Bijoux is a 33yo, G5 P2022, who is currently 19 weeks 2 days as dated by a 9-week ultrasound. She is followed in the High Risk Obstetrical Clinic secondary to HIV that was diagnosed in 2012. She currently is on Complera. She reports that she was on Complera for several years but at the beginning of the pregnancy she became so nauseous and was not keeping it down. They switched her over to Triumeq which had too many significant side effects and she was unable to tolerate it. She has since switched back to Complera and has actually been able to keep it down. Her last viral load in November was over 1 million. She does report that when she was previously on Complera and able to keep it down that her viral load was undetectable. She has an appointment with Dr. Narro for labs on February 2nd and a follow-up appointment for evaluation on February 22nd. She is here today for her anatomic survey. She did have a full sequential screen that was screen negative. On ultrasound there is a live fetus in transverse presentation. Fetal biometry is symmetric and consistent with dates. A detailed anatomic survey was unremarkable, although the spine and 4-chamber heart were …show more content…
She asked about the risk of HIV. I informed her that with a high viral load and not medication, this could be as high as 255. If she is on meds and her viral load is < 1000, the risk would be around 2-5%. I do think she has time to get her viral load under control, especially if she has previously been undetectable on Complera. I advised her to make sure that if she is nauseous that she take her Diclegis properly and then Phenergan prn for nausea. If she gets to a point where she cannot keep the Complera down, we may need to treat with Phenergan or Zofran. I scheduled her to return in 4 weeks for completion of the anatomy and growth. I also gave her notes for proof of pregnancy confirmation as well as note stating that she is unable to
During pregnancy an echocardiogram of the fetus can be done to produce images of the heart by sending ultrasonic sound waves to the vital organ. These sound waves create an image for the physician to analyze the babies heart function, structure sizes, and blood flow. A positive diagnosis before birth has shown to improve chances of survival, and will allow for appropriate care to be readily available at birth. If a baby is born without being diagnosed with the heart defect, some symptoms previous noted such as low oxygen levels can be suggestive of hypoplastic left heart syndrome. The baby may not display any symptoms or signs for hours after birth because of the openings allowing for blood to be pumped to the rest of the body. However, listening to the babies heart can revel a murmur indicating an irregular flow of blood in the heart. If a murmur is heard, or signs of the defect are observed, diagnostic tests will be ordered and performed. An echocardiogram is still the go-to test once the baby is born to evaluate the heart. The echocardiogram will diagnose the newborn, by revealing the underdeveloped left ventricle, mitral and aortic valve, and the ascending aorta commonly seen in
Abstract: The objectives of this lab was to identify the internal and external anatomy of the fetal pig. The experiment was conducted by dissecting a fetal pig and actively seeing the external anatomy, Oral Cavity, Digestive System, Circulatory System, Respiratory System, Urogenital System, and Nervous System.
In regard to her ultrasound, we discussed the finding of an echogenic bowel. I was able to get a verbal report on her quad screen that was screen negative with a risk at 1:7000. Even modifying that risk for echogenic bowel, we would still be better than her age based risk which is overall reassuring. We discussed the other etiologies of echogenic bowel including TORCH infections, cystic fibrosis, and bleeding. She has not had any obvious bleeding where we would suspect fetal swallowing, but it is still a possibility. Her CF screen is negative which reduces this risk significantly. I suggested that she have TORCH titers drawn, both IgM and IgG at her next visit for her Glucola in early
…The infant had been born with anencephaly, or lack of cranial development. The infant’s skull was an open sore that the nurses packed and layered with gauze to give his face a round appearance. Because of lack of cerebral hemispheres, the infant was incapable of any conscious activity. After his birth, the infant was admitted to the neonatal intensive care unit and placed in a bassinet. He was reported to be kicking and breathing, and his ...
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
C. L. a 52-year-old male scheduled for a colonoscopy. Indication was for an initial screening. The patient is allergic to the pertussis vaccine. Vital signs included: temperature 97.1, respiration rate 20, heart rate 98, blood pressure 137/98, and oxygen 98% on room air. Lungs clear bilaterally upon auscultation. The IV attempt was successful on the first try made by me. I placed the IV in the patient’s left hand. This concluded my visit with this patient.
This occurs when the fetal head is in the wrong position. It can also be caused by damage to the muscles of the neck or the neck of the blood supply problems.
In my previous role as a Licensed vocational nurse, I worked in the outpatient setting, Perinatology, where there are high-risk pregnant patients. The patient I helped take care of, was early in her pregnancy, approximately 29 weeks, and was a patient who had been seen in this clinical office
The author of this book is 21 year old Gaby Rodriguez. She came up with the idea for this project because she was told repeatedly by her brothers and sisters that she would end up getting pregnant as a teen just like all of them. I believe that the purpose of this project and subsequently the book, was to show that you do not have to live your life on the basis of stereotypes. It does not and should not matter what anyone says about you, you are the master of your life and nothing anyone says about you should change what you believe about yourself, or what you want to do with your life. I love this book, and the Lifetime movie was great too. I have known too many young girls who have gotten pregnant, and it does not mean that their life is over. If they believe in themselves and have the help and support of loved ones, there is no reason why they cannot finish school and get a college degree.
a baby ranging from low birth weight and abnormalities to death. There are a few government
We also decided to perform a urinalysis for detection of a UTI and that was also negative. The patient’s fasting CBG log was evaluated and was in the range of 100-160 which also was in normal limits. I stepped out of the room to discuss with my preceptor to determine what was the next step in his treatment plan. I discussed with her I was concerned due to the sudden onset, it occurring several times a day, and no other presenting symptoms. We decided to perform a CMP, CBC, TSH, and Hemoglobin A1C. I also spoke with her and she stated the last time this occurred in the patient there was a brain tumor and we should order a CT scan of the brain to rule this
Obstetric Ultrasound -- a Comprehensive Guide to Ultrasound Scans in Pregnancy. Mar. 2006. Web. 13 Apr. 2011. .
For the patient with medications follow up, the patient was 69-year-old female, her hypertension medication was lowered from 50 mg losartan to 25mg on her previous visit because she was having dizziness with 50mg of losartan. At this visit, she brought her BP machine from home to compare with our office BP machine. Also, I encouraged her to continue checking her BP at home regularly. In addition, her BP at home was less than 140/90. Patient was concerned that her BP was too high. I provided assurance and educated her that new guidelines say that BP less than 150/90 in adults 60 years and older requires no medical intervention. Also, her BMI was 19. I encouraged her to eat nutrient rich food that includes fresh fruits, vegetables and milk products. I educated about nutritional supplements such as boost or ensure and avoiding any diet restrictions. For the patient with Pap, she was having pelvic pain, along with regular pap test, I ordered BV, chlamydia and Gonorrhea, and UA. Also, the patient was complaining of peri menopausal symptoms, so I ordered FSH. I encouraged her on safe sex practices and self-breast exam. I ordered
Thus the reason fetal monitoring is important in the case of
...side begins to grow and develop at six weeks the baby is only five eights of an inch in measurement. As the months go on the baby goes thru many changes as well as the mother and her body. The mother may tend to get ill at times or may be fine during her pregnancy. There are also reports that the father may become ill at times as well along with the mother, this is common in men.