion or heartburn
|
Increased progesterone- decreased tone and motility of smooth muscles, resulting in esophageal regurgitation, slower emptying time and reverse peristalsis
|
|
hearburn
|
pyrosis
|
|
What causes constipation
|
increased progesterone, causes increase in water absorption from the colon and hypoperistalsis, and iron supplements
|
|
When should bleeding be reported
|
all instances
|
|
What happens to the thyroid during pregnancy
|
enlarges because of estrogen
|
|
Does insulin cross the placenta
|
No
|
|
What causes the mother to need more insulin
|
Estrogen, progesterone, hCS and cortisol collectively decrease the mothers ability to use insulin
|
|
What is considered a LBW
|
2500g or less; very big risk if less than 1500
|
|
How much folic acid should be consumed
|
400 micrograms
|
|
What is the expected energy expenditure for the first trimester
|
the same as in the prepregnant state
|
|
What is the estimated energy expenditure for the second trimester
|
340 kcal above normal amount
|
|
What is the estimated energy expenditure during the 4th trimester
|
462 kcal abovethe normal amount
|
|
Is theoptimal weight gain during pregnancy known
|
No
|
|
Who are at risk for giving birth to an infant with intrauterine grwoth restriction
|
Normal-weight and underweight women
|
|
Who is more likely to have preclampsia
|
obese women, tons of other risks
|
|
How much weight should be gained if single fetus and with normal BMI
|
11.5-16 kg
|
|
How much should women gain with single fetus and are underweight
|
12.5-18 kg
|
|
How much should women gain with single fetus and are overweight
|
7-11.5 kg
|
|
How much should women gain with twins and are underweight
|
21-28 kg
|
|
How much should women gain with twins and are overweight
|
16.4-20.4
|
|
How much should women gain with twins and are normal weight
|
17-24.5 kg
|
|
How much should women gain with twins and are obese
|
12-17.7 kg
|
|
How much should women gain with single and are obese
|
7 kg
|
|
When are pretem births greater
|
when weight gain is during the last half of pregnancy
|
|
Average weight gain during first trimester
|
1-2.5 kg for normal weight
|
|
What is the recommended weight gain per week for normal weight
|
.4 kg
|
|
What is considered excessive weight gain
|
3 kg per month
|
|
How much does a a women have to gain to be especially at risk
|
18 kg or more
|
|
Are high-protein supplements recommended
|
no- they have been associated with incidence of preterm births
|
|
How many servings of grains
|
6 ounces
|
|
How many servings of vegetables
|
2.5
|
|
How many servings of fruits
|
1.5
|
|
How many servigs from milk group
|
3
|
|
How much meat
|
5 ounce equivalents: fish, nuts, and seeds
|
|
How much oil
|
6 teaspoons
|
|
How much water
|
8-10 glasses or 2.3 L
|
|
What has caffeine been associated with
|
miscarriage and giving birth to infans with IUGR
|
|
How much caffeine is "Okay"
|
no more than 150-300 mg
|
|
What sweetner should be avoided with a woman with PKU
|
Aspartame
|
|
Who is anemia most common in
|
adolescents, AA, and lower socioeconomic
|
|
What is the recommended amount of Iron
|
30 mg of ferrous iron daily, starting by 12 weeks gestation
|
|
What is the recommended amount of calcium
|
There is no increase in the DRI of calcium 1000 for >19 and 1300 <19
|
|
What increase absortion of iron
|
Vitamin C
|
|
What decreases iron absorption
|
Bran, tea, coffee, milk, oxalates,
|
|
When should iron be taken
|
on an empty stomach and at bedtime
|
|
What are good sources of magnesium
|
dairy products, nuts, whole grains, and green leafy vegetables
|
|
IS moderate peripheral edema normal in pregnancy
|
yes
|
|
What is one of the most likely vitams to be lacking in the diets of women of childbearing age
|
E
|
|
What can vitamin E help prevent
|
Preeclampsia
|
|
IF a women has borne a child with a neural tube defect they are advised to take how much folic acid
|
4 mg
|
|
Food can and should be the normal vehicle to meet the additional nutrient needs imposed by pregnancy except
|
Iron
|
|
Practice of consuming nonfood substances
|
Pica
|
|
What increases the woman's risk of obesity later in life
|
adolescent pregnancy
|
|
How much more should be consumed when breast feeding
|
330 kcal for the first 6 months
|
|
What is the average loss during lactation
|
.5-1 kg per month
|
|
What can impair milk production
|
smoking
|
|
What can accumulate in the infant
|
caffeine
|
|
Cutoff values for anemia are higher in these women
|
smoke or live at high altitudes
|
|
How many caloreis should the lactating woman get
|
100kcal
|
|
What should the food plan be for women with diabetes
|
four to six meals and snacks daily, carbohydrate intake distributed
|
|
What might help nausea
|
vitamin b6 or ginger
-eat dry food when nausea -avoid a lot of fluids in the morning -avoid skipping meals -avoid sudden movements -decrease fried or fatty foods -foods at cool temperature -avoid brusing teeth immediately after eating -herbal teas |
|
How much fiber? (constipation)
|
28g
|
|
First trimester is weeks
|
1-13
|
|
Second trimester is weeks
|
14-26
|
|
Third trimester is weeks
|
27-40
|
|
These are detected by an examiner and related mainly to physical changes in the uterus
|
Probable indicators
|
|
When does the ultrasound examination become 100% reliable
|
only at 8-9 weeks
|
|
What is the first step in adapting to the maternal role
|
accepting the idea of pregnancy and assimilating the pregnant state "I am pregnant"
|
|
having conflicting feelings simultaneously is considered a nomal response for people preparing for a new role
|
ambivalence
|
|
When should ambivalence indicate an unresolved conflict with the motherhood role
|
if persists through the 3rd trimester
|
|
What are the two major needs expressed by the woman
|
feeling loved and valued and having the child accepted by the partner
|
|
accepts the growing fetus as disting from herself, usually accomplished by the fifth month. "I am going to have a baby"
|
Phase 2
|
|
prepares realistically for the birth and parenting of the child "I'm going to be a mother"
|
Phase 3
|
|
men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms
|
couvade syndrome
|
|
1st Phase a father goes though. last from a few hours to a few weeks. Accept the biologic fact of pregnancy
|
announcement phase
|
|
2nd phase a father goes though. adjusts to the reality of pregnancy
|
Moratorium phase
|
|
3rd phase a father goes through. last trimester. active involvement in both the pregnancy and his relationship with his child
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Focusing phase
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How will a 2 year old react to the fact of their mom being pregnant
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May exhibit more clinging behavior and revert to the dependent behaviors in toilet training or eating
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How will a 3 or 4 year old react to mom having baby
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They like to be told the story of their own beginning and accept its being compared with the present pregnancy
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How do school-age children react
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They take a more clinical interest "how did the baby get in there?". The look forward to the new baby, see themselves as mother or fathers
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How do early and middle adolescents react?
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preoccupied with the establishment of their own sexual identity
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When should dr. visits be scheduled
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Every month until 28 weeks, then every 2 weeks until 36 weeks, and then every week
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When is the height of the fundus measured
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after the first trimester
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Signs of preeclampsia
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rapidly progressive
high blood pressure protein in the urine swelling,, sudden weight gain headaches and changes in vision usually occurs after 20 weeks |
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Hypertension in pregnancy
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140 systolic
90 diastolic after 20 weeks gestation |
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When should BP be alarming
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SBP>- 125
DBP>- 75 in midpregnancy SBP>130 or DBP>- 85 later in pregnancy Any rise of 30 mmhg SBP over baseline or 15 mmhg DBP |
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excessive n/v, morning sickness
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hyperemesis gravidarum
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How many kicks within an hour after a meal indicate good fetal wellbeing
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4
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How long should the FHT be counted for
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1 minute
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What does the triple screen measue
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MSAFP, hCG and unconjugated estriol
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What test is used for syphilis
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RpR/VDRL
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When is tub bathing contraindicated
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after rupture of the membranes
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What might help prevent urinary tract and vaginal infections
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Yogurt and acidophilus milk
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How long is it recommended to breastfeed
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1 year
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When should breast shells be worn
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for 1-2 hours during the last trimester of pregnancy
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What is linked with peridontal disease
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preterm births and LBW and preeclampsia
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Can dental work be done while pregnant
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Yes, with antibacterial therapy
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How often should you take your pulse while exercising
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q 10-15min
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You pulse should not exceed what when exercising
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140
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How long should you exercise
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No more than 35 minutes
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What is the most common cause of fetal death
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Materl death, next is placental separation (abruptio placentae)
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WHat can be administered during pregnancy
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tetanus
diphtheria recombinant hepatitis B rabies |