Case 1
Define preconception period and discuss why this is an important time for women who are planning to get pregnant.
• Why folate supplement is important.
• Following the guidelines of the United States Preventive Service Taskforce (USPSTF) how you would recommend the folate to be taken. by women who plan to get pregnant?
• Name dietary sources for folate.
• Name patients with higher risk who indicate a need for folate. supplementation is recommended.
Case 2
G.P is a 32 primigravida patient who blood type is B Rh negative. She is on her first trimester and have a vaginal bleeding episode.
• To which group of pregnant women do the American College of Obstetricians and Gynecologist (ACOG) recommend in its guideline’s aspirin 81 mg daily? Explain.
Case 3
C.C is a 36-year-old female patient known in the office who came to consult you because she has been feeling left breast tenderness, low grade fever and malaise for about four days. She delivered her baby 3 months ago and is breastfeeding. You found the left breast warm and painful when examined. Fissures on nipples presented.
• List your diagnosis and support.
• If infection is suspected which bacteria are usually involve in this process.
• Discuss a management plan for C.C (pharmacologic and non-pharmacologic treatment).
• List patient’s education and recommendations.
Once you received your three case numbers; answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:
- An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
- Name the different family developmental stages and give examples of each one.
- Describe family structure and function and the relationship with health care.
Full Answer Section
- Importance of Preconception Period:
- It allows for the identification and management of existing health conditions that could affect pregnancy (e.g., diabetes, hypertension).
- It provides an opportunity to assess and modify lifestyle factors (e.g., smoking, alcohol, diet).
- It enables the initiation of preventive measures, such as folate supplementation, to reduce the risk of birth defects.
- It allows for genetic counseling, if needed.
- It is a time to discuss any medications that the women may be taking.
- Importance of Folate Supplementation:
- Folate is crucial for neural tube development in the early stages of pregnancy.
- Adequate folate intake reduces the risk of neural tube defects (NTDs), such as spina bifida and anencephaly.
- USPSTF Recommendations for Folate Supplementation:
- The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement of 0.4 to 0.8 mg (400 to 800 mcg) of folic acid.
- Supplementation should begin at least 1 month before conception and continue through the first 2-3 months of pregnancy.
- Dietary Sources of Folate:
- Dark leafy green vegetables (spinach, kale)
- Citrus fruits (oranges, grapefruits)
- Legumes (lentils, beans)
- Fortified cereals and grains
- Avocado
- Asparagus
- Patients at Higher Risk Requiring Folate Supplementation:
- Women with a history of NTD-affected pregnancies (higher doses may be recommended).
- Women taking certain medications (e.g., anticonvulsants) that interfere with folate absorption.
- Women with a family history of NTDs.
- Women with obesity.
- Women with diabetes.
Case 2: G.P. and Aspirin Prophylaxis
- ACOG Recommendations for Aspirin 81 mg Daily:
- ACOG recommends low-dose aspirin (81 mg daily) for pregnant women at high risk of preeclampsia.
- High risk factors include:
- History of preeclampsia, especially with preterm delivery.
- Multifetal gestation.
- Chronic hypertension.
- Pre-gestational diabetes.
- Kidney disease.
- Autoimmune disease (e.g., systemic lupus erythematosus, antiphospholipid syndrome).
- The goal is to reduce the risk of preeclampsia, which can have serious consequences for both mother and baby.
- Because the patient is Rh negative, and is having a vaginal bleeding episode, she will also require Rhogam.
Case 3: C.C. and Mastitis
- Diagnosis and Support:
- Diagnosis: Mastitis (likely lactational mastitis).
- Support:
- Breast tenderness, warmth, and pain.
- Low-grade fever and malaise.
- Fissures on nipples (a common entry point for bacteria).
- Recent childbirth.
- Breastfeeding.
- Bacteria Involved:
- Staphylococcus aureus (most common).
- Streptococcus species.
- Management Plan:
- Pharmacological:
- Antibiotics (e.g., dicloxacillin, cephalexin, clindamycin if penicillin allergy).
- Pain relievers (e.g., ibuprofen, acetaminophen).
- Non-Pharmacological:
- Frequent breastfeeding or pumping to ensure complete emptying of the breast.
- Warm compresses to the affected breast.
- Rest.
- Proper latch techniques.
- Good hygiene.
- Patient Education and Recommendations:
- Complete the full course of antibiotics, even if symptoms improve.
- Continue frequent breastfeeding or pumping.
- Proper hand hygiene.
- Proper latch techniques to prevent nipple fissures.
- Rest and hydration.
- Seek medical attention if symptoms worsen or do not improve.
- Proper breast support.
General Discussion Points:
- Effective Health Assessment Parameters:
- Psychosocial Factors:
- Stress levels, anxiety, depression.
- Social support systems.
- Cultural beliefs and practices.
- History of trauma.
- Environmental Factors:
- Exposure to environmental toxins.
- Access to safe housing and clean water.
- Community resources and safety.
Sample Answer
Let's break down these case studies and the additional discussion points.
Case 1: Preconception Care and Folate
- Definition of Preconception Period:
- The preconception period is the time before a woman becomes pregnant, typically defined as the months or years leading up to conception. It focuses on optimizing the woman's health to improve pregnancy outcomes.