Lecture Material Week 4 Flashcards by Brittany Hansel

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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?

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

If unsure about a pts beliefs, religion, practices, what should you do?

Ask, pts generally responsive and willing to educate.

Avoid making assumptions

How well did you know this?

Not at all

Perfectly

What do assumptions lead to?

Bias

How well did you know this?

Not at all

Perfectly

Why would asking about nutrition be important?

Deficiencies
Food borne illnesses
Chronic disease (osteoporosis)

Evaluate rituals, foods, avoidance, allergies, preparation practices

How well did you know this?

Not at all

Perfectly

What nutritional def might a vegan commonly have?

zinc, B12, D, Calcium, amino acids

How well did you know this?

Not at all

Perfectly

What is pellagra?

A deficiency of niacin
Manifests often as 4 Ds,
photosensitive dermatitis, diarrhea, dementia, and death

How well did you know this?

Not at all

Perfectly

What does vitamin C def lead to commonly?

Scurvy

Ricketts

How well did you know this?

Not at all

Perfectly

What are important life events to consider with your pts?

Prenatal Care
Death
Afterlife beliefs
Acceptance of blood products
Acceptance of organs or tissues

How well did you know this?

Not at all

Perfectly

What are topics to discuss concerning religion?

Religion
Participation
Prayer
Relationship between religion and healthcare
Taboos affecting healthcare

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Well visits count for what fraction of ambulatory care?

1/5 of ambulatory care

How well did you know this?

Not at all

Perfectly

What is health maintenance?

holistic approach to minimize illness and death

How well did you know this?

Not at all

Perfectly

What is a screening?

Any test used to detect disease in those at risk

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Complete documentation of adult preventative care includes:

ID of risk factors
Age/gender screenings
Lab testing
Counseling and Education
Immunization status and administration

How well did you know this?

Not at all

Perfectly

What is a risk factor?

Any life variable known to have linkage to increased risk of illness, death, and disability

How well did you know this?

Not at all

Perfectly

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!

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What does syncope during exercise indicate?

Heart problem

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

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