Eloise is a 17 year old Italian female, healthy appearing but is nervous in nature.
History of Present Illness: She presents to the office complaining of fatigue, nausea and vomiting for several weeks but seems to be getting worse. No fever, no sick contacts, no stomach ache or diarrhea. Eloise becomes teary eyed as she is nervous about what might be happening.
In this module, you will review Eloise’s record and complete the risk assessment table based on the information you have about your patient at her 12 week initial prenatal visit. Include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed.
In this module, you will review Eloise’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
16 week prenatal visit
Eloise returns for her 16 week prenatal visit. Her blood pressure is 122/76. She weighs 126 lbs. Fetal heart tones are 135 bpm (beats per minute). She reports no vaginal bleeding, discharge or contractions. Eloise’s fundal exam is consistent with a 16 week gestation at halfway between the pubic hairline and the belly button. She does not report quickening. Eloise continues to feel fatigued during the day. She complain of lightheadedness and shortness of breath. Her sequential screen from her initial prenatal visit was normal.
Laboratory: HGB 10.1/HCT 32.4, MCV 85, MCH 28, MCHC 34, Platelets 212,000
In this module, you will review Eloise’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
30 week prenatal visit
Eloise returns to clinic at 30 weeks. Her blood pressure is 138/90. She weighs 130 lbs. Fetal heart tones are 138 bpm. Her fundus measures 29 cm. She reports positive fetal movement, no vaginal bleeding, discharge or contractions. Her urine dip is neg for protein, glucose and nitrates. Eloise indicates she is taking her vitamins and iron as prescribed. Mild pedal edema noted on examination. She reports no headache, nausea or vomiting. Eloise's 1 hour glucose tolerance test was done at her last visit and her result is 92 mg/dl. CBC done last visit returned HGB 11.0/HCT 34.2.
Laboratory: AST: 16 u/l ALT: 34 u/l Uric Acid: 3.2 mg/dL Fibrinogen: 367 mg/dL
In this module, you will review Eloise’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
34 week prenatal visit
Eloise returns to clinic at 34 weeks. Her blood pressure is 138/96. She weighs 132 lbs. Fetal heart tones are 132 bpm. Her fundal height measures 30 cm. She reports positive fetal movement, no vaginal bleeding, discharge or contractions. Urine dip is trace protein, no glucose and no nitrates. She has plus two pedal edema. She reports no headache, nausea or vomiting.
Laboratory: AST: 20 u/l ALT: 43 u/l Uric Acid: 3.1 mg/dL Fibrinogen 355 mg/dL 24 hour urine protein 58 mg/d
Ultrasound: Cephalic position, EFW is 1637 grams (<10%), AFI 5cm, Placenta is posterior, fundal grade 1, 3 vessel cord.
In this module, you will review Eloise’s prenatal visit. Using the risk assessment table please identify any new risks and include the appropriate testing for this patient, patient education, anticipatory guidance and treatment options, if needed, for current or previous risks and routine matters.
36 week prenatal visit
Eloise returns to clinic for a 36 week visit. Her blood pressure is 150/100. She weighs 142 pounds. Fetal heart tones are 128 bpm. Fundal heights measures 32 cm. She reports decreased fetal movement, no vaginal spotting and no contractions. Urine dip is 1+ protein, no glucose and no nitrates. She has plus two pedal edema and facial swelling. She reports headache and mild nausea. Reflexes are 2 + bilateral with negative clonus. Her GBS swab came back positive from her last visit.