Category:Women's Health: Difference between revisions

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The current YKHC PAP guideline suggests no PAP under 21 and then Q 3 years after that until 30. At 30 years – 65 years of age they need paps Q 5 years—as long as there is no hx of abnormalities.
The current YKHC PAP guideline suggests no PAP under 21 and then Q 3 years after that until 30. At 30 years – 65 years of age they need paps Q 5 years—as long as there is no hx of abnormalities.


We now use liquid PAPs (see LAB section). If abnormal PAPs, they are followed on a database by the CDC Breast and Cervical Care Manager: Nina Jones RN.  We follow the ASCCP guidelines for dealing with abnormal PAPs. There is a great app for it on your smart phone.  
We now use liquid PAPs ([[Lab#Pap smears|see LAB section]]). If abnormal PAPs, they are followed on a database by the CDC Breast and Cervical Care Manager: Nina Jones RN.  We follow the [https://www.asccp.org/management-guidelines ASCCP guidelines] for dealing with abnormal PAPs. There is a great app for it on your smart phone.  


Any abnormal looking cervixes, endometrial biopsies and skin lesion removals in the perineum that you feel need further work up, can be referred to Women’s Health in Bethel. Feel free to contact the Gynecology Case Manager for that @ 543-6557. Mammograms can begin at age 40 but, our current YKHC guideline is to start at age 45 and do them every 2 years.
Any abnormal looking cervixes, endometrial biopsies and skin lesion removals in the perineum that you feel need further work up, can be referred to Women’s Health in Bethel. Feel free to contact the Gynecology Case Manager for that @ 543-6557. Mammograms can begin at age 40 but, our current YKHC guideline is to start at age 45 and do them every 2 years.


For annual exams, you can use Well Woman’s encounter pathway note. Please make sure to document Family History, Procedure History and give Birth Control.
For annual exams, you can use Well Woman’s encounter pathway note. Please make sure to document Family History, Procedure History and give Birth Control ([[media:Contraception_quick_start.pdf|Contraception - Quick Start YKHC Clinical Guideline]]).


If you have a patient with an abnormal breast exam she will need a mammogram and a breast ultrasound, both must be done prior to the surgeon seeing them. You need to clearly document where the mass is. If she is under 40 they will only do a sono. If she is over 40 they will do both a sono/mammo.
If you have a patient with an abnormal breast exam she will need a mammogram and a breast ultrasound, both must be done prior to the surgeon seeing them. You need to clearly document where the mass is. If she is under 40 they will only do a sono. If she is over 40 they will do both a sono/mammo. ([[media:Breast_cancer_screening.pdf|Breast Cancer Screening YKHC Clinical Guideline)]]


All referrals to ANMC surgery, whether to see the general surgeon in Bethel, in Specialty Clinic and/or a surgeon in Anchorage, need to have a phone consult with an ANMC surgeon and be documented on the specialty referral form. The WH Grant Case Manager (543-6296) will make sure that copies of the mammogram and sono go to ANMC for review prior to the patient’s visit.
All referrals to [[Specialty Referrals#General Surgery|ANMC surgery]], whether to see the general surgeon in Bethel, in Specialty Clinic and/or a surgeon in Anchorage, need to have a phone consult with an ANMC surgeon and be documented on the specialty referral form. The WH Grant Case Manager (543-6296) will make sure that copies of the mammogram and sono go to ANMC for review prior to the patient’s visit.


==Women’s Health Grant Info==
*'''[[:Category:YKHC Guidelines#Obstetrics Guidelines|Obstetrics YKHC Clinical Guidelines]]'''
===CDC Breast and Cervical Health Grant===
*'''[[Practicing Medicine in Bush Alaska—Some ABCs|YKHC Common/Unique Medical Diagnoses]]'''
 
*'''[[Specialty Referrals#OB/GYN Referrals|OB/GYN Referrals]]'''
This grant helps YK bring in patients for PAP smears, annual exams, and cancer diagnosis of breast or cervical or uterine cancer.  The grant will pay for travel, meals and lodging if necessary for any women between the ages of 21-64.
*'''[[Prenatal Information]]'''
 
*'''[[OB Common Procedures]]'''
===Women’s Health (WH) Grant Info for PAPs & Mammograms===
*'''[[Sexually Transmitted Infections]]'''
 
*'''[[HROB Stickers--Problems/Plans]]'''
The WH Grant will fund trips to Anchorage for breast biopsy or LEEP procedure, but not for other OB/GYN related issues or surgeries.
*'''[[Pregnancy Termination]]'''
 
*'''[[Women’s Health Grant Information]]'''
The Women's Health Grant is funded by the CDC and is not associated with YKHC. They only fund for certain appointments or follow-ups. These appointments are for Annual PAPs, Mammograms and any abnormal follow-ups. But this differs as to exactly what age the patient is.
 
{|class="wikitable"
|'''Age'''||'''Women’s Health Grant Pays For . . . .'''
|-
|21-19||PAP every three years since last exam (subject to change)
|-
|30-64||PAP q5 years, Mammogram q2 years - five years since last exam
|-
|50-64||PAP q5 years or sooner for F/U, Mammogram q2 years
|-
|>64||No coverage from the grant
|}
 
Any abnormal Mammos or PAP follow-ups will also be paid for by the Grant.
 
Any questions please feel free to call Grant Supervisor Roxanne Andersen Ext: 6696
 
Case Manager Christina Jones RN Ext 6296
 
WH Grant  Admin Assistant: Ext 6990
 
===Women’s Health Contact Information===
====Prenatal Case Manager ====
'''Ann Glasheen''' WHNP Phone 543-6305 Fax 543-6689 for questions regarding HROB patients, Labs, medications.
====Prenatal Case Manager’s Secretary====
'''Rebecca Martins''' Phone 543-6189 Fax 543-6689 for prenatal questions/Be-In-Bethel questions/appointments, info on prenatal appointments and Anchorage appointments.
====OB/GYN Case Manager====
'''Brenda A. Lamont, RN''' Phone 543-6557 Fax 543-6689 for OB/GYN referrals, 17 hydroxy-progesterone medication questions.
====Women’s Health Grant Care Manager====
'''Christina Jones, RN''' Phone 543-6296 Fax 543-6689 for Women’s Health Grant questions, Colpo questions/scheduling, PAP, breast, mammogram follow-up questions
====Women’s Health Grant Secretary====
Phone 543-6990 Fax 543-6689 for Women’s Health Grant appointments, Women’s Health Grant application/questions, OB/GYN appointments (ONLY after a referral has been made)
 
[[media:Midwifery.pdf|Midwifery In Rural Alaska]]: A 1994 article by former YKHC midwife Joan Koval. Still relevant today. PDF will open in your browser. Click your browser's back button to return to the wiki.
Link the Joan Koval article here it is in the women’s health folder…
 
==Prenatal Information==
 
OB Case Managers are the primary resource for the prenatal paperwork. We have a large number of pregnant patients, many who are high risk due to chronic HTN or preeclampsia.  Please at the top of each HPI for a pregnant women put a summary sentence like this example.
 
''Pt is a 32 yr old G5P3 AB1 with an EDC of 12/25/17 at 22 weeks gestation with a history of Cholestasis of Pregnancy and Kell Antibodies.''
 
To document prenatal visits use '''"OP PC Prenatal Visit Note'''." 
 
There are several auto-text that should be used when documenting a prenatal or 1st prenatal visit.  These all start with "''..ob''" (case sensitive).  The ''"..ob1stpnhpi"'' is particularly important to include for 1st Prenatal visits.
 
At the first prenatal visit you will also need to complete the '''1st Prenatal Visit ad hoc form''' and copy the textual rendition of this form to your HPI.
*You should only open one 1st Prenatal Visit ad hoc form for each pregnancy. 
*''If you need to add or modify information'', you should go to the '''Form Browser''', find the 1st Prenatal Visit ad hoc form for the current pregnancy, right click and select '''Modify'''.
 
===Prenatal Appointment Schedule if Uncomplicated===
'''Q4 week''': Appts until 32 weeks<br />
'''Q2 week''': Until be-in-Bethel Date<br />
'''Q1 week''': Appts in Bethel and/or Anchorage<br />
===Prenatal Labs/Sono Needed===
'''1st prenatal(If in SRC do labs)''': CBC, HepBxAg, RPR, CCUA and urine culture, GC/CT, Rubella, PPD (see PowerPlan). Make Bethel appt. for 1st trimester sono. We want a sono as early as possible on everyone. <br />
'''11-13 weeks''': If Advanced Maternal Age, 35 or older, first trimester screening for Down’s. Contact Ann Glasheen for particulars. <br />
'''15-21 weeks''': Do Quad screen<br />
'''18-24 weeks''': Make a 2nd Sono appt. in Bethel for Anatomy screen<br />
'''24-28 weeks''': Prenatal with CBC/GST. If the GST is over 140, will need a GTT ASAP. <br />
'''36 weeks''': Into Bethel and/or Anchorage, CBC, GC/CT, and GBS culture<br />
 
==[[Specialty Referrals#OB/GYN Referrals|OB/GYN Referrals]]==
 
==[[Sexually Transmitted Infections]]==
 
==[[HROB Stickers--Problems/Plans]]==
 
==[[Pregnancy Termination]]==

Latest revision as of 21:19, 20 July 2021

Overview

Each clinic does Women’s Health Care as able, including PAP smears, breast exams, IUD Implanon placements/removal, and endometrial biopsies. There are several case managers who help with women’s health (see attached list). YKHC has a CDC Breast and Cervical Health Grant that helps YK bring in patients for PAP smears, annual exams and cancer diagnosis of breast or cervical or uterine cancer. The grant will pay for travel, meals and lodging if necessary for any women between the ages of 21-64.

The current YKHC PAP guideline suggests no PAP under 21 and then Q 3 years after that until 30. At 30 years – 65 years of age they need paps Q 5 years—as long as there is no hx of abnormalities.

We now use liquid PAPs (see LAB section). If abnormal PAPs, they are followed on a database by the CDC Breast and Cervical Care Manager: Nina Jones RN. We follow the ASCCP guidelines for dealing with abnormal PAPs. There is a great app for it on your smart phone.

Any abnormal looking cervixes, endometrial biopsies and skin lesion removals in the perineum that you feel need further work up, can be referred to Women’s Health in Bethel. Feel free to contact the Gynecology Case Manager for that @ 543-6557. Mammograms can begin at age 40 but, our current YKHC guideline is to start at age 45 and do them every 2 years.

For annual exams, you can use Well Woman’s encounter pathway note. Please make sure to document Family History, Procedure History and give Birth Control (Contraception - Quick Start YKHC Clinical Guideline).

If you have a patient with an abnormal breast exam she will need a mammogram and a breast ultrasound, both must be done prior to the surgeon seeing them. You need to clearly document where the mass is. If she is under 40 they will only do a sono. If she is over 40 they will do both a sono/mammo. (Breast Cancer Screening YKHC Clinical Guideline)

All referrals to ANMC surgery, whether to see the general surgeon in Bethel, in Specialty Clinic and/or a surgeon in Anchorage, need to have a phone consult with an ANMC surgeon and be documented on the specialty referral form. The WH Grant Case Manager (543-6296) will make sure that copies of the mammogram and sono go to ANMC for review prior to the patient’s visit.

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