Exam 1 Flashcards
1
Q
Health
A
a state of complete physical, mental and social well-being and/or the absence of disease or illness.
2
Q
Top 10 Causes of death
A
o Heart disease o Cancer o Chronic lower respiratory disease o CVA o Accidents o Alzheimer’s disease o DM o Influenza and pneumonia o Kidney disease o Suicide *8 can be prevented by healthier life styles
3
Q
Determinants of health
A
o Age o Sex o Heredity o Lifestyle o Social and community networks o Environment o Socioeconomic
4
Q
Levels of Prevention
A
o Primary Prevention
o Secondary Prevention
o Tertiary Prevention
5
Q
Tertiary Prevention
A
restoration and maximizing potential • Restoration and rehabilitation • Rehab following CVA • Surgical procedure • Optimum control of chronic conditions
6
Q
Secondary Prevention
A
early identification and treatment. • Early diagnosis and prompt treatment • Disability prevention • Individual or mass screenings • Selective examinations • Routine physical exam • Cholesterol screening
7
Q
Primary Prevention
A
promoting optimum health before the onset of problems. Precedes disuse or dysfunction. • Health promoting • Specific protection • Diet • Exercise • Immunizations
8
Q
Health people 2020
A
o 42 topic areas & 600 objectives
o Focus on the Determinants of Health
9
Q
Health people 2020, 12 Leading Health Indicator topics
A
o Access to health services o Clinical preventative services o Environmental quality o Injury and violence o Maternal, infant and child health o Mental health o Nutrition, physical activity and obesity o Oral health o Reproductive and sexual health o Social determinants o Substance abuse o Tobacco use
10
Q
Ethical principles
A
o Autonomy o Beneficence o Non-maleficence o Justice o Veracity
11
Q
Autonomy
A
– rights of individuals and their right to determine their lives
• Reason and the ability to make rational choices, to understand one’s environment
• Right to information
• Right to privacy and confidentiality
• Right to appropriate care and treatment
• Difficulties
• Tendency to give advice instead of information
• Persuade clients to change their behavior
• Dismiss the client’s ideas without providing an adequate explanation
• Challenge is accept role of partner and enabler rather than expert and controller
o Beneficence – doing good
• Screening
• Based on economic considerations
12
Q
Beneficence
A
– doing good
• Screening
• Based on economic considerations
13
Q
Non-maleficence
A
– does no harm
• Screening may foster anxiety or be painful
14
Q
Justice
A
– being fair and equitable
• What is the fair distribution of scarce resources
15
Q
Veracity
A
– tell the truth
• Unbiased information based on evidence
• Some cultures do not bale truth in cases of terminal illness
16
Q
At risk adults are those who are:
A
o Depressed o Job changes o Unemployed o Chronic illness o Martial crisis o LGBTIQ o Incarcerated Other minorities
17
Q
Maslow’s hierarchy
A
o Basic physiologic needs o Safety needs o Belongingness/love needs o Esteem needs o Self actualization
18
Q
Self actualization
A
To find self-fulfillment and realize one’s potential
19
Q
Esteem needs
A
To achieve, be competent and gain approval and recognition
20
Q
Belongingness and love needs
A
To affiliate with others, to be accepted
21
Q
Safety needs
A
To feel secure and safe, out of danger
22
Q
Basic physiologic needs
A
Hunger, theist and related needs
23
Q
Immunity
A
Adaptive immunity
Innate immunity
Inflammatory process
24
Q
Adaptive immunity
A
Natural • Passive – maternal • Active – infection Artificial • Passive – antibody transfer • Active – immunization
25
Validity
a test that is able to classify a large portion of diseased and non-diseased individuals correctly.
26
Sensitivity
The number of diseased divided by the total number of individuals
Proportion of correctly classified diseased individuals.
27
Specificity
The number of correctly classified non-diseased divided by the total number of non-diseased individuals.
Proportion of correctly classified non-diseased individuals.
28
Immunizations at birth
Hep B, 1st dose
29
Immunizations at 2 Months
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Hep B, 2nd dose
RV1 (Rotavirus)
DTaP, 1st dose
Hib, 1st dose
PCV, 1st dose
IPV, 1st dose
```
30
Immunizations at 4 Months
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RV1, 2nd dose
DTap, 2nd dose
Hib, 2nd dose
PCV13, 2nd dose
IPV, 2nd dose
```
31
Immunizations at 6 Months
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Hep B, 3rd dose
DTap, 3rd dose
PCV, 3 rd dose
IVP, 3rd dose
Flu, and every year following
```
32
Immunizations at 12 Months
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Hib, 3rd dose
PCV, 4th dose
IPV, 3rd dose
MMR, 1st dose
VAR, 1st dose
Hep A, 1st dose
```
33
Immunizations at 18 Months
DTaP, 4th dose
| Hep A, 2nd dose
34
Immunizations at 4 - 6 Years
DTap, 5th dose
IVP, 4th dose
MMR, 2nd dose
VAR, 2nd dose
35
Immunizations at 11 - 12 Years
Meningococcal, 1st dose
Tdap
HPV
36
Immunizations at 16 Years
Meningococcal, 2nd dose
37
Birth to 5 Years Screening
Height, weight, B/P
Vision Start at age 3-4
At birth: Hemoglobinopathy, phenylalanine, T4 TSH
38
Birth to 5 Years Counseling
Car seat safety or lap belts, bicycle helmets, smoke detectors, flame retardant sleepwear, hot water heater temperature, window/stair guard, safe storage of harmful substances, poison control number, CPR training for caregivers
39
Child 5 - 10 Years Screening
Height, weight, B/P
| Assess for nutritional, learning, developmental problem
40
Child 5 - 10 Years Counseling
Injury prevention: lap belts, helmets, smoke detectors, safe storage of firearms
Substance Abuse: Avoid tobacco, underage drinking, illicit drugs, drinking and driving
Sexual behavior: good touch/bad touch
41
11 - 24 Years Screening
Height, weight, B/P
PAP, Chlamydia screen, Rubella (Females)
Assess for drinking problem
42
11 - 24 Years Counseling
Injury prevention: lap belts, helmets, smoke detectors, safe storage of firearms
Substance Abuse: Avoid tobacco, underage drinking, illicit drugs, drinking and driving
Sexual behavior: STD prevention, abstinence, avoid high risk behavior
43
25 - 64 Years Screening
Height, weight, B/P
Total cholesterol
PAP/ Pelvic
FOB and/or sigmoidoscopy/ colonscopy > age 50
Mammogram + clinical breast exam (50-69)
Assess for substance abuse
Rubella for childbearing women + MVI with folic acid
44
25 - 64 Years Counseling
Injury Prevention
Lap belts, helmets, smoke detectors, safe storage of firearms
Tobacco cessation, safe use of ETOH, diet and exercise
Limit fat and cholesterol, maintain caloric balance
Emphasize grains, fruits and vegetables
Adequate Calcium for women
Regular physical activity
Sexual Behavior
STD prevention, abstinence, avoid high risk behaviors
Dental Health
Regular visits to dentists
Brush, floss and use fluoride toothpaste
45
65+ Years Screening
```
Height, Weight, B/P
FOB, colonscopy or sigmoidoscopy
Mammogram + CBE Stop age 70
Pelvic exam test
Vision and Hearing Screening
Substance Abuse
```
46
65+ Years Counseling
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Tobacco cessation, safe use of ETOH
Diet and Exercise
Limit fat and cholesterol, maintain caloric balance
Emphasize fruit, grains and vegetables
Adequate CA for women
Regular physical activity
Injury prevention
Lap belts, helmets, smoke detectors
Fall prevention, safe storage of firearms
Hot water heater temperature
CPR for household members
```
47
Immunizations at 65+ Years
Pneumococcal
Influenza
TD booster
Shingles
48
Bradshaw Taxonomy of Need
Normative: square feet in homes for foster children/ BP
Felt needs: what someone internally thinks and feels that they need May not express it/ difficult to ascertain
Expressed needs” what people say they need/ may or maynot be an actual need
Comparative needs- comparing one group to another
49
Healthy People 2020 Infant & Children Objectives
Newborn screening
Reduce the number of children living in homes with lead paint
Timely follow-ups
early developmental and autism screening
increase the number of infants put to sleep on their back
increase the number of infant that are breast fed
increase car seats and bike helmets
increase use of protective gear in sports
decrease child abuse
50
Healthy People 2020 Adult Objectives
increase screening for Chlamydia infections
screen for STIs and BV during prenatal visits
increase number of women getting Pap tests
increase glacoma screening
increase colorectal screening
increase mammogram screening
decrease the number of people living in homes w/ lead paint
increase cholesterol screening
increase HTN screening
increase TB screening in those infected w/ HIV
51
Screenings ADOLESCENTS
Yearly Wellness Visits
Height/Weight/BMI/Blood Pressure
Lipid Screening age 17-21 years
Hearing Screening 11 to 14 years, 15-17 years and 18 to 21 years
Vision Annually
Depression Screening at 12 yrs
Alcohol, Tobacco and Drug Use Screening
HIV, Hep B, Hep C and STI Screening for At Risk
Diabetes Screening if At Risk
52
Screenings 5-12
```
Yearly Wellness Visits
Height/Weight/BMI yearly
Blood Pressure yearly
Lipid Screening age 9 to 11 years
Dental Visits
Hearing and Vision Screening yearly
TB testing if At Risk
Hgb/Crit if At Risk
Diabetes Screening if At Risk
Drug/Alcohol Screening for At Risk
STI’s if at High Risk
```
53
Screenings Under 5
Well Child Visits: 12, 15, 18, 24, 30 months, 3, 4 and 5 years
Developmental and Behavioral Screening at 9, 18, 24 or 30 months and each routine visits/wellness
Anemia Screening at 9-12 months routinely; and 1-5 years if at risk. Highest risk between 1 and 2 years(AAP)
Autism Screening 18 and 24 months
Lead Testing if indicated age 1 and 2 years old
Height/Weight/BMI: Every visit
Blood Pressure, Vision, Hearing: Around 3 years old
54
Screenings NEWBORN
Hypothyroidism
PKU (phenylketonuria) – People with PKU can’t process certain foods. They must avoid certain foods and drink a special formula. PKU can cause intellectual disability (mental skills that are below average) if it’s not treated early.
Sickle cell disease – This is a blood disorder that can cause problems like serious pain, infection, or stroke. If it’s found early, sickle cell disease can be watched and treated.
Hemoglobin Electrophoresis
Bilirubin
Hearing - within first month
Developmental Milestones especially under age 3
Wellness Visits: 1,2, 4, 6, 9 months
55
Hypothyroidism
– The thyroid is a gland in the neck that makes the thyroid hormone. Hypothyroidism (low thyroid hormone) can cause problems with growth and development, but it can be treated if it's found early.
56
Formative Evaluation
evaluation of the process
57
Summative Evaluation
evaluation of the outcomes
58
Local Perspective
how the community defines their success
59
Important Factors in Community Process
- establish rapport
- easier if a member of the community
- community member competence
- mutually agreed upon outcomes
60
Community Partnership
- initiated by community
| - needs questionnaire to ascertain need
61
The Ways Individuals Process Information is Determined By:
- genetics
- environment
- Societal Influences
- Developmental level
62
Short Term Strategies
- get their attention
- chunk information
- get to the point quickly
63
Long term Strategies
- connect key information with what the person already knows
- engage the person in interaction with the information
- repeat or restate
64
Patient Goal Setting
- assess pt goals
- mutual goal setting
- realistic goals
65
Addressing Health Behaviors
ensure the pt understands your reasons for addressing the issue
66
Partnership Strategies
- consultant
| - investigator
67
Identify Pt Risk
Normative Permission
| Neutral Language
68
Normative Permission
normalize a health behavior to make behavior more acceptable to pt and therefor, easier to address
69
neutral language
non-judgemental words and tone to address a health behavior
70
Strategies for Teaching Young Teens
- simple, concrete, today & tomorrow focus
- use physical advantages when listing Pros & Cons
- use peer situations
identify confidentiality boundaries
71
Strategies for Teaching Middle Teen
- don't challenge
- work w/ what they know and add to that
- guided peer education
- use Pro's & Con's
- expect slow behavior change
- give structured choices if possible
72
Strategies for Teaching Late Teen
- open discussions
- weigh Pros & Cons
- plan for future
- use reasoning and discuss value
- work with desire to know
73
PEEK
P - physical readiness
E - emotional readiness
E - experiential readiness
K - knowledge readiness
74
Motivational Strategies
- positivity
- decrease the likelihood of failure
- enhance learners self esteem
- acknowledge the learner's responsibility in completing the task
- provide positive closure
75
Strategies for Teaching Adults
- active discussion and role play
- present smaller amount of new material
- help w/ synthesis, analysis and application
- validate that they can learn
- provide an environment that allows for sensory changes
- provide visual information as well
76
Prioritizing Learning Needs
- mandatory
- desirable
- possible
77
Mandatory
needs that must be learned for the survival or situation s in which the learner's life or safety is threatened
78
Desirable
need that are not life threatening but are related to well-being
79
Possible
Needs for information that is "nice to know" but not essential or required to know
80
Cultural Competency
- develop a strategy for continuous education about the predominant cultures you treat
- consider integrating the appropriate use of indigenous medicines and practices
- use co-professionals from other cultures or members of the family or social network that can consult and mediate on specific pt problems
81
Strategies for Teaching Children
- get them interested
- simplify the task
- maintain the pursuit of the goal
-control frustration and risk through achievable goals
demonstrate an idealized version on the act to be performed
82
Strategies for Teaching the Elderly
- visual changes
- memory changes
- slow response time
83
Learning Strategies to Remember
- motivation (self)
- reinforcement
- retention
- transference (a habit has formed)
84
Family
a system, affected by culture, environment, religious-spiritual dimension and other variables which affect the person and society.
85
Correlation of Healthy People 2020 to the Family
- increase the proportion of people who have a source of ongoing care
- reduce adult obesity
- reduce child/teen obesity
- decrease teen and adult drug and alcohol abuse
86
Family Teaching
- more effective
- resource for the individuals
- strong interrelationship between family & health of it's member
87
Calgary Family Assessment Model
- cognitive
- affective
- behavioral
88
Nuclear Family
male, female, kids, dog
89
Extended Family
including grandparents
90
Cohabitating Family
unmarried couple
91
Augmented Family
part of the family that are of no relation
92
unmarried Family
roommates
93
Framingham Study
linked cardiovascular disease with smoking, obesity and high b/p
94
CVD
- #1 killer in the nation, across the board
- >90 milion americans have some form of CVD
- cost of CVD is >$1 billion by 2030
95
CVD and B/P
- HTN is most common primary dx in US
| - most unaware of HTN
96
Benefits of lowering b/p
- decreases incidence of CVA by 35 - 40%
- ...of MI by 20 - 25%
- ...HF by 50%
97
For HTN in pt >60 yr
initiate rx tx for:
- systolic b/p >150
- diastolic of >90
- tx goal <150/90
98
For HTN in pt <60 yr
initiate rx tx for:
- systolic b/p >140
- diastolic of >90
- tx goal <140/90
99
Initiating Tx for HTN
In the general nonblack population, including those with diabetes, initial drug therapy should include a thiazide type diuretic, CCB, ACE-I, or ARB, general black population including those with diabetes, initial drug therapy should include a thiazide type diuretic or CCB
