Prevention Flashcards
Primary prevention goal and examples
preventing health problems Most cost effective form of healthcare Examples: immunizations, counseling for safety; injury prevention and disease prevention
Secondary prevention goal and examples
Detecting disease in early, asymptomatic or preclinical state. minimize impact. Examples: BP check; mammography; colonoscopy
Tertiary prevention goal and examples
In established disease, minimize the effects and adjusting therapy to avoid further organ target damage.
What are immunization principles?
- remove geographic and clinical practice barriers example: provide immunization at senior centers
- When in doubt-re-immunize
- IZ differed is an IZ denied. IZ are only deferred in moderate to severe illness with or without fever.
onset, duration and benefits of active immunity
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
onset, duration and benefits of passive immunity
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
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.
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
Other tetanus considerations
Child < 7 Booster
for adolesents and adults
Pregnancy
DTaP (DT if pertussis contraindicated) Tdap Dose of Tdap for each pregnancy
IZ to avoid with a Hx of an aphylactic reaction with neomycin
IPV, MMR, varicella
IZ to avoid with a Hx of an aphylactic reaction with streptomycin; polymixin B
IPV, vaccinia (small pox)
IZ to avoid with a Hx of an aphylactic reaction with
???
IZ to avoid with a Hx of an aphylactic reaction with baker’s yeast
Hepatitis B, HPV
IZ to avoid when pregnant or immunocompromised
MMR; Varicella, Zoster
IZ to avoid with intussception
rotavirus
IZ to avoid with a Hx of an aphylactic reaction with gelatin
??
Live Vaccines Population precautions - pregnancy, immunocompromised, HIV
MMR, Varicella (chicken pox) Zoster (zostavax), Intranasal influenza virus (flumist), yellow fever, rotavirus, - infants LAIV, Vaccinia.
What are the immediate interventions for anaphylaxis in primary care settings?
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
Define anaphylaxis
acute onset of after exposure Skin and/or mucosa and either respiratory compromise or BP or end organ dyfunction
anaphylaxis of skin and/or mucosa Anaphylaxis noted respiratory compromise
pruritis, urticaria (hives), angioedema dyspnea, wheeze, bronchospasm, stridor
comparison for shingrix and Zostavax
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
How to calculate Pack per day hx
number of packs-per-day x number of years smoked.
Stages of change theory explain and NP intervention
- precontemplation
- No interest, unaware or minimizes the problem
NP: Help patient move toward thinking about changing the unhealthy behavior
Stages of change theory: explain and NP intervention 2. contemplation
- More aware of the consequences of their behavior; might feel stuck Help patient examine and benefits and barriers
Stages of change theory explain and NP intervention
- preparation/determination
- 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
Stages of change theory explain and NP intervention
- Action/Willpower
- 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.
Stages of change theory explain and NP intervention 5. Maintenance
- Maintain the new status quo; avoid back sliding. continue with positive reinnforcement.
NP: Discuss ways to avoid backsliding.
