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FNP 3- Test 3 > GYNO > Flashcards

GYNO Flashcards

1
Q

is a symptom not a diagnosis; causes acronym: PALM COEIN

A

Abnormal uterine bleeding

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2
Q

PALM COEIN

A

structural: polyp, adenomyosis, leiomyoma, malignancy, hyperplasia then nonstructural coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified

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3
Q

Diagnostics for Abnormal uterine bleeding

A

GYN exam to start … followed by labs
Transvaginal ultrasound, pregnancy test, CBC, cervical cancer screening (if due), potential orders: TSH/FTF, hormone tests- prolactin, androgens estrogens, PT/PTT, bleeding disorder labs, endometrial biopsy
45+ should get a endometrial sampling or less than 45 if hx of unopposed estrogen exposure
Heavy bleeding >80mL

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4
Q

Tx for for Abnormal uterine bleeding

A

COCs, progesterone only contraceptives, TXA (Lysteda oral or IV if severe) or NSAIDs taken when pt is bleeding, endometrial ablation, Depo-Provera, Mirena

Acute emergent: ER uterine tamponade, IV, estrogen, uterine artery embolism, hysterectomy

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5
Q

primary vs secondary amenorrhea

A

Primary (never menstruation) vs secondary (previous menstruation)

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6
Q

Female athlete triad

A

amenorrhea, osteoporosis, and disordered eating

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7
Q

Dx for amenorrhea

A

hcg, FSH, LH, TSH, prolactin (Acromegaly; if elevated order MRI or CT), progesterone challenge

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8
Q

Tx for amenorrhea

A

tx underlying cause if discovered. Maintain optimum weight (by either gaining or losing). Irreversible bone loss can occur after 3 yrs of amenorrhea- calcium and vit

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9
Q

mastalgia/ Mastodynia

A

Breast pain

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10
Q

Cyclic vs noncyclic breast pain ?

A

Cyclic → usu 3rd or 4th decade; bilateral outer breasts radiating to upper arm and axilla

Noncyclic → unilateral, localized, sharp, burning. Rarely a presentation of CA

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11
Q

PE for breast pain. questions to ask?

A

mass (change w/ cycle?), nipple discharge (benign: creamy, gray, or green; abnormal: watery, serous, bloody), skin dimpling.

Skin changes that may signify cancer include erythema, edema, retraction, dimpling, peau d’orange, and nipple excoriation or crustiness.

Hx ?s: hormone therapy, breast surgery, age at menarche and menopause, prenancy and lactation, breast CA screening, family hx

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12
Q

dx for noncyclic breast pain

Noncyclic = unilateral, localized, sharp, burning. Rarely a presentation of CA

A

mammogram if postmenopausal; US for young women; CXR if trauma. Hcg

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13
Q

Tx for breast pain

A

reassurance that most pain resolved spontaneously, firm supportive bra, low-fat diet, reduced caffeine, NSAIDs, change OCP to lower estrogen and higher progesterone

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14
Q

What to do if no resolution of symptoms after 3-7 days of ABX for mastitis

A

consider inflammatory breast cancer- get mammogram/ U/S-but mammogram is not indicated in pregnant/lactating women
`

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15
Q

what to rule out with nipple d/c & galactorrhea

A

pituitary adenoma

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16
Q

common in premenopausal and pregnant women, bilateral; only with compression; multiple ducts involved. Clear, gray, yellow, white, or dark green

A

Physiologic galactorrhea

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17
Q

spontaneous, bloody, serous fluid from breast, unilateral, involving one duct, a/w mass

A

Pathologic galactorrhea

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18
Q

Bilateral nipple discharge usually has some physiologic causes, such as_________ . Can draw a prolactin level to assess. *more concern if it’s bloody, green, and if it is spontaneous

A

hyperprolactinemia

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19
Q

Labs for nipple d/c & galactorrhea

A

: Prolactin, TSH, CBC, CMP, hcg- consider mammogram to assess for non palpable masses, test nipple discharge for occult blood; Periareolar US

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20
Q

What to do If prolactin elevated when assessing galactorrhea

A

MRI of brain

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21
Q

Is a rare form of breast cancer. Superficial skin manifestation, usually begins as ductile cancer (1-3% of breast CA cases)
Itchy, usually unilateral, well demarcated, erythematous scaly plaque that’s usually around the nipple and the areola.
Refer - skin biopsy needed and mammogram

A

Paget’s Disease of Breast

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22
Q

Unilateral, continuous hx with slow progression, moist or dry, irregular but distinct border, nipple always involved and disappears in advanced cases, itching common

A

Paget’s Disease of Breast

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23
Q

Usually bilateral, intermittent hx with rapid progression, moist initially, indistinct border, areola involved, nipple may be spared, itching common

A

Eczema of breast

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24
Q

Tx Paget’s Disease of Breast

A

Tx: mastectomy, radiation

Managed by surgical oncologist

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25
Q

Breast masses/ CA protective factors

A

childbirth before 30, multiple births, breastfeeding

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26
Q

Breast masses/ CA risk factors

A

HRT (5% increased risk per year of use; returns to baseline w/in yr of stopping), dense breasts,

Fibroadenomas and cysts do NOT increase risk

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27
Q

usually firm discrete mass or an area of diffuse firmness of breast tissue with or without skin thickening, cysts are rare in post menopausal women and shoulbe considered breast cancer until proven otherwise (unless on HRT)

A

breast cancer mass

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28
Q

most common; painless, freely movable, rubber feeling or hard; increase in size toward end of cycle

A

Fibroadenomas

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29
Q

Breast masses/ CA screening tools

A

Gail model, The Breast Cancer Risk Assessment Tool , Tyrer-Cuzick Model

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30
Q

Breast masses/ CA diagnostics

A

BRCA genetic testing if strong family hx, mammogram (USPSTF biennial 50-74), MRI, 3d mammogram (younger women with dense breasts), diagnostic mammography AND ultrasonography initially for palpable mass 25+ usually just ultrasound for <25 average risk f/u bc 15-18 percent false negative

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31
Q

Breast masses diagnostics if cyst ?

A

cyst→ aspiration and cytology, f/uin 4-6wks to determine if cyst reoccured; non cystic mass→ biopsy

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32
Q

Non-cancerous, usually affects both breasts. change in estrogen/ androgen ratio
Often seen in overweight boys
RT: aging, malnutrition, hypogonadism, thyroid problem, excess drinking/ cirrhosis, testical or adrenal cancer, chemo, ketoconazole, digoxin, exogenous steroids
Normal in newborn male infants due to moms hormones
Obtain family hx of breast or ovarian cancer, BRCA mutation

A

Gynecomastia

Usu resolves on own w/in 6 mos

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33
Q

Aggressive fast-growing cancer. Unilateral
May look like an infection of the breast
Refer!

A

Inflammatory Breast Cancer

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34
Q

Dx for gynocomastia?

A

Diag: if needed, US <25; mammogram >25yo or any age you feel a suspicious mass

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35
Q

extra nipples

A

polythelia

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36
Q

> 6 mo.
Patho: unclear- hyperesthesia/ allodynia and pelvic floor dysfunction
Dd: endometriosis, interstitial cystitis, painful bladder syndrome, depression, IBS, pelvic adhesions, trauma, pelvic inflammatory disease (can be comorbid)

A

chronic pelvic pain

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37
Q

Red flag findings of chronic pelvic pain

A

postcoital bleeding, postmenopausal bleeding, unexplained weight loss, pelvic mass, hematuria, extreme burning/ pain

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38
Q

chronic pelvic pain diagnostics

A

pelvic ultrasound r/o anatomic abnormalities, laparoscopy (severe pain), CBC, ESR, Urinalysis, chlamydia/ gonorrhea, pregnancy test

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39
Q

Tx of chronic pelvic pain

A

Meds: depot medroxyprogesterone, gabapentin, NSAIDS, gonadotropin releasing hormone agonists (Zoladex) (better for endometriosis)
Antidepressants (TCAS, SNRIs, anticonvulsants (lyrica, gabapentin)

Nonpharm: pelvic floor physical therapy, behavioral therapy cutaneous allodynia
Hysterectomy

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40
Q

How to dx and tx vulvar lichen sclerosis

A

dx with biopsy

Tx with steroids

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41
Q

How to dx and tx vulvar lichen sclerosis

A

dx with biopsy

Tx with steroids

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42
Q

starts 6-12 months after menarche starts, a/w low anterior pelvic pain around menstrual cycles

A

Primary dysmenorrhea

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43
Q

some years of painless menstruation then painful menstruation - not described as beginning in adolescents and usually underlying pathology

A

Secondary dysmenorrhea-

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44
Q

Red flags of dysmenorrhea

A

unilateral dysmenorrhea, ectopic pregnancy,

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45
Q

treatment of dysmenorrhea

A

nutrition, vitamines, heat packs, NSAIDS, oral contraceptives, Mirena IUD

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46
Q

pain with sexual activity

A

Dyspareunia-

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47
Q

Possible factors of Dyspareunia

A

RF: PID, endometriosis, postpartum, perimenopausal, psychological factors,
CM: lubrication issue, superficial issue like with lichen planus, lichen sclerosis UTI…lots of differentials, Deep pain- usually endometriosis, structural, bladder stones,

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48
Q

Most common cause of dyspareunia

A

endometriosis

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49
Q

diagnostics for dyspareunia

A

pelvic exam then KOH prep, cultures of vaginal discharge, pap, STI, Q tpvd low oxalate diet calcium citrate, ip test, CBC, ESR, HCG

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50
Q

Nonpharm Tx for dyspareunia

A

Provoked vestibulodynia/ vulvar vestibulitis: 1st line is psychological/ behavioral therapies, endometriosis: Vitamin E/C/gluten free diet, other: pelvic floor therapy, capsaicin cream, lubrication

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51
Q

pharm Tx for dyspareunia

A

estrogen cream, if estrogen CI consider ospemifene (selective estrogen receptor modulator or topical aqueous lidocaine, topical steroids for lichen sclerosus, vaginismus - botox, lidocaine injections, PVD- topical amitriptyline cream, topical estrogen 1x/day 4-8 weeks, interferon injections, endometriosis- hormonally OCP/ surgically

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52
Q

Vulvar area chronic pain at least 3 months

A

Vulvodinia

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53
Q

Fear reaction to any form of vaginal penetration = spasms

A

vaginismus

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54
Q

Inability to perform, lack of arousal, lack of interest, lack of orgams, pain on penetration (one or all of these)
Def: femal sexual interest/arousal disorder, femal orgasmic disorder, genito-pelvic pain/penetration disorder (req 6 mo duration of symptoms)

A

female sexual dysfunction

55
Q

screening tools for female sexual dysfunction

A

sexual satisfaction scale, female sexual function index

56
Q

diagnostic labs for female sexual dysfunction

A

guided by history/PE, if indicated- testosterone, Sex hormone binding globulin, DHEA, estradiol, calculated free testosterone, LH/FSH, pelvic ultrasound, CBC, CMP, A1C, lipid, renal liver,

Ask what meds they are on… SSRIs?

57
Q

Tx options for female sexual dysfunction

A

Vaginal moisturizers, topical vaginal low dose estrogen, SERMS, Testosterone (off label), pelvic floor therapy

58
Q

Nonpharm Tx options for female sexual dysfunction

A

Diet exercise, sleep, cholesterol reduction, tobacco cessation, BP/ glycemic control, psychology

59
Q

PLISSIT model for addressing sexual health with women

A

Give permission, limited information, specific suggestions, intensive therapy

60
Q

Pretty rare but most commonly seen in women in their 50s
Usually remains undetected until sx appear… more extensive
Sx: pelvic pain, urinary urgency, abdominal pain, bloating
Look into this if pt has sx t > 6 months that aren’t going away

A

Ovarian Cancer

61
Q

RF for Ovarian Cancer

A

being in your 50s, having the BRCA1 or the BRCA2 gene, personal history of breast cancer, colon cancer, never having had a child.

62
Q

Stages 1-4 of ovarian cancer

A

Stage 1= CA in 1 or both ovaries
Stage 2= spread to pelvis
Stage 3= spread to abdomen
Stage 4= beyond abdomen

63
Q

hard to diagnose .. transvaginal US; Order CA-125 test (tumor marker); CT pelvis
Expensive test that looks at proteins produced by ovarian cells
Can be elevated from causes other than ovarian cancer (ex. diabetes , lupus)

A

Dx for ovarian cancer

64
Q

Exam pearls for ovarian cancer

A

any evaluation of the ovary in post-menopausal women where you find an enlargement in your evaluation should signify that you want to rule out malignancy and usually requires a referral

65
Q

Most common in post menopausal women btw 50-60 years of age

* post meno-pausal bleeding, fullness or pressure in pelvis

A

Endometrial Cancer

66
Q

RF of Endometrial Cancer

A

Older age, never being pregnant, obesity (excess androgen is converted to estrogen), breast cancer tx meds (tamoxifen), hx of colon cancer, estrogen exposure w/o progesterone
Greater risk if family hx of colon cancer

67
Q

How to dx endometrial cancer?

Stages?

A

Dx: endometrial biopsy

Stage 1= only uterus
Stage 2= uterus and cervix
Stage 3= spread beyond uterus but hasn’t reached rectum or bladder
Stage 4= also affects bladder and rectum and other parts of body

68
Q

Tx of endometrial cancer

A

Tx depends on stage of tumor/ cancer
Surgery, hysterectomy, chemo
Good survival rate if not invaded muscles

69
Q

2nd most common malignancy of female GYN tract.. Decreasing due to HPV vaccine.

A

cervical cancer

70
Q

Most common types of HPV that cause cervical cancer

A

HPV 16 and 18

71
Q

post coital spotting, bleeding around cervix, menorrhagia; thin, watery, foul discharge

A

s/s of cervical cancer

72
Q

RF of cervical cancer

A

exposure to HPV (sexual activity) , increased risk with those sexually active earlier and who have had many partners, HIV, immunocompromised, low SES, women whos moms took DES, smoking

73
Q

protects against 9 types of HPV (including 16, 18, and two more types that cause warts). 3-injection series over 6 mos. Females and males can receive at 9 yrs old; routine pap

A

gardasil

74
Q

CC= Mass on external vaginal area - very rare CA

Need biopsies … Refer out

A

vulvar and vaginal cancers

75
Q

rare and aggressive cancer no burning, itching, or pain

A

Vulvar melanoma

76
Q

asymptomatic, vaginal bleeding not a/w discomfort

A

CM vaginal CA:

77
Q

lump, mass, itching, bleeding

A

CM vulvar CA

78
Q

What to do if suspect vulvar or vaginal cancer?

A

CM vaginal CA: asymptomatic, vaginal bleeding not a/w discomfort
Refer to gyn for biopsy (vulvar) and colposcopy (vaginal)
Diag vaginal CA: PET and CT

79
Q

Usually leave them alone if not causing a problem (large, pain, difficulty getting pregnancy, abnormal bleeding)

A

uterine fibroids

80
Q

Cyst in Introitus… may be asymptomatic unless it’s infected
may see a larger lump on one side, very tender to touch. Often can just be treated with antibiotics.If not better may need I&D
If enlarged gland found in post-menopausal women presume it is carcinoma

A

bartholian cyst

81
Q

how is endometriosis tx

A

BC and NSAIDS *

82
Q

defined as inability to conceive after 1 year of regular timed, unprotected intercourse or donor insemination <35 and 6 months >35, immediate referral for 40+

A

infertility

83
Q

Rf of infertility

A

obesity, cigarette smoking, underweight, shift work, occupational exposure, PCOS, varicocele (bag of worms)

84
Q

Dx for male infertility

A

semen analysis x 2 (2-7 days of abstinence prior to sample) if + oligospermia= 8-10AM FSH, LH, testosterone; if testosterone low obtain prolactin then refer,

85
Q

Dx for female infertility

A

pap, HPV, chlamydia, gonorrhea, imaging- hysterosalpingogram, older than 35 3 day FSH level an estradiol level, ovulation- basal body temperature charting, urinary LH home kit- LH surge 1-2 days precedes ovulation

86
Q

General treatment scope for PCP related to infertility

A

improve nutritional status, normalize weight, eliminate cigarette, caffeine, illicit drugs NSAIDs, ETOH, toxins, fertile window- 5 days before-ovulation, intercourse 2x per week, avoid lubricants that may be spermicidal (recc raw egg white/ vegetable oil)

87
Q

How to tx in preg pts?
Chlamydia
*Gonorrhea
+HIV, hepatitis B, syphilis

A

Chlamydia- azithromycin 1gram orally as single dose

*Gonorrhea (uncomplicated)- ceftriaxone 500mg IM as single dose for persons weighing <150kg

Refer for +HIV, hepatitis B, syphilis

88
Q

Maternal genitourinary and gastrointestinal colonization is the primary risk for the leading cause of neonatal early onset disease (EOD)- eg sepsis, PNA, or meningitis.

A

GBS - Group Beta Strep

89
Q

Who is high risk for Group Beta Strep

A

High risk = History of previous GBS-infected newborn, Gestational age of less than 37 weeks at time of delivery, Prolonged rupture of membranes, Very low birth weight

90
Q

Diagnostics for GBS

A

Genito rectal swab
Screening recommended at 36 0/7-37 6/7 weeks gestation
Findings may include:
Positive genito rectal culture for GBS
Do not screen those with positive GBS bacteriuria as they will require prophylactic treatment regardless.

91
Q

Tx for GBS

A

Intrapartum IV antibiotic recommendations: (abx in labor or after ROM)
Penicillin (PCN) G OR Ampicillin
PCN allergy alternatives include:
Cefazolin
Recommend use of Clindamycin in those with known IgE mediated events after receiving PCN and cephalosporins

Prophylaxis treatment is not necessary for those without signs of labor, with intact membranes and planned mode of delivery is cesarean section.

92
Q

Dx for UTI in pregnant woman

When to screen?

A

Screening for all pregnant women by urine culture once early in pregnancy* (12-16 wks gestation)
UA with reflex culture

Findings may include:
Pyuria
Culture positive for 10^3 or 10^5 colony-forming units/mL (CFU)
Reported symptoms of urgency, frequency and dysuria

93
Q

Common tx for UTI in pregnant woman

A

Amoxicillin 500mg Q8h x3-7 days
Amoxicillin-clavulanate 500mg Q12hr x3-7 days
Cephalexin 500mg Q8h x3-7 days

94
Q

UTI med tx to avoid in pregnany

A

Avoid nitrofurantoin and sulfonamides at end of 3rd and during 1st trimester
Avoid trimethoprim in first trimester

95
Q

what to do after tx UTI in pregnant woman

A

May also provide prescription for yeast tx to be taken at completion of ABX if needed; test of cure after tx and repeat urine cx q6-12 weeks for remainder of pregnancy.

96
Q

Rare disorder consistent with severe, intractable nausea and vomiting (>3 episodes per day), dehydration, large ketonuria and >/= 5% body weight loss.
Possible DDx Gastroesophageal reflux disease (GERD)

A

Hyperemesis Gravidarum (HG)

97
Q

Dx for Hyperemesis Gravidarum (HG)

A

None typically recommended in those without dehydration
May consider CMP, CBC, TSH, quantitative human chorionic gonadotropin (hCG), amylase and urinalysis

Findings may include:
Elevated liver enzymes, bilirubin and amylase
Decreased TSH
Elevated specific gravity and/or ketonuria

98
Q

Tx for Hyperemesis Gravidarum (HG)

A

start with lifestyle modifications
Nonpharmacologic: change prenatal vitamin to folic acid only (Level A); ginger capsules 250mg QID (Level B), consider P6 acupressure wrist bands.

Pharmacologic: Vitamin B6 (pyridoxine) 10-25mg PO (alone or in combination with Doxylamine 12.5mg) 3-4 times a day. (Level A)

99
Q

Low levels of iron, hemoglobin and microcytic hypochromic rbc = Hb, 11 g/dl
Recognize symptoms of fatigue, weakness, rapid heart rate, difficulty concentrating, shortness of breath, pale skin, chest pain, lightheadedness, cold hands and fe

A

IDA

100
Q

CDC cutoffs for IDA In pregnancy

A

Hb 11 g/dl in 1st trimester
Hb < 10.5 g/dl in 2nd trimester
Hb 11 g/dl in 3rd trimester
‘

Normal for women = Female: 12.1 to 15.1 g/d

101
Q

Labs for IDA in pregnancy

A

CBC w/ or w/out diff, Serum ferritin (low), serum iron (low), TIBC (elevated), transferrin sat (low)

102
Q

Tx for IDA in pregnancy

A

treat underlying cause 1st
Iron and vitc rich foods
Oral iron supplementation 60-200 mg/ day elemental ion
Consider Ferrous sulfate 325 mg (65 elemental) TID btw meals if tolerable
Consider Vit C (250-500 mg BID with iron) to max absorption
Continue therapy 3-6 months after deficiency corrected to replenish stores
Educate pregnant women who are vegetarian/ Vegan

103
Q

Tx asthma in pregnancy

A

SABA of choice: Albuterol
ICS of choice: budesonide; however continue same ICS as before preg. If possible
Salmeterol preferred over leukotriene RA or theophylline
If mom’s asthma is poorly controlled, fetus needs close monitoring (serial US with antenatal fetal testing at 32wks)

104
Q

Tx of constipation during pregnancy

A

Tx: water, fiber, psyllium, methylcellulose (Citrucel,) , Colace.

Avoid mineral oil, castor oil, saline, and PEG

d/t progesterone effect on bowel motility (decreased)

105
Q

Early pregnancy Bleeding diagnostics

A

Transvaginal ultrasound

Labs: HCGs, CBC, Coags,

106
Q

monitor closely… could move back into right position spontaneously. 95% resolve prior to birth, don’t do digital exam, refer to OB

A

placenta previa

107
Q

3rd-trimester non-obstetric bleeding causes

A 
Cervicitis 
Vaginitis 
Trauma 
Polyps 
Malignancy
108
Q

3rd-trimester obstetric bleeding causes -

A

Lots of blood- placenta previa, abruptio placentae, vasa previa, uterine rupture

not as much blood- bloody show, intercourse

109
Q

3rd-trimester non-vaginal bleeding causes

A

hemorrhoids, hemautira

110
Q

early vs late postpartum hemorrhage

A

Early= > 500 ml in first 24 hours (blood loss underestimated)

Late= > 500 cc after first 24 hours

111
Q

Major causes of postpartum hemorrhage

A

retained placental fragments, infection, hematomas, sub involution

112
Q

How to manage postpartum hemorrhage

A

D&C , Antibiotics

113
Q

Fertilized ovum implants anywhere outside the uterus

RF: PID, chlamydia, OCP,

A

ectopic pregnancy

114
Q

Ectopic pregnancy triad

A

pelvic pain, amenorrhea, irregular bleeding

115
Q

unruptured- abdominal pain with or without vaginal spotting/bleed, dizziness, shoulder pain (more common in ruptured), amenorrhea for 1-2 months, nausea, fatigue, breast heaviness, unilateral pelvic/abd pain, speculum: bluish coalition of cervix, budging culdesac, highly indicative findings: adnexal mass, involuntary guarding peritoneal signs

A

CM of Ectopic pregnancy

116
Q

Diagnostics for ectopic pregnancy

A

HCG, CBC, transvaginal U/S

Low rising HCG

117
Q

What to do if you suspect ectopic pregnancy

A

send to ER

118
Q

How is ectopic pregnancy treated

A

ER : methotrexate with or without leucovorin or mifepristone, surgical laparoscopy or laparotomy: only treatment option for ruptured; rh negative blood type women should receive RhoGAM

119
Q

What to educate after women received methotrexate for ectopic pregnancy

A

after methotrexate- women should refrain from Sexual activity, ETOH, folic acid vitamins until after resolution of ectopic pregnancy (3 months)

120
Q

Frequent feeding/pumping, augmentin, dicloxacillin, or cephalosporin for staph or strep. Flu-like sx. Can progress to abscess

A

mastitis

121
Q

Screening tools for perinatal mood disorders

A

Beck, Edinburgh, PHQ-9, PPD Screening Scale

122
Q

Dx for perinatal mood disorders

A

assess for thyroid abnormalities and SI

123
Q

Tx of perinatal mood disorders

A

CBT, pharm
Low dose SSRI 5-7 days and refer

SSRIs, vit d, DHA, CBT, massage, acupuncture, yoga

124
Q

first 2-3 mos through first year. Affects entire family (child/partner)
Assess: guilt, fatigue, sleep disturbance, loss of interest/concentration, appetite change, agitation, SI

A

PPD

125
Q

occurs around 2-4 weeks pp delusions, hallucinations, hopelessness → emergency

A

PP Psychosis

126
Q

What qualifies as preterm labor

A

labor before 37 weeks gestation

RF: SES, genetic conditions, periodontal disease, multiple gestation, substance use, maternal infections, preeclampsia

Injectable steroids at 24-34 wks gestation to mature fetal lungs

127
Q

new onset HTN with proteinuria
S/S: dizziness, headache, seeing spots, RUQ discomfort, swelling of face and hands.
Refer

A

preeclampsia

128
Q

Mild vs Severe Preeclampsia

A

Mild : 140/90, Protein 1+

Severe : > 140/90, and 3+ urine, may have elevated LFTS

129
Q

Short term vs long term tx of preeclampsia

A

Short term: Nifedipine, IV Labatelol, Hydralazine
Long term: labetaloal, methyldopa
Baby aspirin, calcium
Delivery at 37 wks

130
Q

Diagnostics for preeclampsia

A

Twice weekly BP and once weekly CBC, liver enzyme, and creat

131
Q

High BP causes seizures
Mag sulfate for seizure prevention
If less than 34 wks gestation need antenatal corticosteroids
Requires emergent delivery

A

Eclampsia

132
Q

HELLP Syndrome

A 
develops in preeclampsia 
H= hemolysis 
E= elevated
L= liver enzymes 
L= low
P= platelets
133
Q

Goal BPs during pregnancy

A

Gestational Hypertension

Primary care can manage GH just needs to be monitored carefully
Want BP 120-160/80-105
Low dose Aspirin

134
Q

FDA guidelines Unplanned pregnancy

A

FDA guidelines: medication abortion is avialable up to 10 weeks with mifepristone and misoprostole
Adoption

FNP 3- Test 3 (5 decks)

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