Lecture Material Week 4 Flashcards
Name some factors to consider about patient variation that will impact what they allow:
Age Education Religion Health literacy & beliefs Beliefs and Norms Language Family Offense in language and gestures Values
Can you think of examples in which cultural adjustments would need to be made?
Communication Issues
Translator & Body language
Offensive gestures
Handshakes with Islamic women etc
Name some questions to consider when evaluating pts health beliefs:
Pts perception about:
What caused it?
How has it impacted you?
Have you seen anyone?
What remedies have you tried?
Will you accept my treatment?What can be said about the idea of family to a patient?
Traditional family model doesn’t always apply
Ask about definition to pts, roles, family values, who has decision making
If unsure about a pts beliefs, religion, practices, what should you do?
Ask, pts generally responsive and willing to educate.
Avoid making assumptions
What do assumptions lead to?
Bias
Why would asking about nutrition be important?
Deficiencies
Food borne illnesses
Chronic disease (osteoporosis)
Evaluate rituals, foods, avoidance, allergies, preparation practices
What nutritional def might a vegan commonly have?
zinc, B12, D, Calcium, amino acids
What is pellagra?
A deficiency of niacin
Manifests often as 4 Ds,
photosensitive dermatitis, diarrhea, dementia, and death
What does vitamin C def lead to commonly?
Scurvy
Ricketts
What are important life events to consider with your pts?
Prenatal Care Death Afterlife beliefs Acceptance of blood products Acceptance of organs or tissues
What are topics to discuss concerning religion?
Religion Participation Prayer Relationship between religion and healthcare Taboos affecting healthcare
If a patient fills out a form prior to their well visit, what is your responsibility concerning it?
Document that it was reviewed with pt
Well visits count for what fraction of ambulatory care?
1/5 of ambulatory care
What is health maintenance?
holistic approach to minimize illness and death
What is a screening?
Any test used to detect disease in those at risk
Levels of Prevention:
Primary: complete prevention of illness
vaccines, hand washing, safer sex
Secondary: Aim to detect in earliest asymptomatic stages
Mammography, HIV screen, PSA
Tertiary: Aim at elimination of consequences
Most health care measures
Diabetic managing to prevent neuropathy
Complete documentation of adult preventative care includes:
ID of risk factors Age/gender screenings Lab testing Counseling and Education Immunization status and administration
What is a risk factor?
Any life variable known to have linkage to increased risk of illness, death, and disability
Why bother to identify risk factors?
While some are un-modifiable (genetic)
Many factors are modifiable
risky behaviors
smoking
diet
Take care to avoid biases!
Name at least five modifiable risk factors
Exercise Diet/Nutrition BMI Tobacco Use EtOH/ Drug use Sexual practices Partner violence Safety measures Occupational history Oral health Blood product transfusions
What does syncope during exercise indicate?
Heart problem
Factors to discuss about exercise:
Type, Duration, Frequency
Any induced symptoms?
Recommended : 30min/ 5xweek
combined cardio and wt
Screen for related conditions:
Anorexia
Over exertional syndromes
Dehydration
Early onset osteoporosis
Factors to discuss about diet and BMI
Frequency and type of food Proportion of caloric intake Screen for nutritional deficiencies Caffeine and vitamin use BMI
What is BMI?
Body Mass Index
wt. controlled for height
(Wt in lbs/ (ht in inches X height in inches)) X 703
BMI numbers and classes:
Normal up to 24.9
Overweight 25-30
Obese >30
Morbidly obese >35
What fraction of Americans use tobacco products?
1/5
Smoking contributes to what percentage of deaths?
20%
What length of education on smoking has been shown to improve outcomes?
2 minutes
What factors are discussed/ documented concerning smoking?
Document type, frequency, when quit
ALWAYS document education
Nicotine replacement therapy
Support systems
Health benefits
Psychodynamic factors (other smokers)What should be addressed/documented concerning alcohol consumption?
Document type, amount, frequency
Screen for Abuse: CAGE
Those with 2+ responses have 7 fold risk of dependence above general population
What is CAGE and how sensitive is it?
C= said you should cut down A= annoyed you G= made you feel guilty E= Eye opener
~ 75% sensitive
Besides CAGE, what other screening test is used. Is it better or worse than CAGE?
AUDIT screening developed by WHO
10?s
More sensitive than CAGE (94%)
What is misuse (in concern to drugs)
unintended purpose or more than prescribed
What is a relatively quick questionnaire addressing drug abuse?
DAST10- Harvey Skinner
Name some drugs of abuse
Marijuana, amphetamines, LSD ,MDMA (molly), mescaline, PCP, ecstasy, opiates, benzodiazepines, barbiturates, glue, huffing inhalants, cocaine, crack
Describe DAST-10 survey
Screens for drug abuse 10 item self report Yes/no written instrument Intended for >r18 Risk stratifies pts
Once an adolescent becomes pregnant, they are an….
emancipated minor
What should be documents for sexual history?
5P's: Partners M/W/both how many Practices Protection from STD Past STD Pregnancy prevention
Who is affected by intimate partner violence?
Men and women
Female prevalence: 50% in a lifetime
Pregnant women at great risk
What infers increased risk for IPV?
+ family history increases risk of intimate partner violence
What to consider/document for IPV?
Always assess safety in home and if pt has a safe place to go
Involve social services early
Document safety plan, referrals, education, and pt understanding
Besides effect for pt, why is IPV a big deal?
Large public health burden
Increased morbidity and mortality
Cost to system exceed 8 billion dollars and 8 million days of missed work
Accident safety questions/topics
Helmet use (bikes motorcycles)
Home Safety: firearms, poop
Sunscreen Use
Older adults: assistance devices for ADLs, safety rails
Children require car seats up to 4yrs or 40lbs
Occupational safety questions/topics
Document pts job type and location
Evaluate potential job hazards
What does OSHA do?
Occupational Safety & Health Administration Monitor exposures: mechanical injury physical- noise, radiation biological- pathogens Chemical Psychosocial
What accounts for 1/3 of all occupational injuries
Back injuries
Why is oral health of concern?
Where would you document it?
Usually document in ROS ENT
Document dental habits, pathology, and dental care
-growing public health problem
-gum disease linked to increased CVD risk
-oral cancer >55 in smokers/drinks, HPB
According to CDC
Fraction of adults with tooth decay:
Fraction 35-44 w/ gum disease
Fraction>65 w/ gum disease
1/3 have untreated tooth decay
1/7 adults 35-44 with gum disease
1/4 adults over 65 with gum disease
What is documents concerning past blood products?
Document history, type, reason, and reactions
Document reaction and infectious disease screenings
What is the most common infectious diseases passed through blood products?
Hep B and Hep C
Complications to blood products:
Anaphylaxis
Iron Overload
TRALI- transfusion related lung injury
hemolytic reactions
What type of blood transfusion eliminates the risk of incompatibility and infectious transmission?
Autologous
Red flags in FH dealing with hereditary risks
Early age onset
Two or more 1st degree relatives
Two or more related conditions in one relative
Conditions that are refractory to prevention and usual treatment
(BRAC1 gene, ovarian, breast, prostate CA)
When should colonoscopy use start?
Greater than 50
unless other risk factors
When should FOBT start?
Greater than 40
Mammography after…
40 than annually
Pap smear test starts
21 or sexually active. annually
Following 3 normal tests in a row, every 3 yrs
DEXA in women greater than
65
HIV and Syphilis screening
All adults over 18 and at risk
Breast exam at
20 and every 3 yrs until 40
yearly after 40
Hernia and testicular exam at
18 and yearly
PSA and prostate exam at
50 and yearly
Focus on WWE
Sexual history IPV Reproductive Education- self breast exam Menopausal/ post menopausal concerns STD concerns
Focus on well man exam
issues pertinent to demographic
Testicular exam, hernia, prostate, rectal, FOBT, PSA, sexual health
Document refusal, deferral, and education appropriately
What to do when pt defers/refuses
Document refusal if pt declines after education
Deferral implies will be addressed later
Document reason for refusal if able
Provide adequate education and document
Patient education is ordered and provided in what percent of office visits?
35%
Most common patient education?
Nutrition and exercise
Who is geriatric?
Those over 65
Common ADLs
What index is used?
bathing, dressing, continence, feeding
Katz index
Common IDLs
What index is used?
shopping, driving, phone, cooking, finances
Lawton Index
Common sensory geriatric problems
vision, hearing, speech
When should you screen for glaucoma
Age 60 or earlier if at risk
