Week 6 Discussion Forum

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Maria, 49-year-old female, annual exam.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. 

In your peer replies, please reply to at least one peer who chose a different case study.

1. Hannahis 32 weeks EGA and comes to you for her routine prenatal appointment.  Her BP is 156/96 and her urine has 2+ protein.  She complains of having a headache that will not go away and just not feeling “right.”

• What will you include in your differential diagnoses and what test(s) will you order to ascertain the correct diagnosis?
• Explain the differences (timing, presence of proteinuria, presence of seizures, BP parameters) between preeclampsia, eclampsia, gestational hypertension, chronic hypertension, and preeclampsia superimposed on chronic hypertension.

Provide evidence from the research to support your decision-making.

2. Mariais a 31-year-old pregnant female at 24 weeks EGA who has come to the clinic for her 24-week prenatal visit and recommended screening tests.  Maria’s one hour glucose test result is 156 mg/DL.  Maria’s BP is 118/78 T 98.7 F, P 68, RR 18, fundal height is 25 cm, no urine/protein in urine, weight is 145 lbs. at 5 lbs. increased from last visit 4 weeks ago, her height is 5’ 5”.

• What is your next step for Maria? Use either the American College of Obstetricians or the American Diabetes Association’s recommendations for diagnosing gestational diabetes mellitus (GDM) and describe their criteria.
• What recommendations or patient teaching will you provide for Maria?

Provide evidence from the research to support your decision-making.

3. Yvetteis a 28-year-old female who walked in without an appointment to be seen for vaginal bleeding. She is an established patient who is 16 weeks pregnant, and this is her first pregnancy. She is crying and accompanied by her husband. A medical assistant escorts them to a room. Her blood pressure is 138/88 mmHg, pulse 84, respirations 16, temperature 98.4°F, and her weight is 145 lb. A urine sample has been obtained. A review of her prenatal care record reveals that she had a normal initial exam, normal lab values and screening tests, takes prenatal vitamins and folic acid, size equals dates, fetal heart tones obtained by Doppler at 14 weeks were 167 bpm, and she is Rh negative. A pelvic exam is performed with a small amount of dark red blood seen in the vaginal vault. The cervix appears closed and there is no visible discharge at the cervix or in the vagina. A wet prep and sample for chlamydia and gonorrhea are gathered. The uterus is palpated and the uterine size equals dates, the external cervical os is closed. No fetal heart tones are heard via Doppler. The wet prep demonstrates many red blood cells, small amount of white blood cells, normal squamous epithelial cells, a moderate amount of bacteria, no spores or pseudohyphae, no trichomonads, and the whiff test is negative.

• What additional history should be gathered, and what labs should be collected?
• Based on your differential diagnoses, what is the next diagnostic modality that should be performed, and what interventions, if any, should be taken?

Provide evidence from the research to support your decision-making.