Yvette is a 28-year-old Hispanic 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 test shows +RBC, +bacteria, +whiff test.

1. What history should be gathered?

Question

What history should be gathered? (Select all that apply.)

A. Bleeding during this pregnancy

B. Onset and character of bleeding C. Presence of clots

D. Presence of tissue

E. How many pads have been used since onset of bleeding

F. Pain associated with bleeding. If pain is present, characteristics of pain

G. Last intercourse

Option A to F should be gathered.

A. Bleeding during this pregnancy

B. Onset and character of bleeding C. Presence of clots

D. Presence of tissue

E. How many pads have been used since onset of bleeding

F. Pain associated with bleeding. If pain is present, characteristics of pain

Explanation:

Option A to F relates to bleeding.

And since the absence of fetal heart tones are via Doppler points to stillbirth (also known as feral demise) or the possibility that the equipment used in carrying out the test are faulty.

At this point, it'd not only be suitable but it'd be the best option to carry out tests that inquires bleeding and wet prep results to ascertain if there's a stillbirth or the equipment used are faulty.

Complete Question:

Yvette is a 28-year-old Hispanic 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 test shows +RBC, +bacteria, +whiff test.

1. What history should be gathered?

A. Bleeding during this pregnancy B. Onset and character of bleeding C. Presence of clots

D. Presence of tissue

E. How many pads have been used since onset of bleeding

F. Pain associated with bleeding. If pain is present, characteristics of pain

G. Last intercourse

A, B, C, D, E,F.

Explanation:

In the above description and question, the lack of fetal heartbeat tones show us that it is either the foetus is dead or bad equipment was used to check the fetal heartbeat tones.

It is therefore important to check why there was bleeding in the first place and why there is presence of red blood in the vagina vault.

Therefore it would be appropriate to gather history or information regarding: bleeding during this pregnancy, when the bleeding started and character of bleeding, presence of clots, presence of tissue, how many pads have been used since onset of bleeding, if the bleeding was painful, if the bleeding was painful, is the pain still present, characteristics of pain.

Information from the wet prep test should be considered as well because it tells us if there is any type of vaginal infection present.

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