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68WM6 Phs2 test 9

68WM6 Phase 2 test 9 - Pregnancy and Prenatal Development

QuestionAnswer
At what day after conception is the embryo fully implanted in the uterus? 6-10 days
When does human fertilization occur? when the sperm penetrates an ovum and unites it
the nural tube closes when? 4 weeks
the gender can be visually determined when? 12 wks
pre-embryonic period aka zygotic phase? 0-2 wks
when does the fetal heart develops 4 chambers 6 wks
embryonic period; all major organ systems formed. very high risk of serious damage if exposed to teratogens during this time. 3-8 wks
days time of implantation 6-10 days
may be able to hear fetal heart beat with a hand held Doppler 10 wks
quickening perceived by mother 16-20 wks
increase in survival rates for premies starts here 28 wks
increase in variability in fetal heart rate with maturation of autonomic nervous system 32 wks
legal age of viability 20 wks
full term pregnancy 38-42 wks
what is vernix the waxy or cheese-like white substance found coating the skin of newborn human babies
Lanugo downy hair found on premature babies
brown fat special heat producing fat that helps newborn maintain temp stability after birth
Surfactant lubricant in the lungs that keeps alveoli from sticking together
what is the function of the placenta? produces four hormones: progesterone, estrogen, hCG, hPL, also the site of exchange of nutrients, Oxygen, and waste products
the side of the placenta that has "beefy" look dirty duncan
the shiny, grayish side of placenta Shiny Shultz
what makes up the umbilical cord? 2 arteries and 1 vein and Wharton's Jelly
the veins in the umbilical cord carry what? fresh oxygenated blood and nutrients TO the fetus
The arteries in the umbilical cord do... carry blood back to mother and waste AWAY from fetus
If an expecting mother is nervous about the pain when you cut the umbilical cord, what do you tell her? Ma'am, you won't feel a thing, the umbilical cord does not have pain receptors.
What are two functions of the amniotic fluid? protects growing fetus and promotes normal prenatal development, maintains stable temp, provides cushion against impacts, allows symmetrical development as major body surfaces fold toward midline, prevents membranes from adhering to fetus, buoyancy
be able to explain blood flow through a fetal heart... seriously, be able to explain blood flow through fetal heart
what factors lead to the closing of the foramen ovale? when baby takes first breaths, the pressure in the left atrium exceeds the pressure in the right atrium.
What causes the ductus arteriosus to close? increased oxygen content of the newborn's blood
What is a monozygotic twin? twins carry the same genetic code and are the same sex. they share a placenta, but each has own umbilical cord
What is a dizygotic twin? seperate placenta, sex and genetic makeup can be different. no more closely related than siblings born at diff times
What are some complications of multifetal pregnancieS? spontaneous abortion, prematurity, uterine over distension, maternal anemia, PIH, placenta previa, abruptio placentae, polyhydramnios
oogenesis formation of female gamete
when does the release of ovum occur? approx 14 days before a woman's next menstrual cycle would begin
how long do sperm live most no longer than 24 hours, few may live up to 5 days
what is the process called that sperm undergo on the way to the ovum allowing them to penetrate the ovum? capacitation
how many chromosomes do sperm carry? 23
the first two weeks after conception is called pre-embryonic period
implantation usually occurs in the ______ portion of the uterus, slightly more often on the _________ wall than the ____________wall upper, posterior, anterior
embryonic stage of pregnancy is when 3-8 weeks
from the 9th week till birth is called fetal period
the amniotic fluid is approx _____ ml at 40 wks 700-800ml
what are the 5 presumptive signs of pregnancy? breast changes, urinary frequency, fatigue, quickening, change in shape of abdomen, skin changes, Chadwick's sign(discoloration of labia-blueish)
probably signs of pregnancy Goodell's sign, abd enlargement, Hegar's sign, Braxton-Hicks, Ballottement, fetal outline, pregnancy tests
T P A L Term infants, Preterm infants, Abortions, Living children
G P Total pregnancies, Living children
Positive signs of pregnancy Fetal heartbeat, fetal movements, visualization of fetus
expected date of delivery 1st day of LMP, count back 3 months, add 7 days
what is a trimester? 13 week period
list 5 goals of prenatal care safe birth for mom and baby, risk assessment, heathly education, counseling, social support, psychological support, adequate antepartum care
what are 3 nursing interventions for prenatal care obtain demographic data, ob hx, PMH, PSH, physical exam
what are 4 areas that you can expand teaching on to help mother prepare and adjust to the pregnancy? rest/sleep , activity and exercise, employment planning, sex, bathing, travel, clothing
what can you teach a mother about dealing with nausea? dry toast or crackers before rising in AM, fluid between meals not with meals, small frequent meals, avoid fried, spicy, or greasy foods
what can you teach you pt r/t constipation drink at least 8 glasses of water a day, add fiber to diet, avoid mucho cheese, curtail sweets, take iron as needed
normal weight gain during prenancy 25-35 lbs
normal pattern of weight gain during pregnancy 3.5 lbs -1st trimester, then about 1 lb p/wk after
how much extra protein do you need while preg 25g/day
what type of foods can you eat to get the extra 30mg/day of iron? fish, red meats, organs(liver), whole grains, dried beans, dried fruits, green leafy veges, molasses
how much extra folic acid p/day? 0.6mg/day
what is on key for pregnant adolescents? positive reinforcement
what is PICA and what can it cause? eating/craving substances that are not normally edible. Constipation/impaction
lactose intolerance is most common in _____ non-european descent
what are four key nutrients in pregnancy? Calcium, Iron, protein, folic acid
During the 1st trimester the mom will have to adjust psychologically. name 3 issues you will expect to help her with focus on self, uncertainty, ambivalence
during the 2nd trimester what issues will the mother be faced with? physical evidence of pregnancy, fetus as primary focus, narcissism and introversion, body image, change in sexuality
what psychological concerns will you expect to appear in the 3rd trimester? vulnerability, increasing dependence, preparation for birth
what impact will pregnancy have on the father? emotionally invested and comfortable, task oriented, may not be able to express feelings, more comfortable as observer
What impact will a pregnancy have on grandparents? Age(I'M OLD!), number and spacing of grandchildren, perception of role as grandparents
what are some cultural considerations for a pregnant woman? communication, modesty, incorporate health benefits into teaching, accept and support practices that are harmless
what are three methods of prepared childbirth? three methods of education? Dick-Read Method, Bradley Method, Lamaze
ther are at least 10 main danger signals in pregnancy, name them.. vaginal drainage more than normal mucous, vaginal bleeding, severe abd pain, persistent vomiting, edema in face/hands, severe sudden headache, dbl vision/blurred vision, rapid weight gain, decrease or no fetal movement
aminocentesis withdrawing of amniotic fluid for lab examination
imaging technique uses high frequency sound waves to visualize internal body structures ultrasonography
Afpha-fetoprotein (AFP) fetal substance used to screen for specific abnormalities such as spina bifida, anencephaly, or gastroschisis, Down Syndrome
Chorionic villus sampling procedure to obtain tissue from the fetal side of placenta to be analyzed to reflect the chromosomal and genetic makeup of the fetus. Used to identify metabolic, chromosomal, or DNA abnormalities.
A third trimester amniocentesis assesses what? Mainly for lung maturity/respiratory complications and also fetal hemolytic diseases when Rh incompatibility is suspected
adequate acdelerations of the fetal heart rate with movement are reassuring that the placenta is functioning properly and the fetus is well oxygenated in what test? Non-stress test
low levels of AFP indicate what? down syndrome or gestational trophoblastic disease - basically chromosomal abnormalities
high levels of AFP indicate what? open neural tube defects- spina bifida, anencephaly, gastroschisis
percutaneous umbilical blood sampling (PUBS) procedure for obtaining fetal blood through ultrasound guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection
You would teach your pt to drink several glasses of water an hour before which kind of ultrasound to ensure a full bladder? transabdominal- used to displace the intestines and life the uterus for better image quality.
what should you teach your pt after an amniocentesis? normal activites after 24 hours, no strenuous activities for 1-2 days, report vaginal bleeding, leakage of amniotic fluid, fever, and contractions.
what are the two categories of pregnancy complications? unique to pregnancy, can occure at any time but are r/t pregnancy
birth of a healthy baby. True or false true
what are 4 types of diagnostic testing? ultrasound exam, doppler ultrasound blood flow assessment, chorionic villus sampling, amniocentesis, non-stress test, vibroacoustic stimulation test, contraction stress test, biophysical profile, percutaneous umbilical blood sampling
determines the gestational age of fetus with measurement of head and long bone, determines location of cervix, uterus, & placenta, determines amount of amniotic fluid ultrasound
uses high frequency sound waves to study the flow of blood through the umbilical artery and vessels doppler ultrasound blood flow assessment
what factors can affect the level of AFP? gestational age, maternal weight, multifetal pregnancy, race, and maternal diabetes
a PUBS test would be ordered to identify what? management of Rh disease, diagnosis of abnormal blood clotting factors, acid-base status of fetus, clarity results of genetic testing, treat blood diseases and give drugs straight to baby via umbilical cord.
PUBS percutaneous umbilical blood sampling
what is a kick count used for? used to assist with detecting a fetus with a compromised oxygen supply
what is a kick count? Maternal assessment of fetal movement-mother counts the number of fetal movements in a prescribed period of time.
what is hyperemesis gravidarum? persistant uncontrolled vomiting. usually before 20th wk of pregnancy
what can you teach your pt about the importance of recognizing hyperemesis gravidarum? loss of 5% or more of preg weight, ketosis, dehydration, electrolyte and acid-base imbalance, metabolic acidosis, vit K and thiamine deficiency
what are some nursing considerations for hyperemesis gravidarum? encourage bland diet/easily digested carbs, drink between meals, sitting upright after meals to reduce gastric reflux, monitor skin turgor & mucous membranes, provide emotional support
what is the most common cause of a spontaneous abortion? severe congenital abnormalities incompatible with life
what are the 6 subgroups of spontaneous abortion? threatened, inevitable, incomplete, complete, missed, recurrent
what is an ectopic pregnancy? implantation of fertilized ovum outside the uterus.
what are some causes of ectopic pregnancy? scarring/abnormality in tube, inflammation, surgery, IUD, hx of ectopic preg
signs/symptoms of ectopic pregnancy abd pain, vaginal spotting, missed period, ruptured tube symptoms
if a pt tells you they have coughed up bloody mucous, are restless, cyanotic, and complain of chest pain, what may they be describing? Disseminated intravascular coagulation (DIC) - life threatening complication in coagulation- basically your pt is bleeding all over
how would you tx a pt with DIC? blood products, heparin, o2 -10-12 L/min, closely monitor I&O, delivery asap
coacaine use, chronic HTN or PIH, blunt trauma, and premature rupture of the membranes are all signs of what abruptio placentae
uterine tenderness, uterine irritability, abd pain, low back pain, high uterine resting tone are all signs of what? Abruptio placentae
as the nurse, what would you want to do for a pt with abruptio placentae? side lying position, wedge under right hip, prep for C-section, blood/fluid replacement-2 large IV's, foley catheter, continuous monitory of FHM(fetal heart monitor), o2 via mask, emotional support
this presents with painless, profuse, bright red bleeding placenta previa
what are the 4 types of HTN disorders r/t pregnancy? preeclampsia, eclampsia, gestational HTN, chronic HTN
s/s for PIH(pregnancy induced HTN) retinal changes, deep tendon reflexes may be brisk(hyper), labs showing liver, renal, and hepatic dysfunction, headache, drowsiness, upset stomach, decreased urine
what is HELLP? Hemolysis, EL-elevated liver enzymes, LP-low platelet count
what drug is given to moms with Rh negative blood? rogam
name 5 types of teratogens infection, ionizing radiation, maternal hyperthermia, pollutants, effects of maternal disorders
oligohyramnios abnormally small volume of amniotic fluid reduces the cushion surrounding the fetus and may result in deformations and decreased lung development
what is the most common substance abuse by pregnant moms smoking
PROM Preterm Rupture Of Membranes
what effects does smoking have on the baby? prematurity, low birth weight, fetal demise, developmental delays, increased incidence of SIDS, neurologic problems
FAS Fetal alcohol syndrome
what are some effects of FAS on the baby? CNS impairment, recognizable combination of facial features, prenatal and postnatal growth restrictions, LBW, developmental delay for up to 1-2 years
what is the most common illicit drug used by moms? marijuana
effects of THC on baby? stillbirth, IUGR, irritability, poor feeding relfexes, N/V/D, prune-belly syndrome caused by absense of abd muscles
side effects of opiods on baby? IUGE(intra uterine growth restriction), perinatal asphyxia, infections, SIDS, intellectual impairment
how can we diagnose substance abuse during pregnancy? toxicology screen, STD?, HIV, hepatitis, fetal diagnostic tests
most common traumas during pregnancy are? accidents, assault, suicide
what are some resources nurses should be familiar with in case of trauma or abuse? national: domestic violence hotline, clearinghouse for the Defense of Battered Women, Coalition against Domestic Violence, Resource Center on Domestic Violence
what can a nurse do to help an abused woman? provide written info in bathrooms, develope personal safety plan, affirm she is not to blame, provide referrals to community help
What is a category A drug r/t pregnancy risk no evidence of risk to fetus exists (very few drugs)
What is a category C drug r/t pregnancy risk animal studies HAVE shown an adverse effect on the fetus, but no adequate well controlled studies have been done
What is a category B drug r/t pregnancy risk animal reproduction studies have NOT demonstrated a risk to fetus. NO adequate and well-controlled studies have been done in preg women
What is a category D drug r/t pregnancy risk positive evidence of human fetal risk based on adverse reaction data, but potential benefits my warrant use of drug despite fetal risks
What is a category X drug r/t pregnancy risk positive evidence of human fetal risk based on human studies and/or adverse reaction data. Risks of using drug clearly outweigh potential benefits
what are the 4 main complications that can occur r/t preexisting diabetes on a newborn? hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome
what are the goals for GDM?(Gestational DM) maintain normal blood glucose level(euglycemic), healthy baby, avoid common complications of diabetics(organ damage)
if no hx of DM when is a diagnostic test done on mother? 24-28 wks
what are the standards for diagnostic GDM test for mom? drink 50gm of oral glucose, blood sample taken 1 hour later, blood glucose >/= 140 then a 3 hr glucose tolerance test is ordered
whenever hypoglycemia is present what dies would you tell your pt and how often do you check blood glucose levels? three meals, three snacks. q 6hr
signs of hypoglycemia shakiness, sweating, pallor, cold,clammy skin, disorientation, headache, hunger, blurred vision
signs of hyperglycemia fatigue, flushed hot skin, dry mouth, thirst, frequent urination, rapid deep respirations, drowsiness, depressed reflexes
the most common cardiac problems during pregnancy result from: rheumatic heart disease, congenital heart disease, mitral valve prolapse
s/s of heart diseas dyspnea, syncope with exertion, hemoptysis(blood in sputum), paroxysmal nocturnal dyspnea, chest pain w/ exertion
additional s/s of heart disease cyanosis, clubbing, continuous heart murmur, cardiac enlargement, extra heart sound-thrill, serious dysrhythmias
tx for heart disease monitor weight gain, limit Na, adequate diet w/ iron, rest, o2 during labor
tx for heart disease r/t labor and pregnancy antiarrhythmics, heparin, prophylactic antibiotics, stool softeners, vaginal delivery
nursing interventions r/t heart disease and pregnancy teach foods high in iron, avoid foods high in sodium, monitor clotting times, adjust anticoagulants, teach s/s of CHF, decrease anxiety, semi-fowlers/side lying position
what is one of the most common problems in pregnancy? anemia
maternal s/s of iron-deficiency anemia pallor, fatigue, lethargy, pica, RBC's(hypochromic), decreased fetal oxygen
foods high in iron red meat, dark green leafy veges
folic acid deficiency can be r/t what? spontaneous abortion, abruption placentae, fetal abnormalities, neural tube defect
best sources of folic acid liver, kidney beans, lima beans, fresh dark green leafy veges
s/s include severe pain, kidney infection, jaundice. The blood is unable to pass through small arteries and tend to clump together and occlude the blood vessels sickle cell anemia
abnormality in the alpha or beta chain which leads to alterations in the RBC membrane and decreases the lifespan of the RBC thalassemia
infections in pregnancy: TORCH stands for Toxoplasmosis, other diseases(hep), Rubella, Cytomegalovirus, Herpes simplex virus
improper handling of cat litter can lead to toxoplasmosis
s/s of toxoplasmosis flu-like symptoms, swollen lymph nodes
retardation, blindness, anemia, LBW, enlarged liver and spleen r/t ?? toxoplasmosis
chronic low grade fever, anorexia, abd pain, jaundice, joint pain r/t ?? Hep B
what can you teach you pt to do to avoid toxoplasmosis? avoid uncooked eggs and unpastorized milk, wash fruits and veges, avoid undercooked meat, wash kitchen utensils carefully after use
transmitted by droplets or direct contact with articles contaminated with nasopharyngeal secretions Rubella
what are three complications of an amniotomy? prolapse of umbilical cord, infection, abruptio placentae
amniotomy AROM-artificial rupture of membranes using a disposable plastic hook
what are some nursing considerations for an amniotomy? FHR, record color, amount, & odor of amniotic fluid, report temp of 100.4 or higher, green fluid(baby pooped)
augmentation of labor artificial stimulation of contractions that have become ineffective
reasons for inducing labor PIH, ROM w/o spontaneous onset of labor, post term labor, intrauterine environment hostile to fetal well being, chorioamnionitis, abruptio placenta, fetal problems, fetal death
what is the desired length of contractions? Desired time between contractions 60-90 seconds, 60 seconds
contraindications to induce labor placenta previa, umbilical cord prolapse, high station of fetus, active herpes, abnormal size of mother's pelvis, abnormal fetus presentation, previous C-section
what are three methods to ripen the cervix for delivery? prostaglandin gel(Prepdil) and Cytotec(Misoprostol) and Laminara(mechanical method)
as the nurse, you assist with stopping tx with oxytocin. what would you expect to do next? increase non-medicated IV fluid, keep woman off her back, give o2 via face mask, possibly to administer terbutaline and Mag Sulfate
what is the most common type of version? what is version r/t pregnancy? external cephalic version (ECV). Manipulating baby position from breech to normal position
contraindications of a version BIG baby, previous C-section, uterine malformation, placenta previa, multifetal gestations, ROM, cord around neck or head, uteroplacental insufficiency, head of fetus in pelvis
risks of version fetus may become tangled in umbilical cord, abruptio placentae, mixing of fetal/mom's blood, C-section for fetal compromise
when would a Doc do an internal version? during birth of 2nd twin. TWINS being the key to internal version
what are some indications from the mother that operative measures may be needed? exhaustion, inability to push effectively, cardiac or pulmonary disease
severe fetal compromise, acute maternal conditions such as CHF or PE, high fetal station, fetus is too big for pelvis are indications for what? C-Section
chignon scalp edema created by vaccum cup during birth
what should you look for after an operative assisted birth on the baby? lacerations, bruising, or abrasion on infant's head, facial asymmetry-indicates nerve damage
how can you comfort mother after an operative assisted birth? place cold application to perineum, observe for vaginal wall laceration(bright red blood), observe for edema and discoloration of labia & perineum
4th degree episiotomy extends completely through the rectal sphincter
1st and 2nd degree episiotomy usually uncomplicated and heal quickly
3rd degree episiotomy extends to rectal sphicter
what nursing interventions would you take with a woman that had an episiotomy? place cold packs during first 12-24 hrs, after 1st 24hrs apply warm applications, provide mild PO analgesics
uterine contractions are too weak to be effective during labor hypotonic labor dysfunction
characterized by contractions that are frequent, cramp-like, and poorly coordinated hypertonic labor dysfunction
what are 3 things you can do to help a mom with ineffective maternal pushing? coach the woman on proper techniques, tell the woman when to push, reduce anxiety
macrosomia large fetus, generally weighing over 4000gm (8.8 lbs)
what are three abnormal fetal presentations? breech, face, brow presentations
what are the 4 types of pelvis shapes? gynecoid(most common/favorable), anthropoid, android(male type-non favorable), platypelloid
what is the most common maternal soft tissue obstruction? full bladder, also fibroids and cervical scar tissue
what are some effects of "fight or flight" response? uses glucose that the uterus needs for energy, causes secretion of hormones that inhibit uterine contractions, diverts blood from uterus, tension of pelvic muscles, increases perception of pain
what is the avg rate p/hr for cervical dialation? *active labor 1.2cm/hr for 1st baby, 1.5cm/hr for women w/previous children
precipitate labor labor that is complete in less than 3 hours
s/s of infection r/t pregnancy abd tenderness, FHR > 160, foul smell of amniotic fluid, tachycardia of mother,
PROM premature rupture of membrane-38 wks or more but contractions do not begin
PPROM preterm, premature rupture of membrane-38 wks or less w/ or w/o contractions
chorioamnionitis infection of amniotic sac
PTL- PreTerm Labor occurs when? between 20-38 wks
PTL risk factors anemia, PROM, age <18 y/o or > 40 y/o, low education level, smokers, chronic stress, non-caucasian, infection, DM or HTN, poor nutrition, underweight
s/s of PTL "just feeling bad", "coming down with something", abd cramps, thigh pain, pelvic pressure, menstrual-like cramps, change in vaginal discharge
what are some ways to stop PTL? bed rest, hydration, UA to detect UTI, tocolytic drugs(inhibit contraction), drugs to increase fetal lung maturity(dexamenthasone & betamethasone)
what can you teach a woman r/t bed rest have two places to rest, have phone close by, help find child care if other children are present
loss of fetal weight, meconium in amniotic fluid, low blood sugar at birth, less efficient placental delivery of o2 and nutrients are signs of ? prolonged pregnancy - 42 wks is the cutoff
how would you assist in tx of prolapsed umbilical cord? knee-chest position, trendelenburg, nurse or dr may push fetus upward, usually ends in c-section, calm quick action to reduce anxiety
s/s of ruptured uterus shock due to bleeding, abd pain, chest pain between scapulae, cessation of contractions, abnormal or absent FHR, palpation of fetus outside uterus, rise in Pulse, drop in BP, bright red blood
what are three causes of uterine inversion? fundal pressure during birth, pulling umbilical cord before placenta detaches, fundal pressure on incompletely contracted uterus after birth
particles such as vernix, fetal hair, and sometimes meconium enters the maternal circulation and obstructs pulmonary circulatory system amniotic fluid embolism
medical management for amniotic fluid embolism CPR, o2, volume expansion, blood transfusions, PRBC's, platelets, FFP
what are the 4 sources of pain r/t pregnancy? dialation, tissue ischemia, pressure and pulling on pelvic structures, stretching of vagina and perineum
what are the effects of excessive catecholamines? reduces blood flow to and from placenta, reduce effectiveness of uterine contractions, lessens pleasure of life event
what are some environmental comfort measures r/t pregnancy? reducing irritants, music and imagery, general comfort, reduce anxiety and fear
what is the goal of 1st stage breathing? prevent pushing
what is the goal of 2nd stage breathing? assist mother to respond to urge - DO NOT HOLD BREATH - less than 8 seconds
where are intrathecal analgesics injected? subarachnoid space
local anesthetic injected into the subarachnoid space in a single dose subarachnoid (spinal) block - woman loses both sensory and motor function below level of block
meperidine(Demerol), fentanyl(sublimaze), butorphanol(Stadol), nalbuphine(Nubain) are examples of what? systemic parenteral analgesic drugs
what medication reduces symptoms of herpes? Acyclovir
treatment before 18 wks can prevent syphilis, what medication could you expect? penicillin
what antibiotic is used most commonly to tx gonorrhea? azithromycin
scaly skin, itching of the vagina, vulva, and cheesy, tenacious white vaginal discharge is a r/t to what STD? candidiasis
profuse vaginal discharge with fishy odor, itching and burning are signs of what? bacterial vaginosis
what is the normal fetal heart beat and fluctuations? 110-160 / 5-15 beats
what are the 4 P's: components of the birth process? Powers, Passage, Passenger, Psyche
describe a hypertonic contraction less than 2 mins apart, longer then 90-120 secs, shorter intervals, incomplete relaxation
Created by: jrstrader