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Zorluk: OrtaPreventive Care and Screening

A 28-year-old primigravid patient at 28 weeks of gestation presents for a scheduled prenatal evaluation. Her pregnancy has been uncomplicated thus far. She reports normal fetal movement and denies any vaginal bleeding, leakage of fluid, or contractions. Her pre-pregnancy body mass index was 23 kg/m^2, and her weight gain has been appropriate. Her blood pressure is 110/70 mmHg. Routine laboratory results from her first-trimester evaluation, including HIV, rapid plasma reagin, and hepatitis B surface antigen tests, were negative. Her last Papanicolaou test was performed two years ago and was reported as normal. She has no acute symptoms today. Which of the following preventive care interventions are currently indicated for this patient? (Select all that apply)

  1. Administration of the tetanus, diphtheria, and acellular pertussis vaccineCevap
  2. Screening for gestational diabetes mellitus with an oral glucose tolerance testCevap
  3. C
    Screening for asymptomatic bacteriuria with a urine culture
  4. D
    Administration of the human papillomavirus vaccine
  5. E
    Screening for cervical cancer with cervical cytology

Cevap

The indicated preventive interventions are the administration of the tetanus, diphtheria, and acellular pertussis vaccine and screening for gestational diabetes mellitus.
The correct preventive interventions for a patient at 28 weeks of gestation include the administration of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine and screening for gestational diabetes mellitus. The Advisory Committee on Immunization Practices (ACIP) recommends the Tdap vaccine during every pregnancy, optimally between 27 and 36 weeks of gestation, to provide passive immunity to the infant against pertussis. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 to 28 weeks of gestation.

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1
Determine the patient's current gestational age and relevant medical history.
The patient is a 28-year-old primigravida at 28 weeks of gestation with an uncomplicated pregnancy and up-to-date prior screenings.
Preventive guidelines during pregnancy are strictly dependent on the specific trimester and gestational week.
2
Identify the recommended immunizations for the late second to early third trimester.
The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is indicated.
Guidelines recommend Tdap vaccination during every pregnancy, optimally between 27 and 36 weeks, regardless of prior vaccination history.
3
Identify the recommended disease screenings for the late second to early third trimester.
Screening for gestational diabetes mellitus is indicated.
Routine screening for gestational diabetes is performed between 24 and 28 weeks of gestation in asymptomatic patients.
4
Evaluate the distractors based on the patient's age and gestational timeline.
Asymptomatic bacteriuria screening is past due, the human papillomavirus vaccine is contraindicated, and cervical cytology is not yet due.
To ensure that unnecessary or contraindicated interventions are not inappropriately ordered.

Anahtar Kavram

Routine preventive care during pregnancy includes administering the Tdap vaccine between 27 and 36 weeks of gestation and screening for gestational diabetes mellitus between 24 and 28 weeks of gestation.
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Konular

Preventive Care and Screening

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