Prevention

Question 1

Primary prevention goal and examples

Answer 1

preventing health problems Most cost effective form of healthcare Examples: immunizations, counseling for safety; injury prevention and disease prevention

Question 2

Secondary prevention goal and examples

Answer 2

Detecting disease in early, asymptomatic or preclinical state. minimize impact. Examples: BP check; mammography; colonoscopy

Question 3

Tertiary prevention goal and examples

Answer 3

In established disease, minimize the effects and adjusting therapy to avoid further organ target damage.

Question 4

What are immunization principles?

Answer 4

1. remove geographic and clinical practice barriers example: provide immunization at senior centers
2. When in doubt-re-immunize
3. IZ differed is an IZ denied. IZ are only deferred in moderate to severe illness with or without fever.

Question 5

onset, duration and benefits of active immunity

Answer 5

immunity from response to vaccine via formation of AB onset of protection is usually 1 month duration is years to life long available for a wide variety of infectious disease

Question 6

onset, duration and benefits of passive immunity

Answer 6

Immunity conferred by AB produced by another host onset of protection is usually within hours duration is time limited - usu 6-9 months available for a limited number of infectious disease examples: varicella, hep A or B; tetanus, rabies, others

Question 7

Rules for tetanus vaccination in Immunocompetent for clean, minor wounds All other wounds (wounds > 6 hours, contamintated with soil, feces, saliva, dirt; puncture, crush, avulsions; wounds from missiles, burns or frostbite.

Answer 7

Tdap/Td IM with hx of < 3 doses or unknown. NO TIG. Tdap if hx of > 3 doses & > 10 years since last IZ. No TIG Tdap/Td IM and TIG, 250 units IM with if hx of < 3 doses. Tdap/Td IM if > 3 doses and > 5 years since last IZ. No TIG

Question 8

Other tetanus considerations

Child < 7 Booster

for adolesents and adults

Pregnancy

Answer 8

DTaP (DT if pertussis contraindicated) Tdap Dose of Tdap for each pregnancy

Question 9

IZ to avoid with a Hx of an aphylactic reaction with neomycin

Answer 9

IPV, MMR, varicella

Question 10

IZ to avoid with a Hx of an aphylactic reaction with streptomycin; polymixin B

Answer 10

IPV, vaccinia (small pox)

Question 11

IZ to avoid with a Hx of an aphylactic reaction with

Answer 11

???

Question 12

IZ to avoid with a Hx of an aphylactic reaction with baker’s yeast

Answer 12

Hepatitis B, HPV

Question 13

IZ to avoid when pregnant or immunocompromised

Answer 13

MMR; Varicella, Zoster

Question 14

IZ to avoid with intussception

Answer 14

rotavirus

Question 15

IZ to avoid with a Hx of an aphylactic reaction with gelatin

Answer 15

??

Question 16

Live Vaccines Population precautions - pregnancy, immunocompromised, HIV

Answer 16

MMR, Varicella (chicken pox) Zoster (zostavax), Intranasal influenza virus (flumist), yellow fever, rotavirus, - infants LAIV, Vaccinia.

Question 17

What are the immediate interventions for anaphylaxis in primary care settings?

Answer 17

Assess ABC Place patient in supine position Activate EMs and facilitate transfer to ED Administer IM EPI (antereolateral thigh) NO ConI Give H1/H2 blockers (H1= diphenhydramine, H2= ranitidine. IV access, oxygen, monitor

Question 18

Define anaphylaxis

Answer 18

acute onset of after exposure Skin and/or mucosa and either respiratory compromise or BP or end organ dyfunction

Question 19

anaphylaxis of skin and/or mucosa Anaphylaxis noted respiratory compromise

Answer 19

pruritis, urticaria (hives), angioedema dyspnea, wheeze, bronchospasm, stridor

Question 20

comparison for shingrix and Zostavax

Answer 20

shingrix not live; Zosta is live attenuated S: 50 or older Z: 60 or older S: cn be given in immunosuppression V: contraindicated for pregnancy, Immunocompromised

Question 21

How to calculate Pack per day hx

Answer 21

number of packs-per-day x number of years smoked.

Question 22

Stages of change theory explain and NP intervention

1. precontemplation

Answer 22

1. No interest, unaware or minimizes the problem

NP: Help patient move toward thinking about changing the unhealthy behavior

Question 23

Stages of change theory: explain and NP intervention 2. contemplation

Answer 23

2. More aware of the consequences of their behavior; might feel stuck Help patient examine and benefits and barriers

Question 24

Stages of change theory explain and NP intervention

3. preparation/determination

Answer 24

3. Shows some change behaviors but might not feel like they have tools to change.

NP: Assist with finding tools to help and lower and remove barriers to change

Question 25

Stages of change theory explain and NP intervention

4. Action/Willpower

Answer 25

4. Believe they have the ability to make the change and actively working to make change. work with patient on use of tools.

NP: Praise change. Acknowledge reverting is common but not insurmountable.

Question 26

Stages of change theory explain and NP intervention 5. Maintenance

Answer 26

5. Maintain the new status quo; avoid back sliding. continue with positive reinnforcement.

NP: Discuss ways to avoid backsliding.