Pre-natal and Well Child Visits

Question 1

What info do you need to get at first pre-natal visit?

(OB History)

Answer 1

G (gravida) - # of times pregnant

T (term) - # of full term deliveries

P (preterm) - # of preterm deliveries

A (abortions) - # of abortions prior to 20 wks

L (living) - # of living children

Question 2

Calculate EDD

example: woman with first day of LMP Feb 14, 2015

Answer 2

Naegele’s Rule: 1st day of LMP + 7 days +9months

example:

Feb 14+ 7days = Feb 21,

Feb21 + 9mo= Nov 21, 2015 is estimated due date

Question 3

which STD do you screen for at initial pre-natal visit?

Answer 3

chylamdia

Question 4

What physiologic changes occur in pregnancy:

(Cardiovascular)

Answer 4

increased HR (by 10-20BPM)

May develop murmur (systolic ejection)

IVC syndrome – may get light-headed or faint

                       →Lie on left side for relief

Producing more RBCs (need more iron)

Question 5

What physiological changes occur in pregnancy?

(Vascular)

Answer 5

Increased risk for VTE

Edema

Blurred vision – don’t need Rx for glasses

Question 6

What physiologic changes occur in pregnancy?

(pulmonary)

Answer 6

Congestion

SOB

Question 7

What physiologic changes occur in pregnancy?

(Gastrointestinal)

Answer 7

N/V

Reflux

Constipation/bloating

Hemorrhoids

Question 8

What physiologic changes occur in pregnancy?

(urinary)

Answer 8

Frequency

Incontinence

increased risk of UTI

Question 9

What physiologic changes occur in pregnancy?

(endocrine)

Answer 9

TGs up by 300% - don’t check cholesterol

*may get: *gesational diabetes mellitus or hypothyroidism

Question 10

What physiologic changes occur in pregnancy?

(Breasts)

Answer 10

Bigger/darker areola, tender breasts

Question 11

What physiologic changes occur in pregnancy?

(Skin, hair, nails)

Answer 11

Mask of pregnancy (blotchy skin darkening)

Linea nigra

Acne

Varicosities

Stretch marks

Increased hair volume

Question 12

What physiologic changes occur in pregnancy?

(MSK)

Answer 12

Back pain

Lax ligaments

Question 13

What are some important education topics to cover pre-natally?

Answer 13

Pregnancy Education

Nutrition

Wt gain of 25-35 lbs (if healthy weight pre-pregnancy→ Underweight women should gain 28 to 40 pounds. Overweight women may need to gain only 15 to 25 pounds during pregnancy

Pre-natal vitamins

Exercise

Seat belt – below uterus, across hips

Avoid toxins

Medications – pay attention to class

Travel- safest mid pregnancy, restricted on commerical airlines in last month

Question 14

Milestones at 1mo

Answer 14

Responds to parents’ faces/voices

Able to fix gaze and focus

Alerts to sounds/noises – startles, change in respiration, etc

Question 15

Milestones at 2mo

Answer 15

Gaze follows past midline

Coos reciprocally

Smiles socially

Able to move head/lift chest briefly when lying prone

Improving head control when upright

Interest in visual stimuli

Question 16

Milestones at 4-5 mo

Answer 16

In prone position, hold head upright and raises body on forearms

Holds head high and steady when seated/upright

Laughs and giggles

Holds own hands, brings hands to mouth

Begins reaching for items with purpose and intent

Rolls over front to back

Question 17

Milestones at 6mo

Answer 17

Squealing, screeching and babbling reciprocally

Shows differential recognition of family and caregivers

Transfers objects from hand to hand

Rolls front to back and back to front

No head lag when pulled to sit

Sits with support

Bears weight on legs

Rakes objects to pick them up

Eating pureed foods

Question 18

Milestones at 9mo

Answer 18

Babbles with single consonants, imitates vocalizations

understands simple words like, “hi” or “bye”

Crawling/scooting/creeping/cruising

Sits independently

Enjoys social games such as peek-a-boo and patty cake

Eating some table foods/starting to self feed

Stranger/separation anxiety

Responds to own name

Question 19

milstones at 1yr

Answer 19

Precise pincer grasp (can pick up Cheerios)

Points with index finger

Pulls to stand, cruises, possibly takes steps alone

Looks for dropped/hidden objects

Says 1-3 words in addition to Mama/Dada

Imitates vocalizations

Bangs things together

Puts items into and takes items out of containers

Plays social games

Drinks from cup and eats table food/self feeding

Question 20

milestones at 18mo

Answer 20

Identifies pictures in a book/turns pages

Follows simple commands

Vocabulary of 10-20 words, 2 word phrases

Imitates words

Walks quickly or runs stiffly

Shows affection – gives hugs and kisses

Uses spoon and cup

Uses toys/things correctly

Throws ball

Stacks 3 blocks

Question 21

Milestones at 2yr

Answer 21

Walks up and down stairs one step at a time

showing defiance

Kicks ball

Vocabulary of 30-40 words, 2 word phrases

Speech 25-50% intelligible to strangers

Follows 2 step commands

Makes horizontal and circular strokes when coloring

Eats independently with utensils/fingers

Climbs on furniture, opens doors

Question 22

Milestones at 3yr

Answer 22

Identifies some colors

Can copy a cross or circle

Speech mostly intelligible to strangers

Speech conversational – uses pronouns, plurals, sentences

Kicks and throws a ball

Knows name, age and sex

Pedals a tricycle

Can dress/undress with assistance

Takes turns and shows affection for friends/family

Can walk up and down stairs, one foot on each step

Question 23

Milestones at 4yr

Answer 23

Can count objects to 5

Identifies most colors

Pedal tricycle/bicycle

Gets dressed without assistance

Draws person with 2-4 body parts

Uses scissors and pencil well

Hops and stands on one foot up to 2 seconds

Enjoys make-believe play

Developing friendships, shows empathy

Can identify/discuss likes and interests

Can retell a favorite story/sing a favorite song