H&P of Geriatric and Obstetric Patients Flashcards
Immunizations you can give during pregnancy
Influenza Tetanus Hepatitis MMR Varicella
Gravidity and Parity
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
Naegele’s rule
Method of establishing estimated date of delivery
Subtract 3 months from LMP (always use day 1) and add 7 days
Other ways to assess date of pregnancy
- -Physical exam of uterus
- -Ultrasound (most accurate time is EARLY)
What two questions should we ask when a woman presents with an early pregnancy?
- Where is the pregnancy? (ectopic)
2. Is it viable? (rule out demise/molar pregnancy)
Molar pregnancy
Abnormal number of chromosomes, no fetus actually develops
Renal threshold in pregnancy
- -It changes during pregnancy, so urine glucose may not be as reliable
- -Gestational diabetes is a problem
Cardiovascular changes in pregnancy
Increased blood volume
Increased CO
Decreased systemic vascular resistance
Fetal presentation
Relation of fetus to maternal spine
Fetal position
Relation of the fetal presenting part to the maternal pelvis
Leopold maneuver
Placement of hands in order to assess fetal presentation
Cervical effacement
Thinning out of the cervix
1st stage of labor
Onset of labor until complete dilation of the cervix
Complete dilation of the cervix
10 cm
2nd stage of labor
Complete cervical dilation to infant delivery
3rd stage of labor
- -Delivery of infant to delivery of placenta
- -Should be
Labor curves by parity
Women who have had a previous pregnancy will typically delivery subsequent babies more quickly
Common changes to vital signs in aging
Arteriosclerosis
Systolic HTN
Widened pulse pressure
Orthostatic hypotension
Decreased maximal HR
Susceptible to hypothermia
Common CV changes with aging
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
What are the daily activities do we want to make sure the elderly can do?
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
What is functional status?
Ability to perform tasks and fulfill social roles associated with daily living
Thorax and lung changes in the elderly
Increased AP diameter
