Chapter 10 - Therapeutic Communication & Health Promotion Flashcards
What is primary prevention?
- Preventing the health problem, the most cost-effective form of healthcare
- Ex: immunizations, safety counseling, injury & disease prevention, smoking cessation
What is secondary prevention?
- Detecting the disease early; asymptomatic or preclinical state to minimize impact
- Ex: screening tests (like BP checks, mammograms, colonoscopy, HgbA1c)
What is tertiary prevention?
- Minimizing the negative disease-induced outcomes
- Ex: in established disease – adjusting therapy to avoid further target organ damage
- Potentially viewed as a failure of primary prevention
What are secondary prevention principles?
- The prevalence of a disease is sufficient to justify screening
- The health problem has a significant effect on quality and/or quantity of life
- The target disease has a long asymptomatic period
- A population-acceptable screening test is available
CAGE Questionnaire
- C – have you ever felt you ought to Cut down on drinking?
- A – have people Annoyed you by criticizing your drinking?
- G – have you ever felt bad or Guilty about your drinking?
- E – have you ever had a drink first thing in the morning to steady your nerves, “eye-opener”
- Can modify for other forms of substance abuse
- If patient answers “yes” to at least 2 questions, there is a high sensitivity and specificity that the patient has a problem
When should mammograms be started in women?
• Around age 40
When should a woman first get a Pap smear?
• Age 21
How to calculate pack-years for smoking?
• Number of PDD x number of years smoked
When to report child and elder abuse?
- Child abuse reporting is mandatory in all 50 states
* Elder abuse reporting differs by state
What are the Prochaska and DiClemente Stage of Change?
- Pre-contemplation – patient is not interested in change; provider helps patient to think about changing their behavior
- Contemplation – patient is considering change, may feel “stuck”; provider should help the patient examine benefits and barriers to change
- Preparation – patient exhibits some behavior changes or thoughts, often reports feeling like they don’t have the tools to proceed; provider helps patient find and use tools
- Action – patient is ready to go forth with change, takes concrete steps, inconsistent with carrying through; provider works with patient on using tools, encourages healthy behavior, acknowledging reverting back to common
- Maintenance/relapse – patient learns to continue with the change, adopted the change; provider uses continued positive reinforcement
What are the 5 A’s of Assessing Readiness?
- Ask – identify and document tobacco use at every visit
- Advise – urge tobacco user to quit
- Assess – is tobacco user willing to attempt to quit
- Assist – for patient willing to make an attempt, use counseling or pharmacotherapy to help
- Arrange – schedule follow-up contact preferably the first week after the quit date
Leading causes of death: age 15-34
- 1: unintentional injury
- 2: suicide
- 3: homicide
Leading causes of death: age 34-44
- 1: unintentional injury
- 2: malignant neoplasm
- 3: heart disease
Leading causes of death: age 45-64
- 1: malignant neoplasm
- 2: heart disease
- 3: unintentional injury
Leading causes of death: age 65+
- 1: heart disease
- 2: malignant neoplasm
- 3: chronic lower respiratory diseases (COPD, pneumonia, flu)
Leading overall causes of deaths
- 1: heart disease
- 2: malignant neoplasm
- 3: chronic lower respiratory diseases (COPD, pneumonia, flu)
Suicide statistics
- Men complete suicide more often than women
- Completed suicides are highest in elderly men
- Suicide attempts are higher among women than men
Exercise recommendations for adults and older adults
- Aerobic exercise (choose 1): 150 minutes of moderate intensity activity (brisk walk, tennis), 75 minutes of vigorous intensity activity (jogging, swimming), a combination of the 2
- Muscle strengthening: all adults should perform activities to maintain or increase strength at least 2 days weekly
Contraindications to exercise
- Progressive worsening of exercise tolerance or dyspnea at rest/exertion
- Ischemia at lower exercise threshold
- Acute systemic illness and/or fever
- Uncontrolled DM
- Valvular heart disease requiring surgery
- Severe aortic stenosis
- Myocardial infarction (< 3 weeks ago)
- New-onset A. fib
- Resting HR > 120
What type of prevention would these examples be considered?
• Counseling about reducing risk for STIs
• Skin survey for precancerous lesions
• Administering flu vaccine
• Adjusting therapy to enhance glycemic control
- Counseling about reducing risk for STIs – primary
- Skin survey for precancerous lesions – secondary
- Administering flu vaccine – primary
- Adjusting therapy to enhance glycemic control – tertiary
What type of prevention would these examples be considered?
• Checking fasting lipid profile
• Teaching the benefits of participating in consistent moderate-intensity physical activity
• Ensuring adequate illumination at home
• Screening for emotional, physical, or financial abuse
- Checking fasting lipid profile – secondary
- Teaching the benefits of participating in consistent moderate-intensity physical activity – primary
- Ensuring adequate illumination at home – primary
- Screening for emotional, physical, or financial abuse – secondary
Which of the following provides the most accurate information in alcohol abuse?
a. Elevated hepatic enzymes
b. Positive response to two items on the CAGE questionnaire
c. Abnormal RBC indices
d. Elevated serum triglycerides
b. Positive response to two items on the CAGE questionnaire
A 65-year-old Native American man presents for an annual physical examination. His is without complaint, denies tobacco or alcohol use, and has not seen a healthcare provider in more than 10 years. The patient states, “I am a really healthy person. I would not come in except my wife and daughter told me I should have a checkup.” As part of today’s visit, he should be screened for:
a. Pancreatic cancer
b. Hemolytic anemia
c. Hepatic sclerosis
d. Visual defect
d. Visual defect
A 25-year-old woman presents with finger-shaped ecchymotic areas on her right shoulder that are an incidental finding during a physical examination. She denies abuse or assault. You respond:
a. “Your bruises look as if they were caused by someone grabbing you.”
b. “Was this an accident?”
c. “I notice the bruises are in the shape of a hand.”
d. “How did you fall?”
c. “I notice the bruises are in the shape of a hand.”
C is correct because: this is the most factual statement
A is incorrect because: this implies you are calling the patient a liar
B and D are incorrect because: these give the patient an excuse
