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Interview (2nd) Dr. D. Ores. NYC

From a holistic standpoint a hospital admission was recommended. This would facilitate stabilizing the patient from a medical standpoint and connecting patient with different services that can offer support.


 * 1) Talk to patient and try to see what the problem is/or was that precipitated current situation. Obtain fetal heart-beat. Get a ‘thumb nail’ mental status evaluation and full medical history.
 * 2) Start a peripheral IV and attach her to monitors.
 * 3) Screen carefully for pre-eclampsia: Serial BP checks. Check urine for protein (300mg +). Check for peripheral edema and/or facial edema. Indications already present
 * 4) Carefully track I+O fluids. Oral/Urine/Emesis/IV. Calculate necessary hydration.
 * 5) Monitor blood glucose q 6 hours until WNL. {NB a blood sugar over 400 leads to ‘spilling’ sugar into urine, which in turn would cause further electrolyte imbalance}. IV saline/glucose and insulin pump as indicated (and/ fast acting and Lente insulin titrated to blood glucose).
 * 6) Na and K must also be monitored to check return to WNL.(Osmotic pressure can cause loss of electrolytes in urine - along with the glucose).
 * 7) The patient’s blood pressure must be monitored and, if appropriate, hypertensive medication used. Mg…etc. Blood Presssure should be kept below 140/90.
 * 8) The Hemoglobin A1C is also raised and this would imply her blood sugar levels have been elevated for a sustained period of time. A dietician could help the patient outline a dietary plan for the pregnancy which would address blood glucose levels and appropriate weight gain.
 * 9) Fetal ultrasound should also be checked (for a base line for fetal size and volume of amniotic fluid).
 * 10) Psychological / psychiatric assessment is essential as the issue of neglect of other children must be considered. This issue is compounded by her recent unemployed status, financial stress, living with her Mother - in a small apartment - and her divorce. Important to establish which adults are ‘in the picture’ and their roles. The fact that she is coming for her initial OB/GYN visit at 21 weeks could suggest the patient is struggling emotionally and mentally.
 * 11) Insurance advisors can help her with a return to a program or her eligibility for assistance (financial) - especially as the patient is a pregnant diabetic.
 * 12) Social Services can advise patient about the status of the child custody issues.

ONGOING
 * 1) <span style="font-family: 'ArialMT','sans-serif'; font-size: 18.6667px;">Monitor patient for S/S anemia and pre-eclampsia and appropriate glucose and weight levels.
 * 2) <span style="font-family: 'ArialMT','sans-serif'; font-size: 18.6667px;">Discharge when stable.
 * 3) <span style="font-family: 'ArialMT','sans-serif'; font-size: 18.6667px;">Advise F/S, QID.
 * 4) <span style="font-family: 'ArialMT','sans-serif'; font-size: 18.6667px;">Patient should (minimally) be seen 2 x week.

<span style="color: #0b50da; font-family: 'Comic Sans MS',cursive;">Well I am struggling with navigation etc but will call someone to find out. . . For now will post under patient profile Jo

<span style="color: #0b50da; font-family: 'Comic Sans MS',cursive;">Hi ladies. I love what everyone has come up with so far, but in looking at the other group's pages I have come to realize I led you all in the wrong direction. Apparently everything we come up with and change has to be done through the link on the health assessment wiki...not the one I created. When you go to the health assessment wiki page you'll see all the groups listed on the right hand side, when you click on group one that's where all our work is to be displayed. I will move everything to that page. I'm sorry ;(

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Hello~ <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">The labs were seperated but when I went to save it, they all bunched together can anyone help! <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Audrey

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;"> Hello~ <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Just added some info feel free to change what you feel needs to be altered. <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Audrey

Hi all, continued to add information on our patient. Dawn

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">All

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">I added info under 'Pregnant Diabetic Page'. Please add/alter as you wish.

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">I like the idea of unstable diabetic etc.

Jo :)

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Hello~ <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">I agree Jo, I think we should make our patient have some issues to make it interesting. How does an unstable, overweight diabetic with an unplanned pregnancy sound? I think by making her a more complicated case the more information we can include or is that to much? <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Audrey

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Hi Audrey and Karen <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Welcome Audrey! I think the fact you are posting means you're good to go. What do you think Karen?

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">I am posting a brief interview (and will talk more) about interview with Doctor. <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">We need to expand her profile a bit: <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">1. Is she a stable diabetic? <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">2.What is her current weight? <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">3.Is this a planned pregnancy? <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">4. Other social issues/problems?

Let's get creative :) Best - Jo

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">Helllo~ <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">The page looks great! I received the email that I am not a member however the page says that I am. Can anyone explain? Should we start assigning portions of health information? <span style="color: #561010; font-family: 'Comic Sans MS',cursive;">~Audrey

<span style="color: #561010; font-family: 'Comic Sans MS',cursive;">I hope that you all can find this page, so that we can start developing our patient, and commence discussion on interviews and such. If you look to your right you will see links one that says home, and the other that says Patient 1 Pregnant Diabetic. If you click on the second link I started a page where we can begin inputting data about our patient. I figure we can use the home page for general communication. Let me know what you think so far.

<span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">Hi all, I have taken it upon myself to start our page. Once you have become a member, you will be able to change and edit things as you see fit. I figured we could start by brainstorming about our Wiki's name. Hope you like the design layout I chose, if not feel free to make any changes. I wanted our logo to be a pregnant shadow or picture, but if you find something that will work better, let me know. Thanks, KB

Hi All, Our Page looks great. I believe I'm all set to get started. Dawn

<span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">Hi Karen <span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">So good to chat yesterday. Thank you again for starting this page and the picture is really wonderful. Off to interview Doc. now and will try to create a new page with his interview. . . . <span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">Hello to all in Group 1. Looking forward to chatting.

<span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">Well Hello again to all in Group 1. I am about to write up a quick overview of my chat with the Doctor and perhaps add a link that pertains to the piece. <span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">Jo

<span style="color: #7e00ff; font-family: 'Comic Sans MS',cursive;">Best - Jo. . . =Welcome to Your New Wiki!=

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