Exam 1 Flashcards
Health
a state of complete physical, mental and social well-being and/or the absence of disease or illness.
Top 10 Causes of death
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
Determinants of health
o Age o Sex o Heredity o Lifestyle o Social and community networks o Environment o Socioeconomic
Levels of Prevention
o Primary Prevention
o Secondary Prevention
o Tertiary Prevention
Tertiary Prevention
restoration and maximizing potential • Restoration and rehabilitation • Rehab following CVA • Surgical procedure • Optimum control of chronic conditions
Secondary Prevention
early identification and treatment. • Early diagnosis and prompt treatment • Disability prevention • Individual or mass screenings • Selective examinations • Routine physical exam • Cholesterol screening
Primary Prevention
promoting optimum health before the onset of problems. Precedes disuse or dysfunction. • Health promoting • Specific protection • Diet • Exercise • Immunizations
Health people 2020
o 42 topic areas & 600 objectives
o Focus on the Determinants of Health
Health people 2020, 12 Leading Health Indicator topics
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
Ethical principles
o Autonomy o Beneficence o Non-maleficence o Justice o Veracity
Autonomy
– 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
Beneficence
– doing good
• Screening
• Based on economic considerations
Non-maleficence
– does no harm
• Screening may foster anxiety or be painful
Justice
– being fair and equitable
• What is the fair distribution of scarce resources
Veracity
– tell the truth
• Unbiased information based on evidence
• Some cultures do not bale truth in cases of terminal illness
At risk adults are those who are:
o Depressed o Job changes o Unemployed o Chronic illness o Martial crisis o LGBTIQ o Incarcerated Other minorities
Maslow’s hierarchy
o Basic physiologic needs o Safety needs o Belongingness/love needs o Esteem needs o Self actualization
Self actualization
To find self-fulfillment and realize one’s potential
Esteem needs
To achieve, be competent and gain approval and recognition
Belongingness and love needs
To affiliate with others, to be accepted
Safety needs
To feel secure and safe, out of danger
Basic physiologic needs
Hunger, theist and related needs
Immunity
Adaptive immunity
Innate immunity
Inflammatory process
Adaptive immunity
Natural • Passive – maternal • Active – infection Artificial • Passive – antibody transfer • Active – immunization
Validity
a test that is able to classify a large portion of diseased and non-diseased individuals correctly.
Sensitivity
The number of diseased divided by the total number of individuals
Proportion of correctly classified diseased individuals.
Specificity
The number of correctly classified non-diseased divided by the total number of non-diseased individuals.
Proportion of correctly classified non-diseased individuals.
Immunizations at birth
Hep B, 1st dose
Immunizations at 2 Months
Hep B, 2nd dose RV1 (Rotavirus) DTaP, 1st dose Hib, 1st dose PCV, 1st dose IPV, 1st dose
Immunizations at 4 Months
RV1, 2nd dose DTap, 2nd dose Hib, 2nd dose PCV13, 2nd dose IPV, 2nd dose
Immunizations at 6 Months
Hep B, 3rd dose DTap, 3rd dose PCV, 3 rd dose IVP, 3rd dose Flu, and every year following
Immunizations at 12 Months
Hib, 3rd dose PCV, 4th dose IPV, 3rd dose MMR, 1st dose VAR, 1st dose Hep A, 1st dose
Immunizations at 18 Months
DTaP, 4th dose
Hep A, 2nd dose
Immunizations at 4 - 6 Years
DTap, 5th dose
IVP, 4th dose
MMR, 2nd dose
VAR, 2nd dose
Immunizations at 11 - 12 Years
Meningococcal, 1st dose
Tdap
HPV
Immunizations at 16 Years
Meningococcal, 2nd dose
Birth to 5 Years Screening
Height, weight, B/P
Vision Start at age 3-4
At birth: Hemoglobinopathy, phenylalanine, T4 TSH
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
Child 5 - 10 Years Screening
Height, weight, B/P
Assess for nutritional, learning, developmental problem
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
11 - 24 Years Screening
Height, weight, B/P
PAP, Chlamydia screen, Rubella (Females)
Assess for drinking problem
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
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
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
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
65+ Years Counseling
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
Immunizations at 65+ Years
Pneumococcal
Influenza
TD booster
Shingles
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
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
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
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
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
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
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
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.
Formative Evaluation
evaluation of the process
Summative Evaluation
evaluation of the outcomes
Local Perspective
how the community defines their success
Important Factors in Community Process
- establish rapport
- easier if a member of the community
- community member competence
- mutually agreed upon outcomes
Community Partnership
- initiated by community
- needs questionnaire to ascertain need
The Ways Individuals Process Information is Determined By:
- genetics
- environment
- Societal Influences
- Developmental level
Short Term Strategies
- get their attention
- chunk information
- get to the point quickly
Long term Strategies
- connect key information with what the person already knows
- engage the person in interaction with the information
- repeat or restate
Patient Goal Setting
- assess pt goals
- mutual goal setting
- realistic goals
Addressing Health Behaviors
ensure the pt understands your reasons for addressing the issue
Partnership Strategies
- consultant
- investigator
Identify Pt Risk
Normative Permission
Neutral Language
Normative Permission
normalize a health behavior to make behavior more acceptable to pt and therefor, easier to address
neutral language
non-judgemental words and tone to address a health behavior
Strategies for Teaching Young Teens
- simple, concrete, today & tomorrow focus
- use physical advantages when listing Pros & Cons
- use peer situations
identify confidentiality boundaries
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
Strategies for Teaching Late Teen
- open discussions
- weigh Pros & Cons
- plan for future
- use reasoning and discuss value
- work with desire to know
PEEK
P - physical readiness
E - emotional readiness
E - experiential readiness
K - knowledge readiness
Motivational Strategies
- positivity
- decrease the likelihood of failure
- enhance learners self esteem
- acknowledge the learner’s responsibility in completing the task
- provide positive closure
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
Prioritizing Learning Needs
- mandatory
- desirable
- possible
Mandatory
needs that must be learned for the survival or situation s in which the learner’s life or safety is threatened
Desirable
need that are not life threatening but are related to well-being
Possible
Needs for information that is “nice to know” but not essential or required to know
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
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
Strategies for Teaching the Elderly
- visual changes
- memory changes
- slow response time
Learning Strategies to Remember
- motivation (self)
- reinforcement
- retention
- transference (a habit has formed)
Family
a system, affected by culture, environment, religious-spiritual dimension and other variables which affect the person and society.
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
Family Teaching
- more effective
- resource for the individuals
- strong interrelationship between family & health of it’s member
Calgary Family Assessment Model
- cognitive
- affective
- behavioral
Nuclear Family
male, female, kids, dog
Extended Family
including grandparents
Cohabitating Family
unmarried couple
Augmented Family
part of the family that are of no relation
unmarried Family
roommates
Framingham Study
linked cardiovascular disease with smoking, obesity and high b/p
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
CVD and B/P
- HTN is most common primary dx in US
- most unaware of HTN
Benefits of lowering b/p
- decreases incidence of CVA by 35 - 40%
- …of MI by 20 - 25%
- …HF by 50%
For HTN in pt >60 yr
initiate rx tx for:
- systolic b/p >150
- diastolic of >90
- tx goal <150/90
For HTN in pt <60 yr
initiate rx tx for:
- systolic b/p >140
- diastolic of >90
- tx goal <140/90
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
