Women's Health
Focusing on women's health:
Name and describe the components and rationale of the gynecological health history.
Define and describe each component of the GTPAL system used to document pregnancy history.
Following the guidelines of the United States Preventive Service Taskforce (USPSTF) what screening recommendations would you do to G.R. a 66-year-old female patient who visits you at the office for the first time (last visit to her PCP 5 years ago) with only positive health history of hysterectomy 10 years ago due to fibroids.
A 35-year-old women with a BMI of 40 comes in asking about combined hormonal contraception’s. You explain the contraindications for hormonal contraception include (name more than 4 contraindications).
GTPAL System: GTPAL stands for Gravidity (the number of pregnancies), Term (the total number of births beyond 24 weeks gestation), Preterm (births before 24 weeks gestation), Abortions/Miscarriages (total number of abortions or miscarriages) and Living children (number alive at the time). This system is used to document pregnancy history in order to identify any potential problems associated with women's reproductive health. By collecting this data it can help healthcare providers better manage their patients' care plans including testing, screenings, treatments and follow-up visits.
Screening Recommendations: For G.R., a 66-year old female patient who has not had a visit with her PCP in five years and has only a positive health history of hysterectomy 10 years ago due to fibroids following the USPSTF guidelines would include annual blood pressure screening; colorectal cancer screening beginning at age 50; lipid profile testing every 5 years; bone density measurements starting at age 65; mammography screening every two years starting at age 50; vision examination every 2 years starting at age 65 if no symptoms present; hearing test once after age 65; influenza vaccine annually beginning when available until May each year followed by Tdap booster dose every 10 years if recommended by ACIP guidelines; pneumococcal polysaccharide vaccine one time after age 65 unless previously received according USPSTF Guidelines A & B recommendations; vaccination against Hepatitis B upon recommendation from provider per CDC guidelines along with smoking cessation counseling on an ongoing basis as needed by patient and review medications for side effects such as falls risk due to sedation etc..
Contraindications for Hormonal Contraception: Contraindications for hormonal contraceptives include uncontrolled high blood pressure, active liver disease or liver tumors, breast cancer or other estrogen sensitive cancers, thromboembolic disorders or significant coagulopathies such as Factor V Leiden mutation since they increase risk for venous thromboembolism , abnormal vaginal bleeding without evaluation prior use since could be signficant pathology suchas endometrial cancer , allergy/hypersensitivity reaction including severe allergic reactions known as angioedema which can cause marked swelling around eyes , hands feet lips genitalia , pregnant women cannot start new hormonal contraceptive method until she delivers baby . Additionally caution should be taken when prescribing combined oral contraceptives containing drospirenone due its higher risk for serious cardiovascular events compared with other progestin components . Lastly certain drugs interact negatively with ethinyl estradiol found in most combination methods such tetracyclines antibiotics anti epilepics HIV medications require changes in dosing schedule .