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Fall 2020 Primary Care FNP > Middle Adult > Flashcards

Middle Adult Flashcards

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1
Q

Middle Adult

Age

A

35-65

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2
Q

Developmental Theories

  • Middle Adult: ______ vs Self-______
    • Helping _____ become responsible, happy adults
    • Rediscovering or developing new ______ in the ______ with spouse
    • Developing an affectionate but ______ relationship with aging ____
    • Reaching the peak in one’s ______
    • Achieving mature s____ and c____ responsibility
    • Accepting and adapting to b______ changes
    • Maintaining and developing _____ships
    • Developing leisure time ______
A
  • Generativity vs. Self Absorption
    • children
    • satisfaction, relationship
    • independent, parents
    • career
    • social, civic
    • biological
    • friendships
    • activities
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3
Q

History

PMH

A
  • HTN
  • Anemia
  • CHF
  • Valvular Disease esp MVP
  • Dyslipidemia
  • Cancer
  • DM 1/2
  • OA/RA
  • CKD
  • Hep B/C
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4
Q

History

PSH

SH

FH

A
  • TAH (total abdominal hysterectomy)
  • TNR
  • ORIF-Hips (know any ortho surgeries bc usually need to be on standing anticoags)
  • Cholecystectomy
  • Support
  • Advance Directives
  • Cancer
  • Blood D/O, Glaucoma
  • Age of Demise
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5
Q

Risk Factors For Disease

  • Al______
  • Prescription and Street ____ use
  • Sm______
  • S______ Lifestyle
  • H_____
  • Lack of ______ to Shopping
A
  • Alcohol
  • Drug
  • Smoking
  • Sedentary
  • Housing
  • Access
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6
Q

Medications

  • _______ F___ and D___*
  • H____ Supplements
  • Medications that cause _______
  • ____pharmacy
    • Multiple _____
    • Multiple _____
A
  • ALLERGIES, FOOD and DRUG
  • Herbal
  • bleeding
  • polypharmacy
    • providers
    • pharmacies
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7
Q

Health Maintenance Guidelines

  • B_____
  • CPE =
  • F _ _ _
  • S____/C_____
  • P _ _
  • Mamm_____
A
  • Bloods
  • Complete Physical Exam
  • FOBT
  • Sigmoidoscopy/Colonoscopy
  • PSA
  • Mammogram
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8
Q

Health Maintenance Guidelines cont.

  • Calculating B _ _
  • Imm______
  • S _ _?
  • H___- C?
  • PP _ ?
  • D_____ Evaluations
  • H_____ and V_____ Screening

When to screen AAFP

A
  • BMI
  • Immunizations
  • STI
  • Hep C
  • PPD
  • Dental
  • Hearing, Vision
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9
Q

What website to go to for evidence based clinical preventitive services such as screenings, couseling services, and preventative medications?

A

US Preventitive Service Task Force

https://www.uspreventiveservicetaskforce.org/uspstf

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10
Q

Screening Guidelines

  • Visit (4) for cancer, everyday, DM, Heart
  • _ _ _ _ -2019 Clinical Preventive Service Recommendations (Files and Resources)
  • Electronic Preventive Services Selector? http://epss.ahrq.gov/PDA/index.jsp
A
  • www.cancer.org, www.everydaychoices.org, American Diabetes Association, and American Heart Association
  • AAFP
  • The USPSTF recommendations app for mobile devices
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11
Q

AHA CV Risk Calculator

  • 2018 Prevention Guidelines Tool CV Risk Calculator
    • What website?
  • ASCVD Risk Estimator Plus - American College of Cardiology
    • What website?
A
  • CV Risk Calculator
    • http://static.heart.org/riskcalc/app/index.html#!/baseline-risk
  • ASCVD Risk Estimator
    • http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
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12
Q

Lipid Screening

  • Age ___ or older have their cholesterol and other traditional risk factors checked every ____ to ___ years
  • After age ___, your HCP will also want to use an _____ to calculate your __-year risk of experiencing ___ or ____.
A
  • 20, 4-6 yrs
  • 40, equation, 10yr, CVD or stroke
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13
Q

2018 Journal of American College of Cardiology (JACC)

  • Total Cholesterol
    • Low
    • Good
    • Borderline to moderately elevated
    • High
  • HDL Cholesterol
    • Low
    • Good
    • Borderline to moderatley elevated
    • High
  • LDL Cholesterol
    • Low
    • Good
    • Borderline to moderately elevated
    • High
  • Triglycerides
    • Low
    • Good
    • Borderline to moderately elevated
    • High
A
  • Total
    • n/a
    • <200 (lower the better)
    • 200-239
    • > 240
  • HDL
    • <40
    • Ideal > 60, > 40 men, > 50 women
    • n/a
    • > 60
  • LDL
    • n/a
    • <100, <70 if CAD present
    • 130-159
    • > 160, _>_190 very high
  • Triglycerides
    • n/a
    • <149, ideal <100
    • 150-199
    • _>_200, 500 very high
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14
Q

Blood Glucose

USPSTF recommendations

A
  • Recommends screening for abnormal blood glucose as part of CV risk in adults 40-70 yo who are overweight or obsese
  • Clinicians should offer or refer pts with abnormal BG to intensive behavioral counseling interventions to promote healthful diet and physical activity
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15
Q

HgB A1C

Chart

A
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16
Q

Fasting Blood Glucose

  • The normal fasting blood glucose range for adults in most labs is ___-___ mg/dL. The normal range may vary slightly from lab to lab
  • Imaired fasting glucose lvl=
  • Prediabetes glucose lvl=
  • Diabetes lvl=
  • At what age to test?
    • Age ___ then
    • Age 50-65 Q__ years
    • 65+ Q __ years
A
  • 70-100
  • > 100
  • 100-125
  • > 126
  • 45
  • Q3y
  • Q3y
17
Q

Blood Testing –before you order–

  • The Health Care Finance Administration (HCFA) requires ______ carriers to establish policies to ensure the medical _____ of services being paid for by the Medicare program
  • Carriers in your local area have the authority to establish a list of B____ tests and test pro_____ which may require medical do______ in order for re______ to take place
  • Carriers will then only approve payment for those particular test procedures when they have determined them to be medically necessary for the pt. As a result, a claim submitted without a diagnosis c____ that indicates medical necessity based upon local carrers policites. You will then have to pay for these Blood tests out of your own ______
A
  • Medicare, necessity
  • Blood, procedures, documentation, reimbursement
  • code, pocket
18
Q

Cervical Cancer Screening

  • Women aged 21-65y
    • The USPSTF recommends screening for cervical cancer every
      • 21-29 yo =
      • 30-65 yo =
    • https://www.aafp.org/afp/2019/0215/od1.html
A
  • 3y with cervical cytology alone
  • 3y with cervical cytology alone, every 5 years with high-risk HPV (hrHPV) testing alone, or every 5y combination of both

No screening >65 unless high risk

19
Q

Cervical Cancer Screening

USPSTF recommendations for women >65

A

Recommends AGAINST screening for cervical cancer in women >65 who have adequate prior screening and are not otherwise at high risk for cervical cancer

20
Q

Mammogram ACP 2019

  • Age 40 =
  • Age 50-74
A
  • Ave risk women without sx should start to discuss with physician benefits, harms, and personal preferences of br CA screening w mammography before 50 yo
  • Screen with mammography every other year

American College of Physicians

21
Q

Mammogram USPSTF

USPSTF Recommendations

40-49?

Women who place a higher value on the potential benefit than the potential harms may choose to begin _____ screening btwn age 40-49.

A

40-49 yo, decision to start screening mammography in women prior to age 50 should be an individual one.

biennial

22
Q

Mammogram

What age range do we screen? And how often?

A
  • Women 50-74 yo
  • USPSTF recommends biennial screening mammography for women aged 50-74y.
23
Q

Mammogram USPSTF

  • In addition to false _____ and unnecessary b______, all women undergoing regular screening mammography are at risk for diagnosis and treatment of noninvasive and invasive BR CA that would otherwise not have become a threat to their health or even apparent, during their lifetime (known as “_______”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent over______.
  • Women with a parent, sibling, or child with br CA are at a ______ risk for br CA and thus may benefit more than average-risk women from beginning screening in their __’s.
A
  • positives, biopsies, “overdiagnosis”, overtreatment
  • higher risk, 40’s
24
Q

Breast Cancer

  • The most likely to benefit from screening are those at ______ risk
    • _ MH in a m_____ or s______
    • Previous biopsy with atypical _______
    • First childbirth =
A
  • increased
    • FMH, mother, sister
    • hyperplasia
    • after age 30
25
Q

Breast Cancer

  • The age to discontinue mammography is ______
  • _____ women have a higher probability of getting and dying from breast CA, but also a greater risk of dying from ____ causes
  • Women with ______ conditions limiting their life expectancy are _____ to benefit from screening mammography
  • ______ evidence showing that CBE’s and SBE’s affect breast cancer moratlity
A
  • uncertain
  • Older, other
  • comorbid, unlikely to benefit
  • Insufficient
26
Q

SBE (Self Breast Exam)

  • Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast ca that _____ potential harms
  • These discussions should include the _______ regarding each screening test, the risk of breast ca, and individual patient pre_____. The recommendations below are based on current best evidence as summarized by the USPSTF and can help ____ physicians and pts
  • These recommendations are intended to apply to women who are ____ at increased risk of developing Breast Ca and only apply to _____ screening procedures.
A
  • minimizes
  • evidence, preferences, guide
  • not, routine
27
Q

Colon Cancer

  • Strongly recommends screening men and women ___ y and older for colorectal cancer
    • _ _ _ _
    • Flexible _______
    • _ _ _ _ + Flexible _____
    • C_______
    • Double _____ Barium _____
      • Recommendation will change this year
A
  • 50
    • FOBT
    • Sigmoidoscopy
    • FOBT + Flex Sigmoidoscopy
    • Colonoscopy
    • Contrast Enema
28
Q

Direct Visualization Tests

How often?

  • ​Colonscopy
  • CT Colonography
  • Flex Sig
  • Flex Sig with FIT
A
  • Every 10 y
  • Every 5 y
  • Every 5 y
  • Every 10 y
29
Q

Stool Based Tests

How often?

  • FOBT?
  • FIT?
  • FIT-DNA?

Starts at 50 unless family hx, which in this case when do you start?

A
  • Every year
  • Every year
  • Every 1-3 years

If fam member was diagnosed at 45 you minus 5 years and start screening pt at age 40

30
Q

Colon Cancer

  • Screening strategy should be based on _____ options, medical con______, patient _____ and ad_____. Risks and benefits of each should be discussed with patients.
  • Testing interval depends on the ____.
  • _____ done ______ has the greatest reduction in mortality.
A
  • available, contraindications, preferences, adherence
  • test
  • FOBT, annually
31
Q

Colon Cancer

  • __-__ yrs for Colonoscopy based on the natural history of a_____ p___.
  • __ year intervals for (2)
  • Initiating screening at age < __ should be done in ___ risk individuals and those with a ___ member with colon cancer at age < ___
  • BEGIN AT AGE __
A
  • 8-10, adenomatous polyp
  • 5, Flex Sigs and Double contrast barium enema
  • <50, high risk , fam member, <60
  • 50*
32
Q

Ovarian Cancer Screening

  • Recommendations?
    • Includes (3) tests
  • __ evidence showing that these interventions reduce mortality
  • FYI: ______ Cancer
A
  • AGAINST routine screening
    • CA-125, US, Pelvic Exam
  • No
  • UTERINE

Bleeding post menopausal - should be screened for uterine cancer

33
Q

Health Maintenance

  • D___/Ex______
  • Screening for D______
  • Screening for I _ _
  • Risk Reduction - _______ use, s_____ activity
  • Imm_____
  • P_ _ Testing
  • C _ _
  • B____ Work
  • Sc_____ Tests
  • D____/V_____
A
  • Diet/Exercise
  • Depression
  • IPV
  • Substance, Sexual
  • Immunizations
  • PPD
  • CPE
  • Blood
  • Screening
  • Dental/Vision
  • TB testing is rly based on individuals. Health care workers, etc.*
  • In primary care, rly depends on pts insurance - in this age group: CBC, BMP, LFTs, Thyroid T4 or TSH, VDLR (Syphilis) may be appropriate, and urinalysis*
  • Dental and Vision Q2 yrs is fine*

Fall 2020 Primary Care FNP (11 decks)

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