H&P of Geriatric and Obstetric Patients

Question 1

Immunizations you can give during pregnancy

Answer 1

Influenza
Tetanus
Hepatitis
MMR
Varicella

Question 2

Gravidity and Parity

Answer 2

G - number of pregnancies
P - number of pregnancies with birth beyond 20 weeks
T - number of term pregnancies
P - number of preterm pregnancies
A - number of abortions, miscarriages, ectopic pregnancies
L - number of living children

Question 3

Naegele’s rule

Answer 3

Method of establishing estimated date of delivery

Subtract 3 months from LMP (always use day 1) and add 7 days

Question 4

Other ways to assess date of pregnancy

Answer 4

• -Physical exam of uterus

- -Ultrasound (most accurate time is EARLY)

Question 5

What two questions should we ask when a woman presents with an early pregnancy?

Answer 5

1. Where is the pregnancy? (ectopic)

2. Is it viable? (rule out demise/molar pregnancy)

Question 6

Molar pregnancy

Answer 6

Abnormal number of chromosomes, no fetus actually develops

Question 7

Renal threshold in pregnancy

Answer 7

• -It changes during pregnancy, so urine glucose may not be as reliable
• -Gestational diabetes is a problem

Question 8

Cardiovascular changes in pregnancy

Answer 8

Increased blood volume
Increased CO

Decreased systemic vascular resistance

Question 9

Fetal presentation

Answer 9

Relation of fetus to maternal spine

Question 10

Fetal position

Answer 10

Relation of the fetal presenting part to the maternal pelvis

Question 11

Leopold maneuver

Answer 11

Placement of hands in order to assess fetal presentation

Question 12

Cervical effacement

Answer 12

Thinning out of the cervix

Question 13

1st stage of labor

Answer 13

Onset of labor until complete dilation of the cervix

Question 14

Complete dilation of the cervix

Answer 14

10 cm

Question 15

2nd stage of labor

Answer 15

Complete cervical dilation to infant delivery

Question 16

3rd stage of labor

Answer 16

• -Delivery of infant to delivery of placenta

- -Should be

Question 17

Labor curves by parity

Answer 17

Women who have had a previous pregnancy will typically delivery subsequent babies more quickly

Question 18

Common changes to vital signs in aging

Answer 18

Arteriosclerosis

Systolic HTN

Widened pulse pressure

Orthostatic hypotension

Decreased maximal HR

Susceptible to hypothermia

Question 19

Common CV changes with aging

Answer 19

Cardiovascular – neck vessel bruits, loss of atrial kick, S3 or S4 heart sounds, systolic aortic murmur, aortic stenosis

Peripheral vascaular system – abdominal aortic aneurysm, temporal arteritis

Abdomen – acute abdominal disease is not common but can be ignored due to aging

Reproductive – menopause, BPH

Musculoskeletal – loss of lean body mass and strength, strength training in older adults can slow or reverse process

Nervous system – mental status, motor and sensory function

Question 20

What are the daily activities do we want to make sure the elderly can do?

Answer 20

Bathing

Dressing

Toileting

Transferring

Continence

Feeding

Question 21

What is functional status?

Answer 21

Ability to perform tasks and fulfill social roles associated with daily living

Question 22

Thorax and lung changes in the elderly

Answer 22

Increased AP diameter