Module 6 Flashcards
What is the visit schedule for prenatal/postnatal care?
-Initial visit: between 6-8 weeks gestation (after 2 missed periods)
-Every 4 weeks until 28 weeks
-Every 2 weeks until 28-36 weeks
-Every week from 36-40 weeks
-Twice weekly if greater than 40 weeks
**closer supervision warranted for pts developing any of these problems: decreased fetal movement, GDM, PIH, PreE or placental problems
What are the initial labs?
CBC with differential
Blood type and Rh
Antibody screen
RPR and VDRL
HIV screening
HepB surface antigen (HBsAG)
Rubella and Varicella-zoster titers
Urinalysis/Urine C&S (clean catch or cath sample)
Pap smear if >21 yrs old (omit if normal Pap within past 3 years) –> include HPV co-testing if over age 30
DNA probe for Gonorrhea and Chlamydia
-screen for HSV in pts with past or current herpes lesions
-screening (wet prep) for trichomonas, candidiasis or bacterial vaginosis in those with sx
-Glucose challenge test if previous gestational diabetes or high risk for diabetes
-offer cystic fibrosis screening
-Zika testing if meets CDC criteria (exposure to Zika)
-Hb Electrophoresis to detect sickle cell or thalassemia based on racial/ethnic background and family hx
-PPD or Interferon Gold Test for those at high risk of TB
What are the choices for aneuploidy screening?
Neural tube defects: 13, 18, 21
2 options
1. stepwise integrated screening - two separate risk measures that are compared:
*first step between 11 0/7 and 13 6/7 weeks gestation: US measurement of fetal nuchal translucency. Serum test: pregnancy associated plasma protein A (PAPP-A) and BHCG. Used to screen for Trisomy 13, 18, 21
*second step between 15-18 weeks gestation: maternal AFP to detect open neural tube defect
2. Quadruple screening (15-20 weeks gestation, ideally 16-18 weeks):
*maternal serum a-fetoprotein (AFP)
*Serum B-human chorionic gonadotropin (BHCG)
*Unconjugated estriol
*Inhibin
What are the standard things that are checked at routine prenatal visits?
-weight
-urine dipstick for glucose, protein and nitrates
-BP
-Fundal height (after 18 weeks gestation)
-Fetal heart tones - audible with doppler usually after 10-12 weeks but really depends on patient habitus and fetal cooperation
-fetal movement - quickening by 18-20 weeks in a primiparous, 14-18 weeks in multigravida
-edema
-patient report of pressure/cramping/contractions
What are the danger signs of each trimester?
-Danger signs late pregnancy
*bleeding, leaking or change in vaginal discharge
*fever >100.6F (oral)
*pain-abdominal, uterine, or urinary
*decreased fetal movement (any concerns, patient should be assessed by BPP and NST)
What is the importance of antenatal Rhogam?
Rh Negative mothers (also called D negative)
-antibody screen
-if screen is negative, prophylactic Rhogam 300mg (anti-D immune globulin) is given to prevent isoimmunization
Can you name items for nutritional counseling?
-Nutritional counseling regarding carbohydrate intake
-blood glucose home monitoring
-Maternal/fetal SE of uncontrolled blood sugar levels
-Optimal glucose levels:
*fasting = 70-95
*1 hr postprandial < 130-140
*2 hr postprandial < 120
A firm, round, mobile, discrete, non-tender breast mass with well-defined borders is most likely consistent with:
fibroadenoma
Routine screening for group B strep (GBS) in pregnancy is recommended at:
36 weeks GA
A 29 year old female is seen in the clinic for an initial OB visit. As the NP, you will order all the following labs except:
TSH
Will want CBC and Rubella titer
You are examining a 10 year old female during a well child check. On physical exam, you notice she has developed breast buds. This is indicative of what stage of development?
Tanner 2
The development of axillary and public hair is known as:
pubarche
Which of the following statements is true regarding placenta previa?
diagnosed by US
Medications for initial antihypertensive therapy during pregnancy include all the following except:
enalapril
Methyldopa and labetalol okay
A patient is 32 weeks pregnant. She does not have a history of HTN and her BP up to now have been normotensive. Her BP today is 142/90. Her repeat BP was 144/92 four hours later. Urine dipstick is negative for protein. This is classified as:
gestational HTN
Your OB patient presents to the clinic at 26 weeks gestation for her routine 1-hour 50g oral glucose challenge test. Her result from the lab is 160. As the NP, what is your next plan of action?
order a 3-hour 100g OGTT
Montgomery glands
sebaceous
-responsible for lubrication of nipple, help prevent cracks and fissures during breastfeeding; hypertrophy during third trimester
mastodynia
breast tenderness; common in first trimester of pregnancy
Fibrocystic breast changes
-common or rare?
-related to what?
-differentiating factors of this disorder from others
-what test to dx?
-benign?
-tx
-common
-influx of hormones (estrogen and progesterone) and correlates often w/ the premenstrual phase of woman’s cycle
-painful, bilateral, mobile, masses; multiple; in the breast
*size rapidly fluctuates depending where person is in cycle (caffeine aggravates!)
-<35yrs = US; >35yrs = Mammogram
-fibrocystic breast changes are considered benign; do not inc risk of breast CA
-wear supportive bra, reduce caffeine intake, mild analgesics (tyl, ibup)
Fibroadenoma of the breast
-benign or metastatic?
-when do they increase in size?
-when will regress?
-typical findings
-gold standard for dx?
-benign, common; occurs frequently in women w/i 20 yrs after puberty
-during pregnancy or w/ estrogen replacement during menopause
-regress after menopause
-round, firm, moveable, nontender; 1-5cm in size
-biopsy
Nipple discharge
-when does this occur?
-how to eval discharge
-during pregnancy; d/t SE of medications; pituitary tumor
-consider the nature of discharge: serous, bloody, masses, unilateral/bilateral, spontaneously occur or must be manually expressed?
Nipple discharge
-clinical manifestations of physiologic nipple discharge
-physical exam (what is ordered; who to refer to)
occurs bilaterally, multiductal, milky nipple discharge in nonlactating breasts
-if physical exam is benign, imaging is negative, and discharge is multiductal and not bloody, order pregnancy test, prolactin levels, check renal and thyroid fx (refer to endocrinology as warranted depending on test findings)
Nipple discharge
-clinical manifestations of pathologic nipple discharge
-causes of nipple discharge?
-what does blood nipple discharge indicate? What should be ordered?
-unilateral, spontaneously occurs, serous or serosanguinous; comes from single duct
-commonly d/t intraductal papilloma (benign wart-like tumor that grows w/i the milk ducts of the breast)
-CA; US/mammogram depending on pt age (<35 US, >35 mammogram)
childbearing year
13 months
-2M preconception
-9M pregnancy
-2M PP