Question

Select three of the nine types of histories identified in pp. 94 – 96 of your Hawkins text. Imagine that your patient has some positive history in each of these three areas. For example, if you select genetic history, your patient may have a family history of cystic fibrosis.
How will you educate your patient about these risks/concerns?
What testing may be required?
Will you need any referrals?

Hawkins P 94-P 96

I. DEFINITION
Advanced planning aimed at reducing maternal and perinatal mortality
and morbidity
II. ETIOLOGY
A. Reasons for promoting preconception care (PCC ) include
1. Maximizing healthy life for woman and baby
2. Identifying any medical condition or medications in either
prospective
parent
3. Identifying genetic disorders
4. Reviewing past gestational and pregnancy history
5. Identifying high-risk exposures (e.g., tobacco, drug, and alcohol
use) and environmental hazards (e.g., toxins; chemicals, including
pesticides, gases, certain foods)
III. HISTORY
A. Woman’s medical and surgical history, including but not limited to
1. Diabetes
2. Phenylketonuria (PKU)
3. Cardiovascular issues, including elevated blood pressure
4. Lung
5. Thyroid
6. Kidney
7. Infectious diseases (e.g., HIV, hepatitis B and C, toxoplasmosis,
rubella, varicella, tuberculosis [TB], sexually transmitted infections
[STI s], vaginosis, vaginitis)
8. Autoimmune diseases
9. Connective tissue disorders
10. Eating disorders
11. Metabolic conditions
12. Psychiatric illness or mental health issues
13. Epilepsy
14. Thromboembolic episodes
15. Any surgery
16. Diethylstilbestrol (DES) exposure
17. Allergies
B. Obstetric and gynecologic history
1. Contraception
2. Menstrual history
3. Gynecologic history
4. Pap smear history
5. High-risk behaviors (including STI s)
6. Pregnancy history, including spontaneous abortion and
therapeutic
abortion
C. Immune status: need to have documentation
1. Rubella
2. Tuberculosis

3. Hepatitis A, B, and C
4. Varicella
5. Tetanus if 10 years or more in the past
6. Polio
7. Influenza
D. Drug history
1. Current prescription medications: Some medications have different
safety periods between cessation of menses and conception.
2. Current over-the-counter medications
3. Current vitamin and botanical use
4. “Street” drug–use history
E. Nutritional status
1. Height and weight, body mass index (BMI)
2. Eating habits; note especially fad diets, veganism
3. Food allergies
4. Caffeine and artificial sweetener intake
5. History of being overweight or underweight: underweight
BMI, less than 19.8 kg/m2; overweight BMI, greater than 25 to
29.9 kg/m2; and obese BMI, greater than 30.0 kg/m2 (National
Institutes of Health guidelines)
6. History of an eating disorder
7. Current exercise habits and other physical activities
F. Genetic history
1. May use a genogram to identify couples with a personal or family
history of problematic diseases, such as
a. Tay–Sachs disease
b. Thalassemia
c. Sickle cell disease or trait
d. Phenylketonuria
e. Cystic fibrosis
f. Hemophilia
g. Mental retardation
h. Myotonic dystrophy
i. Adult polycystic kidney disease
j. Birth defects
k. Other anemias
2. Family background
a. Related outside marriage
b. Ethnic background: African American, Mediterranean,
Ashkenazi Jew, and Asian
G. Exposure to teratogenic toxins; areas of concern include
1. Exposure to
a. Metals (lead)
b. Organic solvents
c. Gases
d. Ionizing radiation
e. Pollutants (e.g., secondhand smoke)

f. Pesticides, herbicides
g. Lead paint
h. Plastics, vinyl monomers
i. Hyperthermia
2. Use of
a. Alcohol
b. Tobacco products
H. Social history
1. Age
2. Marital/partner status
3. Family structure; household composition
4. Support systems
5. Employment/financial status
6. Cultural beliefs
7. Child care issues
8. Safety issues (e.g., spousal/partner abuse)
9. Work history: exposure to chemicals, radiation, standing at work,
and occupational risks such as not wearing respirator, mask, and
special clothing
I. Partner health history
Thorough health/genetic/social history should be taken on prospective
fathers. Little conclusive research has been done on how
a partner’s exposures to chemicals/toxins/drugs may affect fetal
development. Recent studies have indicated that alcohol consumption
in the month prior to conception contributes to low spermatogenesis.
Findings need to be integrated with maternal health history
findings.
IV. PHYSICAL EXAMINATION
A. Baseline height, weight, BMI, and vital signs
B. General physical examination, including pelvic examination
C. Comprehensive exam based on medical history
V. LABORATORY EXAMINATION
A. Pap smear as indicated per American Society for Colposcopy and
Cervical Pathology (ASCC P) guidelines
B. Baseline studies may be considered, including
1. Blood Rh and type
2. Hemoglobin/hematocrit
3. Urinalysis
4. Rapid plasma reagin (RPR) test/Venereal Disease Research
Laboratory (VDRL) test
5. Check status for
a. Hepatitis B, C
b. Varicella

Answer 1

Answer :

1. From A medical and surgical history our patient is having infectious disease that is HIV. ( human immuno deficiency virus) which will cause the AIDS ( acquired immuno deficiency syndrome).

Education to the clients regarding this problem :

* Avoid multiple sex partners.

* Avoid to transfus contamination blood and fluids.

* use safety precautions while contact with partner.

* education about risk factors like it will transmit through contaminated needles and syringes, body fluids ect, so maintain adequate precautions.

* it will transmit from one person to another person through sexual contact.

* Avoid prostitution.

Tests required for that :

Blood test like : CD 4 count, because this count may decreases in HIV clients.

* HIV kit test.

* ELISA test Enzyme linked immunosarbant Assay.

2. From C immune status : my client is having Tuberculosis.

Client Education :

* it is immune suppressive disorder.

* educate clients regarding avoid to exposure to infections and allergents.

* avoid to exposure to the cold environment.

* use personal protective equipments like mask to prevent transmission from one person to other.

* this is air borne disease and it may spreads easily.

* education about using of utensils superately.

* maintain isolation .

Tests should be performed like :

* Montoux test by using purified proteins derivatives, after 48.- 72 induration we measure to identify the infection is positive or negative.

* chest X - rays.

* sputum examination.

3. From F genetic history : client is having mental retardation :

Education to parents :

* taking care regarding care of daily living activities to client.

* educate to avoid getting consanguinous marriages , because due to this consanguinous marriages.

* advice parents to get hospital for early interventions for client or children.

* assist client in all activities , because he or she can not able to perform their activities by there own.

Tests are :

* performing mental health examination.

* genetic testing during pregnancy.