HPI 

Ms. Sodo is a 38 year old female who is presenting for a follow up visit to her obstetrician’s remote clinic. She is at 24 weeks gestation. She has missed several follow up appointments due to childcare, transportation and employment issues. She is taking her prenatal vitamin, labetalol and baby aspirin as prescribed, but has not been checking her blood pressure. She feels the swelling is getting worse in her legs. She has had normal weight gain since the last visit. Her appetite is okay. She is eating processed food because she has no time or energy to cook. She feels her baby moving fairly regularly throughout the day and night. She never received a call from the maternal fetal medicine specialist’s office. Denies contractions or vaginal leakage of fluid. 

ROS

+ nausea and vomiting

+ minimal lower extremity edema

no fevers or chills

no SOB

no cough 

no CP

no changes in bowel habits

no abdominal pain/contractions

no urinary symptoms

no vaginal bleeding

no numbness or tingling

no weakness

no vision changes

no headache

Physical Exam

Temp.: 98.7° HR: 85 BP: 150/95 RR:12 

FHR: 140

Urinalysis: 1+ protein, no glucose

General: Overweight black female appears fatigued and anxious

Eyes: no scleral icterus

CVS: Regular rate and rhythm, normal S1, S2, no S3, +S4, +2/6 systolic ejection murmur, no rubs

Lungs: clear to auscultation, no rales, rhonchi or wheezes

Abd: obese, + bowel sounds, soft, nontender. Fundal height 24cm.

Extr: no clubbing or cyanosis. 1+ pitting bilateral lower extremity edema to mid shin

Neuro: alert, oriented. fine motor movements intact. facial movements symmetrical and intact. normal gait