Family Exam - Pathway to Passing

Family Exam - Pathway to Passing

• Gravida (Grava): total pregnancies, including current. It counts all pregnancies, including term, premature, abortions, and current.
• Para (Para): previous pregnancies that lasted more than 20 weeks. It only counts pregnancies that went past 20 weeks, including term and premature babies.
• TPAL: a system to track pregnancies. T = term pregnancies, P = premature, A = abortions, L = living children.
• Chadwick's signs: bluish color of the cervix.
• Haegar's Sign: softening of the isthmus.
• Goodell's sign: softening of the cervix.
• Quickening: fluttering feeling that occurs around 20 weeks.
• Pap Smear Results:
  • Under 21: no screening.
  • Ages 21-29: every 3 years.
  • Ages 30-65: every 3-5 years with HPV co-testing. If over 65 with no abnormal signs, screening can stop.
  • Women with hysterectomies: no more pap smears unless for pre-cancer diagnosis.
• Cervical cancer screening starts at age 21 for vaccinated or unvaccinated women.
• Prenatal Visits: complete medical history & physical; fetal heart tones, fundal height, blood pressure, lab results, urine dipstick; estimated date of conception; check for headaches, rapid weight gain, vaginal discharge, vaginal bleeding, fetal movement.
• Doctor Visits During Pregnancy:
  • Initial visit: 8 weeks
  • 8-28 weeks: monthly
  • 28-36 weeks: every 2 weeks
  • 32-40; 40+: weekly/ bi-weekly as needed.

Contraindications for Oral Contraceptives

• Thrombophlebitis
• Smoker
• CVA
• CAD
• Suspected breast cancer
• Benign/cancer of the liver
• Impaired liver function

Prenatal Visits: Important Times to See Doctor

• Initial visit: 8 weeks in
• 8-28 weeks: monthly
• 28-36 weeks: every 2 weeks
• 32/37-40 weeks: weekly
• 40+: 1-2 times a week

Common Discomfort in Pregnancy (by trimester)

• First Trimester: nausea, vomiting; weight gain of ½ – 1 lb per week after the first trimester.
• Second Trimester: backache, round ligament pain, constipation, indigestion, excessive vaginal bleeding (1-12 weeks can be ectopic).
• Third Trimester: cramps, edema, frequent urination.

Warning Signs in Pregnancy

• Bright red bleeding
• Painful contractions with dark brown blood, hypotension, and shock-like symptoms.
• Fetal distress (abruptio placentae)
• Fetal heartbeat not heard after 12 weeks.
• Shortness of breath, swelling, deep vein thrombosis.

Mental Health

• Anorexia
  • Risk factors: perfectionist, high expectations of self and family history of eating disorders, mood disorders, and alcoholism.
  • Symptoms include: dental erosion, gum disease, esophagitis
• Bulimia: episodes of overeating followed by purging.
• Risks for bulimia include: poor impulse control, low self-esteem, family history of issues and obesity, substance abuse.
• Anxiety/Depression: frequent and severe anxiety and depression can be symptoms to look for and treat.

Risk Factors for Specific Conditions

• Diabetes: No glucose/ketones in the urine of pregnant woman.
• Obesity: Excessive body fat over 20% over ideal body weight and a BMI over 28
• ADHD: cluster of behaviors inattention and impulsivity that are more frequent and severe for same age peers

Gestational Diabetes, Diagnosis:

• Glucose challenge test (screening)
• Oral glucose tolerance test (diagnostic)

Management of Other Conditions

• Obesity: Calculate height & weight (BMI), skin tags, hyperpigmented skin, Waist > 35 inches for women and and > 40 inches for men. Waist size 35 inches (women) or over 40 inches (men) is a concern.
• Pediatric Obesity: Develop an alliance with family, use non-controversial food diets, and exercise regularly to help lose weight. Child weighing >120% of their expected height is obese.
• Elder Abuse: Notice if there are any missing funds, unusual activity in financial accounts; check for bruising, wounds, fractures; be attentive to fear or depressive mood.