Focused Study Flashcards
Types of Macrocytic Anemia
Vitamin B 12 Deficiency Folic acid Deficiency Hypothyroidism dug-induced anemia Reticulocytosis Liver Disease
Types of Microcytic Anemia
Iron Deficiency
Lead poisoning
Sideroblastic
Genetic anomaly - sickle cell or Thalassemia
Types of Normocytic Anemia
Reticulocyte Count - Chronic Disease Blood loss Infection Aplastic Anemia
Iron Deficiency Anemia
Microcytic Decreased MCV Low MCH High TIBC Low Ferritin
B12 Deficiency Pernicious Anemia
Macrocytic Increased MCV Normal or High MCH High Ferritin Low B12
Anemia of Chronic Disease
Normocytic
everything normal except H&H
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.
Adaptive immunity
Natural • Passive (maternal) • Active (infection) Artificial • Passive (antibody transfer) • Active (immunization)
Live vaccines
LAIV (Live attenuated influenza vaccine), MMR, Var, Zos and/or yellow fever
IPV, MMR, Varicella
History of Anaphylactic reaction:
Neomycin
IPV, Smallpox
History of Anaphylactic reaction
Streptomycin, polymyxinB, Neomycin
Hepatitis B
History of Anaphylactic reaction
Baker’s yeast
Varicella
History of Anaphylactic reaction:
Gelatin, neomycin
MMR
History of Anaphylactic reaction:
Gelatin
Autonomy
rights of individuals and their right to determine their lives
Beneficence
doing good
• Screening
• Based on economic considerations
Non-maleficence
– do 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
Vulnerable Populations at risk for health promotion
o Depressed o Job changes o Unemployed o Chronic illness o Martial crisis o LGBTIQ o Incarcerated
Primary Prevention
promoting optimum health before the onset of problems. Precedes disuse or dysfunction.
Secondary Prevention
early identification and treatment.
Tertiary Prevention
restoration and maximizing potential
• Restoration and rehabilitation
Healthy People 2020 4 Goals
- Attain longer lives free from preventable disease.
- Achieve health equity; improve the health of all groups.
- Create social and physical environments that promote good health for all.
- Promote quality of life across all life stages.
Screenings
NEWBORN
- PKU
- Sickle Cell
- Hypothyroidism
- Hearing
- Developmental milestones
- Wellness visits 1, 2, 4, 6, 9
Screenings
Kids <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
Sceenings Kids 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 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 Adults
age for mammograms o 21 to begin self exams o >50, yearly age for Paps o 21
Influences that effect how we process information
- genetics
- environment
- Societal Influences
- Developmental level
Teaching Kids
- 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
Teaching teens
• simple, concrete, today & tomorrow focus
- use physical advantages when listing Pros & Cons
- use peer situations
identify confidentiality boundaries
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
Families
• assessment • function • involvement with children • teaching o more effective - resource for the individuals - strong interrelationship between family & health of it's member
Physical activity
o children 60 minutes per week
o adults 150 minutes per week
• formula
o 220 – age X 0.6 = target HR
Dash Diet
o Eat more fruits, vegetables, and low-fat dairy foods.
o Cut back on foods that are high in saturated fat, cholesterol, and trans fats.
o Eat more whole-grain foods, fish, poultry, and nuts.
o Limit sodium, sweets, sugary drinks, and red meats.
Modifiable Risk Factors
• High cholesterol • Smoking • DM • Thyroid • 30% unaware of thyroid issues o Contributing behaviors • Diet • Physical activity • 37% of adults are obese
Non-Modifiable Risk Factors
- Age
- Family hx
- Genetic determinants
CVD
- Stage I HTN – 130 – 139/80 – 89
- Implement lifestyle changes alone
- Use BP meds w/ CVD, DM, CKD.
- Stage II HTN >140/90
- Reinforce lifestyle changes and initiate meds
Benefits of Lowering B/P
- Decreased CVA by 35 – 40%
- Decreased MI by 20 – 25%
- Decreased HF by 50%
JNC - 8 Recommendations
>60
Goal: <150/90
JNC - 8 Recommendations
<60
Goal: <140/90
JNC - 8 Recommendations
Tx non-black
Thiazide type diuretic, CCB, ACE – 1 or ARB.
No beta-blockers for initial Tx, larger stroke outcome.
JNC - 8 Recommendations
Black
Thiazide type diuretic or CCB
JNC - 8 Recommendations
18 w/ CKD & HTN
monitor labs: place on ARB & ACEI
Reduction of LDL w/ diet changes
8 - 14 mmHg
Reduction of LDL w/ lower sodium, <2.4 GM/day
2 - 8 mmHg
Reduction of LDL w/ physical activity, aerobic activity
4 - 9 mmHg
Reduction of LDL w/ ETOH limited to 1 - 2 drinks
2 - 4 mmHg
Pt. to receive Statins
o Dx atherosclerotic CV (ASCVD)
o Primary LDL >190 (high intensity statin)
o DM 40 -75 yr. w/ LDL 70 – 189. (moderate intensity statin)
o 10 yr. ASCVD > 7.5% (high intensity statin)
o < 75 yr. ASCVD → high intensity statin
o >75 yr. → moderate intensity statin, as tolerated
High Intensity Statin
- LDL lowered at least 50%
- Atorvastatin 40/80mg
- Rosuvastatin 20/40mg
Moderate Intensity Statin
- LDL lowered 30 – 50%
- Atorvastatin 10/20mg
- Rosuvastatin 5/10mg
- Simvastatin 20/40mg
- Pravastatin 40/80mg
- Lovastatin 40mg
- Pitavastatin 2-4mg
Low Intensity Statin
- LDL lowered <30%
- Simvastatin 10mg
- Pravastatin 10-20mg
- Lovastatin 20mg
- Fluvastatin 20-40mg
- Pitavastatin 1mg
Labs to check prior to Tx initiation Statin
o Fasting lipid
o A1C, if DM unknown
o ALT
o CK, if indicated
Monitor response of Statin initiation
in 6 wks. and then routine q 6 – 12 months.
Family Genogram
Family diagram that views the family from identification data that depicts each member of the family with connections between the Generations
