WHNP Basics! NCC study set 2016
Latest Update
When would you see ++ ketones on a urine dip...What is going on with the mom? -
Answer 1. diabetes
2. hyperemesis gravidarum
"Ketones are chemicals that the body creates when it breaks down fat to use for
energy. The body does this when it doesn't have enough insulin to use glucose, the
body's normal source of energy. When ketones build up in the blood, they make it
more acidic." -google
Varney's Normal Lab Values in Pregnancy - Answer
1st trimester vag bleeding - Answer LQQSDAA questions and spec exam to
determine etiology of bleeding.
CBC, blood type (and antibody screen?) to know if hemodynamically stable and if Rh
-/needs Rhogam.
TVUS immediately, and if not immediately available, get a bHCG immediately and
the TVUS as soon as possible.
Ensure to give pt warning signs of ectopic if pregnancy location is unknown and she
is going home.
If miscarriage, give edu re: B/R/A to expectant management vs Miso (vs
D&C/aspiration if available.)
How much Rhogam do I order for the person who is Rh neg and has 1st trimester
bleeding? Per AAFP:
"The dose of RhO(D) immune globulin is 50 mcg (250 IU) in women with bleeding
before 12 completed weeks' gestation."
TVUS Dx of early pregnancy loss, per Loren - Answer
Warning signs for COCs - Answer ACHES!
Abdominal pain (severe)
Chest pain (sharp, severe, SOB)
Headache (severe, dizzy, unilaeral)
Eye problem (scotomata, blurred vision, blind spots)
Severe leg pain (calf or thigh)
Warning signs for IUDs - Answer PAINS!
Period late/missed; abnormal spotting or bleeding
Abdominal pain
Infection- vaginal discharge
Not feeling well- fever, aches, chills
String missing, shorter or longer
,WHNP Basics! NCC study set 2016
Latest Update
When to RTC after BCM initiation - Answer RTC 3 months for BCM supervision/BP
check if OCP, ring or patch
RTC 3 mos for wt, BP and repeat inj if Depo
RTC PRN in Nexplanon
RTC after first menses following insertion if IUD for thread check
Infertility work-up per Up to Date - Answer Minimal work up: "The minimal work-up
includes serum prolactin, thyroid-stimulating hormone (TSH), FSH, and assessment
for polycystic ovary syndrome (PCOS)."
"Diagnostic tests — In addition to the history and physical examination, the initial
diagnostic evaluation consists of:
●Semen analysis to detect male factor infertility.
●Documentation of normal ovulatory function. Women with regular menses
approximately every four weeks with moliminal symptoms are almost always
ovulatory.
●A test to rule out tubal occlusion and assess the uterine cavity. We usually perform
a hysterosalpingogram (HSG), which evaluates both the uterus and tubes, but
laparoscopy with chromotubation combined with hysteroscopy may be more
appropriate in women suspected of having endometriosis. Dilute indigo carmine or
methylene blue can be used for the chromotubation dye. (See 'Role of laparoscopy'
below.)
●A test or tests of ovarian reserve such as cycle day 3 follicle-stimulating hormone
(FSH) or estradiol, clomiphene citrate challenge test, anti-müllerian hormone (AMH),
or antral follicle count."
Women with periods q 28 days "with molimina symptoms prior to menses (breast
tenderness, bloating, fatigue, etc.) are most likely ovulatory. In women who do not
describe their cycles as such, laboratory assessment of ovulation should be
performed. Ovulation is most easily documented by a mid-luteal phase serum
progesterone level, which should be obtained approximately one week before the
expected menses. For a typical 28-day cycle, the test would be obtained on day 21.
A progesterone level >3 ng/mL is evidence of recent ovulation
An alternative is to have the patient use an over-the-counter urinary ovulation
prediction kit. These kits detect luteinizing hormone (LH) and are highly effective for
predicting the timing of the LH surge that reliably indicates ovulation. Home kits have
a 5 to 10 percent false positive and false negative rate. Therefore, serum
confirmation can be useful in patients who are unable to detect a urinary LH surge.")
My hypothetical plan for a patient coming for infertility complaint - Answer Full
physical- top and bottoms off, spec
Expl recurrent preg loss to pt, work-up process, available tx depending on dx
Order Prolactin, TSH, a1c
Dirty catch today for GC/CT
Order blood draw for HIV, RPR
,WHNP Basics! NCC study set 2016
Latest Update
Consider advising pt to obtain OTC urine ovulation kit
If same male partner, advise pt to consider semen analysis and to RTC with partner
for exam and consult
Rx PO FA .4 mg (aka 400 mcg) daily
(if hx NT defects or on anticonvulsant, needs 4 mg FA daily)
Refer for genetic counseling
Pre-conception counselling re: diet, avoid alcohol, tobacco and drugs, environmental
exposures
Consider obtaining mid-luteal phase serum progesterone level (1 wk before
expected menses, ie, day 21 if 28 day cycle)
Consider TVUS to identify uterine anomaly, & HSG if covered by ins
Consider Clomid rx if initial work up labs WNL/ after treating abnormal etiologies of
abnormal labs
RTC ?1 wk for lab result review and next step in work-up, bring partner if same for all
losses
Normal CBC lab values for cis females - Answer Hct: 37-47%
Hgb: 12-16 g/dL (non-pregnant)
11 g/dL 1st and 3rd T, 10.5 in 2nd T
MCV: 80-95 mm(3) (low in iron-deficiency anemia and thalassemia, high in B12 for
FA deficiency)
MCH: 27-21 pg/cell (low in iron-deficiency anemia and thalassemia)
WBC: 5,000-10,000 mm(3) may be elevated in late pregnancy or labor
Neutrophils: increased with acute bacterial infection and trauma ("shift to left")
Basophils, eosinophils: increased with allergic or parasitic reaction
Lymphocytes and monocytes: increased with chronic bacterial and acute viral
infections.
Platelets: 150,000- 400,000/mm(3)
Normal UA lab values for cis females - Answer ! Clean catch !
Normal findings:
No nitrites, ketones, crystals, casts or glucose
clear, amber, yellow, aromatic
pH: 4.0- 8.0
Protein: 0- 8 mg/dL
Specific gravity: 1.005-1.030
Leukocyte esterase negative
, WHNP Basics! NCC study set 2016
Latest Update
WBCs: 0-4 per HPF
RBCs: 2 or less
Normal lipid profile lab values for non-pregnant cis females - Answer ! Fast 12-14
hours before test!
Total cholesterol: < 200 md/dL (may be elevated in pregnancy)
Triglycerides: 35-135 (may be elevated in pregnancy)
LDL: < 130
HDL: >40
Normal thyroid function lab values for non-pregnant cis females - Answer TSH: 0.4-
4.7 mU/mL
(high in hypothyroid, low in hyperthyroid or too much Synthroid)
Free T4: 0.58- 1.64 ng/dL
(high in hyperthyroid, low in hypothyroid)
TOTAL T4: 4.5- 12.0 micrograms/dL
(elevated in pregnancy, OCP use, estrogen tx)
Normal liver function lab values for NON-PREGNANCT cis females - Answer
Direct/conjugated bilirubin: 0.1- 0.3 mg/dL
(high with gallstones)
Indirect/unconjugaed bilirubin: 0.2 - 0.8 mg/dL
(high with hepatitis, cirrhosis, hemolytic anemia)
Albumin: 3.5- 5.0 g/dL
(high with dehydration,
low with liver dz, malabsorption syndrome, nephropathy, severe burn, malnutrition,
inflammatory dz)
Liver enzymes (in U/L)-
ALP: elevated in liver dz, bone dz, MI
AST: 0-35
ALT: 4-36
LDH: 100-190
Serum hormone levels for cis female- for evaluation and treatment monitoring of
infertility, and to assist in DDX of gonadal dysfunction - Answer Estradiol
FSH
Latest Update
When would you see ++ ketones on a urine dip...What is going on with the mom? -
Answer 1. diabetes
2. hyperemesis gravidarum
"Ketones are chemicals that the body creates when it breaks down fat to use for
energy. The body does this when it doesn't have enough insulin to use glucose, the
body's normal source of energy. When ketones build up in the blood, they make it
more acidic." -google
Varney's Normal Lab Values in Pregnancy - Answer
1st trimester vag bleeding - Answer LQQSDAA questions and spec exam to
determine etiology of bleeding.
CBC, blood type (and antibody screen?) to know if hemodynamically stable and if Rh
-/needs Rhogam.
TVUS immediately, and if not immediately available, get a bHCG immediately and
the TVUS as soon as possible.
Ensure to give pt warning signs of ectopic if pregnancy location is unknown and she
is going home.
If miscarriage, give edu re: B/R/A to expectant management vs Miso (vs
D&C/aspiration if available.)
How much Rhogam do I order for the person who is Rh neg and has 1st trimester
bleeding? Per AAFP:
"The dose of RhO(D) immune globulin is 50 mcg (250 IU) in women with bleeding
before 12 completed weeks' gestation."
TVUS Dx of early pregnancy loss, per Loren - Answer
Warning signs for COCs - Answer ACHES!
Abdominal pain (severe)
Chest pain (sharp, severe, SOB)
Headache (severe, dizzy, unilaeral)
Eye problem (scotomata, blurred vision, blind spots)
Severe leg pain (calf or thigh)
Warning signs for IUDs - Answer PAINS!
Period late/missed; abnormal spotting or bleeding
Abdominal pain
Infection- vaginal discharge
Not feeling well- fever, aches, chills
String missing, shorter or longer
,WHNP Basics! NCC study set 2016
Latest Update
When to RTC after BCM initiation - Answer RTC 3 months for BCM supervision/BP
check if OCP, ring or patch
RTC 3 mos for wt, BP and repeat inj if Depo
RTC PRN in Nexplanon
RTC after first menses following insertion if IUD for thread check
Infertility work-up per Up to Date - Answer Minimal work up: "The minimal work-up
includes serum prolactin, thyroid-stimulating hormone (TSH), FSH, and assessment
for polycystic ovary syndrome (PCOS)."
"Diagnostic tests — In addition to the history and physical examination, the initial
diagnostic evaluation consists of:
●Semen analysis to detect male factor infertility.
●Documentation of normal ovulatory function. Women with regular menses
approximately every four weeks with moliminal symptoms are almost always
ovulatory.
●A test to rule out tubal occlusion and assess the uterine cavity. We usually perform
a hysterosalpingogram (HSG), which evaluates both the uterus and tubes, but
laparoscopy with chromotubation combined with hysteroscopy may be more
appropriate in women suspected of having endometriosis. Dilute indigo carmine or
methylene blue can be used for the chromotubation dye. (See 'Role of laparoscopy'
below.)
●A test or tests of ovarian reserve such as cycle day 3 follicle-stimulating hormone
(FSH) or estradiol, clomiphene citrate challenge test, anti-müllerian hormone (AMH),
or antral follicle count."
Women with periods q 28 days "with molimina symptoms prior to menses (breast
tenderness, bloating, fatigue, etc.) are most likely ovulatory. In women who do not
describe their cycles as such, laboratory assessment of ovulation should be
performed. Ovulation is most easily documented by a mid-luteal phase serum
progesterone level, which should be obtained approximately one week before the
expected menses. For a typical 28-day cycle, the test would be obtained on day 21.
A progesterone level >3 ng/mL is evidence of recent ovulation
An alternative is to have the patient use an over-the-counter urinary ovulation
prediction kit. These kits detect luteinizing hormone (LH) and are highly effective for
predicting the timing of the LH surge that reliably indicates ovulation. Home kits have
a 5 to 10 percent false positive and false negative rate. Therefore, serum
confirmation can be useful in patients who are unable to detect a urinary LH surge.")
My hypothetical plan for a patient coming for infertility complaint - Answer Full
physical- top and bottoms off, spec
Expl recurrent preg loss to pt, work-up process, available tx depending on dx
Order Prolactin, TSH, a1c
Dirty catch today for GC/CT
Order blood draw for HIV, RPR
,WHNP Basics! NCC study set 2016
Latest Update
Consider advising pt to obtain OTC urine ovulation kit
If same male partner, advise pt to consider semen analysis and to RTC with partner
for exam and consult
Rx PO FA .4 mg (aka 400 mcg) daily
(if hx NT defects or on anticonvulsant, needs 4 mg FA daily)
Refer for genetic counseling
Pre-conception counselling re: diet, avoid alcohol, tobacco and drugs, environmental
exposures
Consider obtaining mid-luteal phase serum progesterone level (1 wk before
expected menses, ie, day 21 if 28 day cycle)
Consider TVUS to identify uterine anomaly, & HSG if covered by ins
Consider Clomid rx if initial work up labs WNL/ after treating abnormal etiologies of
abnormal labs
RTC ?1 wk for lab result review and next step in work-up, bring partner if same for all
losses
Normal CBC lab values for cis females - Answer Hct: 37-47%
Hgb: 12-16 g/dL (non-pregnant)
11 g/dL 1st and 3rd T, 10.5 in 2nd T
MCV: 80-95 mm(3) (low in iron-deficiency anemia and thalassemia, high in B12 for
FA deficiency)
MCH: 27-21 pg/cell (low in iron-deficiency anemia and thalassemia)
WBC: 5,000-10,000 mm(3) may be elevated in late pregnancy or labor
Neutrophils: increased with acute bacterial infection and trauma ("shift to left")
Basophils, eosinophils: increased with allergic or parasitic reaction
Lymphocytes and monocytes: increased with chronic bacterial and acute viral
infections.
Platelets: 150,000- 400,000/mm(3)
Normal UA lab values for cis females - Answer ! Clean catch !
Normal findings:
No nitrites, ketones, crystals, casts or glucose
clear, amber, yellow, aromatic
pH: 4.0- 8.0
Protein: 0- 8 mg/dL
Specific gravity: 1.005-1.030
Leukocyte esterase negative
, WHNP Basics! NCC study set 2016
Latest Update
WBCs: 0-4 per HPF
RBCs: 2 or less
Normal lipid profile lab values for non-pregnant cis females - Answer ! Fast 12-14
hours before test!
Total cholesterol: < 200 md/dL (may be elevated in pregnancy)
Triglycerides: 35-135 (may be elevated in pregnancy)
LDL: < 130
HDL: >40
Normal thyroid function lab values for non-pregnant cis females - Answer TSH: 0.4-
4.7 mU/mL
(high in hypothyroid, low in hyperthyroid or too much Synthroid)
Free T4: 0.58- 1.64 ng/dL
(high in hyperthyroid, low in hypothyroid)
TOTAL T4: 4.5- 12.0 micrograms/dL
(elevated in pregnancy, OCP use, estrogen tx)
Normal liver function lab values for NON-PREGNANCT cis females - Answer
Direct/conjugated bilirubin: 0.1- 0.3 mg/dL
(high with gallstones)
Indirect/unconjugaed bilirubin: 0.2 - 0.8 mg/dL
(high with hepatitis, cirrhosis, hemolytic anemia)
Albumin: 3.5- 5.0 g/dL
(high with dehydration,
low with liver dz, malabsorption syndrome, nephropathy, severe burn, malnutrition,
inflammatory dz)
Liver enzymes (in U/L)-
ALP: elevated in liver dz, bone dz, MI
AST: 0-35
ALT: 4-36
LDH: 100-190
Serum hormone levels for cis female- for evaluation and treatment monitoring of
infertility, and to assist in DDX of gonadal dysfunction - Answer Estradiol
FSH
