WH Dx 7 Flashcards
preeclampsia
multisystem progressive disorder characterized by new onset of HTN and proteinuria or the new onset of HTN plus significant end-organ dysfunction with or without proteinuria
multisystem progressive disorder characterized by new onset of HTN and proteinuria or the new onset of HTN plus significant end-organ dysfunction with or without proteinuria
preeclampsia
preeclampsia - typically presents when
after 20 weeks gestation or PP
preeclampsia risk factors
6
- past hx of preeclampsia
- pre-existing medical conditions - gestation DM, chronic HTN, lupus, pre-pregnancy overweight or obesity, CKD
- multifetal pregnancy
- nulliparity
- family hx of preeclampsia
- advanced maternal age >35
preeclampsia clinical prestation (mains)
3
- bad headache
- change in vision (blurry vision, flashes of lights, spots)
- belly pain
preeclampsia s/sx
7
- HA - severe and/or persistent
- changes in vision
- belly pain - upper, epigastric
- HTN >140/90
- severe HTN >160/110
- AMS
- new dyspnea, orthopnea
preeclampsia DD
3
- HELLP syndrome
- Chronic HTN
- CKD
preeclampsia education
6
- this is a dangerous condition that some people get when they’re pregnancy and starts after 20 weeks typically
- typically you have THN and protein in your urine
- preeclampsia has been linked to other health conditions
- lower your risk of getting this condition again by not smoking, eating healthy foods, keeping a healthy weight, and being active
- restricted activity is recommended - no heavy lifting, daytime rest with feet elevated, relaxation techniques
- monitor BP twice daily
preeclampsia meds
none -
delivery for 37 weeks or greater with preeclampsia with or without severe features;
before 34 weeks, close monitoring;
34-36 weeks delivery or monitor with severe features;
<34 weeks pre term labor
preeclampsia tests
4
CBC
serum creatinine levels
liver panel
urinary protein test
preeclampsia f/u
twice weekly for labs and fetal monitoring; q3-4 weeks for US to assess fetal growth
preeclampsia red flags
4
- severe HTN
- bleeding from vagina
- notice your baby is moving less than normal
- thinking you might be in labor
pregnancy first trimester - timing starts when
a normal pregnancy starts the first day of your LMP
pregnancy first trimester cardinal presenting ysmptoms
amenorrhea and suspicion increased if they also report any sexual activity while not using contraception
pregnancy first trimester s/sx
6
- amenorrhea
- not using protection
- NV
- breast enlargement and tenderness
- increased urinary frequency without dysuria
- fatigue
pregnancy first trimester DD
5
PCOS
poor nutrition
depression
anxiety
premature menopause
pregnancy first trimester education
8
- a normal pregnancy starts the clock at the first day of your LMP
- pregnancy is officially 40 weeks
- 1st trimester is frist day of LMP to 13 weeks and 6 days
- prenatal care should be started in the first trimester, preferably before 10 weeks
- eat a well balanced diet
- stay active
- avoid smoking and drinking
- get certain vaccines
pregnancy first trimester - how to help nausea
4
- avoid trigger foods/drink
- eat before, or as soon as you feel hungry to avoid empty stomach
- consume fluids at least 30 minutes before or after solid food
- ginger supplements may help
pregnancy first trimester meds
prenatal vitamin
pregnancy first trimester tests
5 (labs = 8)
- pregnancy test, urine
- calculate the EDD
- transvaginal US to help estimate gestational age
- starting at 10 weeks we can do genetic testing to assess for risk of developing birth defects
- standard panel of labs - h/h, CMV, ferritin, screening for rubella immunity, urine protein sample, urine culture, cervical cancer screening, STD testing
pregnancy first trimester f/u
every 4 weeks until 28 weeks
pregnancy first trimester AG
2
tdap vaccine
flu shot
pregnancy first trimester red flags
5
- unable to eat or drink for long periods of time d/u NV
- vomiting more than 2-3 times each day on most days
- temp 100.4 or more
- HA that doesn’t go away with Tylenol
- bleeding and cramping
pyelonephritis
bacterial infection that causes inflammation in the kidneys
bacterial infection that causes inflammation in the kidneys
pyelonephritis
pyelonephritis s/sx
7
fever
flank pain
nausea
vomiting
burning with urination
increased frequency
urgency
pyelonephritis DD
3
appendicitis
PID
STD
pyelonephritis education
4
- you should start to feel better 48-72 hours after abx tx
- drink more fluids to help decrease bladder infections
- take cranberry supplements
- always urinate after intercourse
pyelonephritis meds
2
empiric abx
tylenol
pyelonephritis test
urinalysis with culture
pyelonephritis f/u
48-72 hours after abx start
pyelonephritis AG
2
STD screening
get vaccinated (HPV)
pyelonephritis red flags
3
- worsening symptoms following abx
- persistent symptoms 48-72 hours after starting therapy
- recurrent sx within a few weeks of treatment
rectocele
anterior protrusion of the rectum, tissue herniates through a defect in the rectovaginal septum into the vaginal lumen
anterior protrusion of the rectum, tissue herniates through a defect in the rectovaginal septum into the vaginal lumen
rectocele
rectocele risk factors
8
advanced age
genetics
greater parity
hx of vaginal delivery
hx of pelvic surgery
obesity
constipation
COPD
rectocele s/sx
7
- pelvic pain or pressure
- posterior vaginal bulge
- obstructive defecation
- incomplete defecation
- constipation
- dyspareunia
- erosions and bleeding of mucosa
rectocele PE should include
anal sphincter
vaginal exam
rectocele DD
3
- enterocele
- uterine prolapse
- cystocele (bladder prolapse)
rectocele education
4
- implement lifestyle changes
- eat a well balanced diet with enough fiber
- drink plenty of fluids to help with constipation
- do pelvic floor exercises such as kegels
rectocele meds
no meds - treatment is based on severity of rectocele;
conservative mgmt - eating a high fiber diet, increasing water intake, performing kegels;
next is vaginal pessary - helps hold rectocele up and prevent it from protruding forward;
last is surgery
rectocele tests
clinical dx - can do a defecography which is an x ray with contrast to determine the size of the rectocele but is not needed for dx
rectocele f/u
2 weeks to assess interventions
rectocele red flags
4
- worsening s/sx
- abd pain
- inability to defecate
- change in urinary pattern
Gonorrhea s/sx in females
6
- cervicitis - vaginal pruritis, mucopurulent discharge
- intermenstrual bleeding
- menorrhagia
- urethritis - dysuria
- PID - pelvic/abd pain, abnormal vaginal bleeding, dyspareunia, abd tenderness, cervical motion tenderness
- bartholinitis - perilabial pain and discharge, edema of the labia, enlargement and tenderness of gland
gonorrhea s/sx in males
2
urethritis
epididmyitis
gonorrhea can infect what additional areas
2
rectum
pharynx
chlamydia - most females are ___
asymptomatic
chlamydia - most commonly infected site
cervix
chlamydia s/sx in females
7
- change in vaginal discharge
- intermenstrual vaginal bleeding
- post-coital bleeding
- dysuria
- pyuria
- PID
- purulent endocervical discharge
chlamydia s/sx in men
4
- urogenital infections - urethritis, epididymitis
- testicular pain/tenderness
- hydrocele
- prostatitis
chlamydia - other common infections in males and females
3
- conjunctivitis
- pharyngitis
- proctitis (inflammation of distal rectal mucosa)
trichomoniasis s/sx in females
9
- purulent, malodorous, thin vaginal discharge
- vaginal burning
- pruritis
- dysuria
- urinary frequency
- lower abd pain
- dyspareunia
- erythema of vulva and vaginal mucosa
- vaginal discharge is green-yellow and frothy
trichomoniasis s/sx in males
3
- urethritis
- clear or mucopurulent urethral discharge
- dysuria
STDs DD
5
gonorrhea -> chlamydia
chlamydia -> gonorrhea
trichomoniasis
PID
BV
STD education
5
- many STDs can be transmitted through any type of sex
- get screened for STDs if you suspect you have one, have multiple sex partners, or have a new sex partner
- there is no definitive way to prevent STDs if you are sexually active
- wear a condom every time
- get vaccinated
gonorrhea tx
abx
chlamydia tx
abx
trichomoniasis tx
abx
gonorrhea test
female - NAAT vaginal swab
males - NAAT first catch urine sample
chlamydia test
female - NAAT vaginal swab
males - NAAT first catch urine
trichomoniasis test
female - NAAT vaginal swab
male - NAAT urethral swab
STDs f/u
48-72 hours
STDs AG
3
- <25 years, get screened annually for chlamydia, gonorrhea, and HIV
- > 25 get screened at least once for HIV
- do sexual activity counseling
STDs red flags
5
worsening sx
persistent or recurrent symptoms
change in bladder or bowel function
fever
increased bleeding
