1
Q

Types of Macrocytic Anemia

A
Vitamin B 12 Deficiency 
Folic acid Deficiency 
Hypothyroidism
dug-induced anemia
Reticulocytosis
Liver Disease
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2
Q

Types of Microcytic Anemia

A

Iron Deficiency
Lead poisoning
Sideroblastic
Genetic anomaly - sickle cell or Thalassemia

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3
Q

Types of Normocytic Anemia

A
Reticulocyte Count - 
Chronic Disease
Blood loss
Infection
Aplastic Anemia
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4
Q

Iron Deficiency Anemia

A
Microcytic
Decreased MCV
Low MCH
High TIBC
Low Ferritin
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5
Q

B12 Deficiency Pernicious Anemia

A
Macrocytic
Increased MCV
Normal or High MCH
High Ferritin
Low B12
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6
Q

Anemia of Chronic Disease

A

Normocytic

everything normal except H&H

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7
Q

Validity

A

a test that is able to classify a large portion of diseased and non-diseased individuals correctly.

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8
Q

Sensitivity

A

The number of diseased divided by the total number of individuals
Proportion of correctly classified diseased individuals.

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9
Q

Specificity

A

The number of correctly classified non-diseased divided by the total number of non-diseased individuals.

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10
Q

Adaptive immunity

A
Natural
•	Passive (maternal)
•	Active (infection)
Artificial
•	Passive (antibody transfer)
•	Active (immunization)
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11
Q

Live vaccines

A
LAIV (Live attenuated influenza vaccine), 
MMR, 
Var, 
Zos 
and/or yellow fever
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12
Q

IPV, MMR, Varicella

A

History of Anaphylactic reaction:

Neomycin

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13
Q

IPV, Smallpox

A

History of Anaphylactic reaction

Streptomycin, polymyxinB, Neomycin

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14
Q

Hepatitis B

A

History of Anaphylactic reaction

Baker’s yeast

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15
Q

Varicella

A

History of Anaphylactic reaction:

Gelatin, neomycin

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16
Q

MMR

A

History of Anaphylactic reaction:

Gelatin

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17
Q

Autonomy

A

rights of individuals and their right to determine their lives

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18
Q

Beneficence

A

doing good
• Screening
• Based on economic considerations

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19
Q

Non-maleficence

A

– do no harm

• Screening may foster anxiety or be painful

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20
Q

Justice

A

being fair and equitable

• What is the fair distribution of scarce resources

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21
Q

Veracity

A

tell the truth
• Unbiased information based on evidence
• Some cultures do not bale truth in cases of terminal illness

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22
Q

Vulnerable Populations at risk for health promotion

A
o	Depressed
o	Job changes
o	Unemployed
o	Chronic illness
o	Martial crisis
o	LGBTIQ
o	Incarcerated
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23
Q

Primary Prevention

A

promoting optimum health before the onset of problems. Precedes disuse or dysfunction.

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24
Q

Secondary Prevention

A

early identification and treatment.

25
Q

Tertiary Prevention

A

restoration and maximizing potential

• Restoration and rehabilitation

26
Q

Healthy People 2020 4 Goals

A
  • 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.
27
Q

Screenings

NEWBORN

A
  • PKU
  • Sickle Cell
  • Hypothyroidism
  • Hearing
  • Developmental milestones
  • Wellness visits 1, 2, 4, 6, 9
28
Q

Screenings

Kids <5

A
  • 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
29
Q

Sceenings Kids 5 – 12

A
  • 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
30
Q

Screenings Adolescents

A
  • 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
31
Q

Screenings Adults

A
age for mammograms
o	21 to begin self exams
o	>50, yearly
age for Paps
o	21
32
Q

Influences that effect how we process information

A
  • genetics
  • environment
  • Societal Influences
  • Developmental level
33
Q

Teaching Kids

A
  • 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
34
Q

Teaching teens

A

• simple, concrete, today & tomorrow focus
- use physical advantages when listing Pros & Cons
- use peer situations
identify confidentiality boundaries

35
Q

Teaching Adults

A
  • 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
36
Q

Families

A
•	assessment
•	function
•	involvement with children
•	teaching
o	more effective
- resource for the individuals
- strong interrelationship between family &amp; health of it's member
37
Q

Physical activity

A

o children 60 minutes per week
o adults 150 minutes per week
• formula
o 220 – age X 0.6 = target HR

38
Q

Dash Diet

A

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.

39
Q

Modifiable Risk Factors

A
•	High cholesterol
•	Smoking
•	DM
•	Thyroid
•	30% unaware of thyroid issues
o	Contributing behaviors
•	Diet
•	Physical activity
•	37% of adults are obese
40
Q

Non-Modifiable Risk Factors

A
  • Age
  • Family hx
  • Genetic determinants
41
Q

CVD

A
  • 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
42
Q

Benefits of Lowering B/P

A
  • Decreased CVA by 35 – 40%
  • Decreased MI by 20 – 25%
  • Decreased HF by 50%
43
Q

JNC - 8 Recommendations

>60

A

Goal: <150/90

44
Q

JNC - 8 Recommendations

<60

A

Goal: <140/90

45
Q

JNC - 8 Recommendations

Tx non-black

A

Thiazide type diuretic, CCB, ACE – 1 or ARB.

No beta-blockers for initial Tx, larger stroke outcome.

46
Q

JNC - 8 Recommendations

Black

A

Thiazide type diuretic or CCB

47
Q

JNC - 8 Recommendations

18 w/ CKD & HTN

A

monitor labs: place on ARB & ACEI

48
Q

Reduction of LDL w/ diet changes

A

8 - 14 mmHg

49
Q

Reduction of LDL w/ lower sodium, <2.4 GM/day

A

2 - 8 mmHg

50
Q

Reduction of LDL w/ physical activity, aerobic activity

A

4 - 9 mmHg

51
Q

Reduction of LDL w/ ETOH limited to 1 - 2 drinks

A

2 - 4 mmHg

52
Q

Pt. to receive Statins

A

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

53
Q

High Intensity Statin

A
  • LDL lowered at least 50%
  • Atorvastatin 40/80mg
  • Rosuvastatin 20/40mg
54
Q

Moderate Intensity Statin

A
  • LDL lowered 30 – 50%
  • Atorvastatin 10/20mg
  • Rosuvastatin 5/10mg
  • Simvastatin 20/40mg
  • Pravastatin 40/80mg
  • Lovastatin 40mg
  • Pitavastatin 2-4mg
55
Q

Low Intensity Statin

A
  • LDL lowered <30%
  • Simvastatin 10mg
  • Pravastatin 10-20mg
  • Lovastatin 20mg
  • Fluvastatin 20-40mg
  • Pitavastatin 1mg
56
Q

Labs to check prior to Tx initiation Statin

A

o Fasting lipid
o A1C, if DM unknown
o ALT
o CK, if indicated

57
Q

Monitor response of Statin initiation

A

in 6 wks. and then routine q 6 – 12 months.

58
Q

Family Genogram

A

Family diagram that views the family from identification data that depicts each member of the family with connections between the Generations