Module 1 - Health Promotion, Screening, & Immunizations Flashcards
1
Q
How often should patients receive the influenza vaccine?
A
- Recommended annually for all age groups unless contraindicated
- Special populations: high risk populations include residents of chronic care facilities and nursing homes, individuals with a pmhx of asthma, neurological disorders, COPD, cystic fibrosis, CAD, DM, CKD, HIV/AIDs, cancer, pregnant women, American Indians and Alaskan Natives
2
Q
How often should patients receive the Tetanus, Diphtheria and acellular pertussis (Tdap) vaccine?
A
- Adults with unknown or incomplete history of 3 dose primary series should complete the primary adult series which includes 1 dose Tdap followed by 2 doses of Td at 1 month and 6 months
- Then they will need a Tdap booster every 10 years
- Special Populations: Pregnant women should receive 1 dose of Tdap during each pregnancy, preferably during gestational weeks 27-36, regardless of prior history of receiving Tdap.
3
Q
How frequently should adults get vaccinated for varicella?
A
- Adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine (VAR) 4-8 weeks apart
-
Pregnant women and immunocompromised patients should NOT receive the vaccination
- They should get vaccinated after their pregnancy
4
Q
When should patients receive their herpes zoster vaccination?
A
- This vaccination is recommended for all adults aged 60 years or older, regardless of whether they had a prior episode of herpes zoster
- Special Populations: NOT RECOMMENDED in Adults age 60 years or older with severe immunodeficiency or malignancy that affects the bone marrow or lymphatic system or who receive systemic immunosuppressive therapy, or HIV+ adults with a CD4 T-lymphocyte count <200.
5
Q
When should patients receive the HPV vaccine?
A
- Adult females through age 26 years and adult males through age 21 years who have not received any HPV vaccine should receive a 3-dose series at 0 months, 1-2months, and 6 months.
- Special Populations: Men who have sex with men through age 26 should receive 3 dose series; Adult females and males through age 26 years with immunocompromising conditions ( including HIV, transplantation, malignant neoplasm, autoimmune disease and immunosuppressive therapy) should receive a 3 dose series.
- Pregnant women are NOT recommended to receive vaccine- although the vaccine poses no harm.
6
Q
When should patients receive their pneumococcal vaccination?
A
- Adults age 65 yrs or older are recommended to receive 1 dose of PCV13 and 1-3 doses of PPSV23 (5 years apart) depending upon indications. Do not administer both in the same visit.
- If an adult 65 yrs or older receives PPSV23 initially, no further doses of PPSV23 are indicated.
7
Q
What type of patients should receive the PPSV23 Pneumococcal vaccination?
A
- Adults age 19-64 with chronic heart/lung/liver disease, asthma, DM, or cigarette smokers
- At age 65 yo they should also receive recommended dosing above.
8
Q
What type of patients should receive the PCV13 Pneumococcal vaccination?
A
- Adults age 19-64 yrs with immunocompromising conditions or anatomical or functional asplenia (including splenectomy) should receive PCV 13 and a dose of PPSV23 8 weeks later, followed by a 2nd dose of PPSV23 5 years after first dose.
- At age 65 years they will need additional dosing.
9
Q
When should patient’s receive the hepatitis A vaccine?
A
Adults any age group may receive a 2 dose series of single-antigen hepatitis A vaccine (HepA) at 0 and 6-12 months
10
Q
Who is the Hepatitis A vaccine recommended for?
A
- The series is recommended for adults with the following indications: chronic liver disease, receiving clotting factor concentrates, men who have sex with men, use injection or non-injections drugs or work in labs with hepatitis A virus-infected primates.
- Also, adults who travel in countries with high or intermediate levels of endemic hepatitis A or anticipate close personal contact with an international adoptee from a country as stated above should receive vaccination within the first 60 days of arrival in the US.
11
Q
When should patients receive the hepatitis B vaccination?
A
- Adults who seek protection from hepatitis B virus infection may receive a 3 dose series of single-antigen hepatitis B vaccine (HepB) at 0, 1, and 6 months.
- This is an optional vaccination
12
Q
Which populations are at high risk for hepatitis B and should be vaccinated?
A
- Sexual exposure: sex partners of HBsAg positive persons, sexually active persons who are not in a mutually monogamous relationship, persons seeking evaluation or treatment for a sexually transmitted infection and men who have sex with men
- Injection drug users, household contacts of HBsAg positive persons, residents and staff of facilities for developmentally disabled persons, incarcerated, healthcare and public safety workers
- Adults with chronic liver disease, including Hep C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis and elevated LFTs > twice the upper limits of normal.
- Adults with ESRD on dialysis, HIV + individuals should receive series.
- Pregnant women who are at risk for HepB virus by inclusion of any of the above mentioned classes.
13
Q
When and who should patients receive a meningococcal vaccination?
A
- First-year college students aged 21 or younger who live in residence halls should receive 1 dose of MenACWY and revaccinate in 5 years if they have not received MenACWY at age 16 years or older.
14
Q
What type of patients should receive the Haemophilus influenza type b vaccination?
A
- Adults who have anatomical or functional asplenia or sickle cell disease, or who are undergoing elective splenectomy should receive 1 dose of H. influenza type b conjugate vaccine (Hib) if they have not previously received Hib.
- Hib should be administered at least 14 days prior to splenectomy.
- Adults with a hematopoietic stem cell transplant should receive 3 doses of Hib in at least 4 week intervals 6-12 months after transplant regardless of their Hib history.
15
Q
What is primary prevention?
A
Defined as health promotion that receded disease or onset of symptoms
16
Q
What is secondary prevention?
A
- Defined as identification and diagnosis, early intervention and limitation of disability in disease and injury encompassing secondary response to illness.
- Goals are to shorten or halt the disease process or prevent complications and further disability.
17
Q
What is tertiary prevention?
A
- The main goal of tertiary care is to restore or arrest disability. Objectives include returning the patient to optimal health within the constraints of disease impairment, preventing a further decline or arresting the progression of disease complications.
- Consulting specialized services- occupational, speech therapy, rehabilitative services, etc.) are examples of tertiary care. The inclusion of an interdisciplinary team to manage services is the best care model.
18
Q
What are the guidelines for coronary artery disease screening?
A
- Beginning at age 20, a fasting lipoprotein profile is recommended every 5 years, to include total cholesterol, LDL, HDL, and triglycerides.
- If total cholesterol > 200mg/dl, a cardiovascular disease risk factor screening is also indicated.
- Recommended daily intake of cholesterol is < 300mg
19
Q
What are the guidelines for breast cancer screening for women?
A
- Age < 40yo who are NOT high risk: self- breast exam monthly & clinical breast exam every 3 years
- Age < 40 yo who ARE high risk: self- breast exam monthly & clinical breast exam annually; mammograms ordered in consultation with physician regarding risks.
- Age > or equal to 40 yo who are NOT high risk: self-breast exam monthly & clinical breast exam annually; may begin screening mammograms between age 40-50 yrs old; after age 50 recommend mammograms annually in all cases
- Age > or equal to 40 yo who ARE high risk: self-breast exam monthly, clinical exam annually and mammogram annually
- Age > 74 yo annual screening should continue as long as life expectancy is > 10 years based on co-morbidities.
20
Q
What are the cervical cancer screening guidelines?
A
Pap test in females every 3 years beginning after intercourse or by age 21 years.
21
Q
What are the diabetes screening guidelines?
A
Assessment at age 45 years of age for all genders to include: blood glucose every 3 years.
22
Q
What are the colorectal cancer screening guidelines?
A
Assessment at age 50 years of age for all genders to include:
- Colorectal screening- annual home fecal occult blood testing and flexible sigmoidoscopy every 5 years or a double contrast barium enema or colonoscopy every decade.
- High risk patients ( if history of polyps, inflammatory bowel disease and heritable risk factors)- begin screening at age 40
23
Q
What are the prostate cancer screening guidelines?
A
- Prostate-specific antigen (PSA) with a digital rectal examination (DRE) for average risk males annually
- PSA with annual DRE for high risk patients (positive family history) at age 40
24
Q
What are the osteoporosis screening guidelines?
A
- Women at age 65 years should undergo screening for osteoporosis
- If the following risk factors are present, begin screening at age 60:
- weight less than 70 kg
- no estrogen replacement
- family history
- Smoking
- sedentary lifestyle
- alcohol or caffeine use
- low calcium or vitamin D ingestion
25
Q
What are the skin cancer screening guidelines?
A
- The 2016 U.S Preventive Services Task Force concludes that for asymptomatic adults, current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.
- If suspicious lesions develop, using the ‘ABCDE rule’ which involves looking for the following characteristics: asymmetry, border, irregularity, non-uniform color, diameter greater than 6 mm and evolving over time- individuals should contact their clinician for assessment.
