CCS - Pregnant (amenorrhea)

Question 1

PRESENTATION

Common Features of Pregnancy

Answer 1

Amenorrhea (lengthened from normal menstrual cycle)

Breast Tenderness

Question 2

PHYSICAL EXAMS

Physical Exams for Pregnancy

Answer 2

• General Appearance - normal
• Breasts - mildly Enlarged and Tender
• Lungs - normal
• Heart - normal
• Abdomen - normal
• Genitalia - mildly Enlarged Uterus
• Extremities/Spine - normal
• Neuro - normal

Question 3

DIAGNOSIS

Orders for Pregnancy

Answer 3

1. Physical Exam: Breasts, Genitalia
2. Beta hCG: Urine, Qualitative

Question 4

CONFIRMED PREGNANCY ORDERS

Order for Confirmed Pregnancy

Answer 4

• Transvaginal Ultrasound (dating)
• Urine: U/A, Gram stain, Culture
• CBC
• Type and Screen, blood
• Rubella serology
• RPR, serum
• Hepatitis B surface antigen, serum
• HIV test, ELISA, serum
• Pap smear
• Cervical DNA probe test, chlamydia
• Cervical DNA probe test, gonorrhea
• Varicella-zoster virus, IgG antibody
• Counsel patient
• Advise patient, prenatal counseling
• Prenatal vitamins

Question 5

MONITORING

Monitoring for Pregnancy

Answer 5

• Follow-up visits every 4 weeks until 28 wks
• Follow-up visits every 2 weeks 28wks - 36wks
• Follow-up visits every 1 week > 36wks

Question 6

SEQUENCING

CCS Order Sequence for Pregnancy

Answer 6

1. Physical Exams - Full exam
2. Orders - Beta hCG
3. Clock - advance to pregnancy test results
4. Confirmed Pregnancy Orders
5. Clock - reschedule in 4 weeks, advance clock to end
6. End Orders - none