exam 1 Flashcards
o Gestation age
- Full-term ≥ 37 weeks gestational age
* Premature < 37 weeks gestational age
o Trimester of pregnancy
- 1st trimester: week 1-12
- Organogenesis in first 8 weeks
- After 1st 8 weeks, most teratogenic effects are related to fetal growth retardation
- 2nd trimester: week 13-27
- 3rd trimester: week 28-birth
o Prenatal Care Visits
- Every 4 weeks until 28 weeks gestation
- Every 2 weeks at 26-36 weeks gestation
- Every weekly from 36 weeks onward until delivery
- More frequent for high-risk pregnancy
• Birth weight
o Low Birth Weight (LBW) = 1,500 g – 2,500g
o Very Low Birth Infant (VLBW) = 1,000 g – 1,500 g
o Extreme Low Birth Weight (ELBW) = < 1,000 g
o Category-A
o Adequate well-controlled studies, no increased fetal risk
Category
o B
o (Australia: B1, B2, B3)
o Animal studies show no harm to the fetus but no adequate well-controlled studies in pregnant women, or animal studies have shown an adverse effect but well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus
Category-C
o Animal studies have shown an adverse effect and no adequate well controlled studies in pregnant women, or no animal studies have been conducted and there are no adequate and well controlled studies in pregnant women
Category-D
o Studies well controlled or observational, in pregnant women have demonstrated a risk to the fetus. However benefits may outweigh the risks.
Category-X
product is contradicted in women who are or may become pregnant.
• Pregnancy Visit 1 Labs
o Pregnancy confirmation (hCG level)
• blood or urine
o Rhesus type (Rh type) and antibody screen
o Genetics testing
o Screening for anemia
• Complete blood count, iron deficiency
o Urinalysis
o Rubella and varicella immunity
• Don’t vaccinate while pregnant. Must already be immune before being pregnant
o STI- HIV, syphilis, Hep B, chlamydia, gonorrhea on 1st visit and 3rd trimester
o Precautions to prevent other infections
• Example: toxoplasmosis- a possible source is cat litter
o Thyroid function -TSH, T3, T4
o Type 2 diabetes
• 1st trimester visit
o Physical exam, updated histories, and education (nutrition, medication, warning signs)
• 2nd trimester visit
o 15-24 weeks gestation
• Ultrasound and blood tests
o 24-28 weeks gestation
• gestational diabetes
• recheck Rhesus type (Rh) and antibody screen
• CBC (screen for anemia)• 3rd trimester visit
o 28-36 weeks
• Tdap Vaccine
• STI screening
• Group B beta-hemolytic streptococcus screening
• Fetal assessment
o 36 week onward
• Education on preparation for labor, delivery, postpartum issues, etc.
• Failure to Thrive
o Inadequate physical growth diagnosed by observation of growth over time using a standard growth chart (WHO, CDC)
o Weight falls below 5th percentile or drops in crossing 2+ major percentile lines
• How to use growth chart
o WHO charts for patient < 2 years
o CDC charts for patient 2-20 years
o Make sure you have the correct chart for age and gender
o Make sure you have the correct chart of the measurement you wish to plot
• Antibody and Vaccine
o Live vaccine 1st => wait 2 weeks before give antibody
o Antibody 1st => wait 3 months+ before give vaccine
o Exception = monoclonal antibodies and red blood cells
o Polysaccharide vaccines are not consistently immunogenic in children < 2 years. Give conjugated form.
• Hepatitis B
o 3 doses = 0, 1-2, 6-18 months
• 1st dose after birth before hospital discharge
• If baby’s mom is positive for antibody or weigh less 2,000 g then give HepB vaccine and HBIG within 12 hours of birth
• Rotavirus
o LIVE ORAL VACCINE o 1st dose given before 15 weeks of age and all doses administered by 8 months of age o RV5 (RotaTeq) = 3 dose series at 2, 4, and 6 months of age o RV1 (Rotarix) = 2 dose series at 2, 4 months of age
• Haemophilus influenzae type b (Hib)
o Earlier the dose if given, the more in a series they are needed
Urinalysis
Urinalysis
• Protein, culture
• Sign and symptoms of urinary tract infection
• Treat UTI even when asymptomatic
Type 2 diabetes
- Fasting plasma glucose >125 mg/dL
* A1C > 6.5%
* Random plasma glucose > 200 mg/dL, confirm by elevated fasting or A1C
• Diphtheria/ Tetanus/ Pertussis
o If doses given at 2 months of age, 4-5 doses are required
- DTaP = 1st 3 doses separated by 4 weeks and 4th dose at least 6 months from last dose
- 2 months of age, 3 months of age, 6 months of age, and 15 months of age
- Booster dose of DTaP at 4-6 years of age if all four doses given before 4th birthday
• Diphtheria/ Tetanus/ Pertussis
o If dose began at 12 months of age
o If dose began at 12 months of age, then only 3 doses required
• Diphtheria/ Tetanus/ Pertussis
basics
o Tdap boost 11-12 years age
o Tdap for 27-36 weeks of each pregnancy
o Tdap for anyone who have never received it
