A 20 year-old G1P0A0 female presents to your clinic complaining of crampy lower abdominal pain and spotting. She states her last period was 5 weeks ago, she took a home pregnancy test yesterday and it was positive. She states she tried to make an OB appointment but they could not get her in for several weeks. What questions would you ask this patient? Describe how you would assess and treat this patient using evidence-based practice.

Introduction:

When a patient presents with lower abdominal pain and spotting, it is important to consider the possibility of pregnancy as an underlying cause. In this case, a 20-year-old G1P0A0 female reports a positive home pregnancy test and difficulty in obtaining an immediate obstetric (OB) appointment. To properly assess and treat this patient, a comprehensive approach is required, which includes obtaining detailed history, conducting a physical examination, and considering evidence-based practice for optimal management.

History:

To begin the assessment, a specific set of questions should be asked to gather relevant information from the patient. The following questions would help in understanding the patient’s condition:

1. Confirmation of Pregnancy:
– When did you take the home pregnancy test?
– Can you describe the procedure you used to take the test?
– Did you take multiple tests to confirm the result?

2. Menstrual History:
– When was your last menstrual period?
– How regular are your menstrual cycles?
– Have you experienced any changes in your periods recently?

3. Pain Description:
– Can you describe the characteristics of the pain you are experiencing?
– When did the pain start?
– Is the pain constant or intermittent?
– Do certain activities or positions alleviate or worsen the pain?

4. Severity of Symptoms:
– On a scale of 0 to 10, how would you rate the severity of your pain?
– Has the pain worsened or improved since it started?
– How would you rate the amount of spotting or bleeding you are experiencing?

5. Associated symptoms:
– Have you experienced any episodes of dizziness, fainting, or lightheadedness?
– Have you noticed any unusual vaginal discharge or odor?
– Have you experienced any fever, chills, or body aches?

6. Obstetric History:
– Have you ever been pregnant before? How many times?
– How were your previous pregnancies and deliveries?

Physical Examination:

The physical examination should include a general assessment of the patient’s overall condition, vital signs, and a focused examination of the abdomen and pelvic region. The following components should be considered:

1. Vital Signs:
– Measure the patient’s blood pressure, heart rate, respiratory rate, and temperature.

2. General Examination:
– Assess the patient for signs of distress, dehydration, or pallor.
– Observe the patient’s general appearance, including her level of alertness and any signs of pain or discomfort.

3. Abdominal Examination:
– Palpate the abdomen to assess for tenderness, masses, or any abnormal findings.
– Auscultate for bowel sounds and assess for any abnormal bowel sounds.
– Assess for signs of peritoneal irritation such as guarding or rebound tenderness.

4. Pelvic Examination:
– Conduct a pelvic examination to assess the cervix, uterus, and ovaries.
– Look for any signs of cervical changes, such as bleeding or discharge.
– Note any tenderness or masses on palpation of the pelvic organs.

Treatment and Evidence-Based Practice:

The management of this patient should be guided by evidence-based practice to ensure optimal care and outcomes. The next steps in the management of this patient would depend on the obtained history and findings from the physical examination. However, some general principles can be applied based on the information provided:

1. Referral to Obstetric Care:
– Given the positive home pregnancy test and the patient’s desire for an obstetric appointment, it is important to refer the patient to an obstetrician or a prenatal care provider.
– Prompt scheduling of an appointment is necessary to ensure appropriate prenatal care initiation.

2. Considerations for Urgent Evaluation:
– If the patient experiences worsening abdominal pain, increased vaginal bleeding, or signs of ruptured ectopic pregnancy (such as severe pain, syncope, hypotension), emergency evaluation is necessary.
– These signs may indicate a potentially life-threatening condition requiring immediate surgical intervention.

3. Non-Urgent Evaluation:
– If the patient’s vital signs are stable, with only mild pain and spotting, non-urgent evaluation can be pursued.
– This may involve further assessment by an obstetrician or gynecologist to determine the viability and location of the pregnancy, as well as to assess for any signs of complications.

4. Supportive Care:
– Provide the patient with information about early pregnancy symptoms, warning signs of complications, and general prenatal care advice.
– Counseling regarding lifestyle changes, such as smoking cessation, alcohol avoidance, and healthy diet, can be offered to promote a healthy pregnancy.

Conclusion:

In conclusion, when a 20-year-old G1P0A0 female presents with lower abdominal pain and spotting, thorough history-taking, physical examination, and evidence-based practice are essential for proper assessment and management. Prompt referral for obstetric care is crucial to ensure appropriate prenatal care initiation. Urgent evaluation may be required in some cases, while others may warrant non-urgent evaluation. Providing supportive care and counseling is also important to optimize the patient’s overall well-being during pregnancy.