Unit 3 Flashcards
Influenza immunization
1 dose annually all ages
LAIV - 19-49y/o
Tdap or Td
all ages
a dose Tdap then Td booster every 10 years
Zoster immunization
> 50 y/o
Recombinant: 2 doses (2-6 months apart, minimum 4 weeks apart)
Live:
1 dose if not previously vaccinated
HPV immunization
female: 2 or 3 doses 19-26 y/o
Male: 2 or 3 doses 19-21 y/o
MMR immunization
healthcare born 1957 or later w/o evidence of immunity: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
born before 1957: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
MMR immunization
19-60 y/o
healthcare born 1957 or later w/o evidence of immunity: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
born before 1957: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
Varicella immunization
19-38 y/o
w/o evidence of immunity: 2 dose serious 4-8 weeks apart
Vaccines contraindicated in pregnany
(Vagina IZ A Hateful Monster)
Varicella
IPV
Zoster
Hep A
HPV
MMR
Tdap and pregnancy
every pregnancy between 27-36 weeks (passive pertussis antibody to infant)
influenza and pregnancy
inactivate recommended
Meningococcal and pregnancy
give if indicated
Hep A and B and pregnancy
safety not determined
cardiovascular disease: risks
HTN hyperlipidemia age family history smoking obesity DM
cardiovascular disease: screening
Framingham Risk Calculator
ACC Risk Calculator
cardiovascular disease:
primary prevention
changing modifiable risk factors exercise adequate sleep reduce stress ASA?
cardiovascular disease:
secondary prevention
ECG
stress test
cardiac cath
calcium score?
cardiovascular disease:
tertiary prevention
limiting impact of diagnoses disease
Pharm: ACE/BB
breast cancer: risks
age family history ETOH smoking denser breast tissue
breast cancer: screening
GAIL calculator
breast cancer:
primary prevention
change modifiable risk factors
pharmacological therapy to lower risk
breast cancer:
secondary prevention
clinical breast exam
SBE
mammography
breast cancer:
tertiary prevention
pharm intervention to prevent reoccurrence past surgery
colorectal cancer:
primary prevention
changing modifiable risk factors
colorectal cancer:
secondary prevention
guaiac
colonoscopy
colorectal cancer:
tertiary prevention
limiting effect of treating CA
cervical cancer:
primary prevention
condoms
smoking cessation
limit partners
abstinence
cervical cancer:
secondary prevention
PAP
HPV testing
cervical cancer:
tertiary prevention
preventing reoccurrence
hysterectomy
colorectal cancer: risks
certain diets smoking ETOH obesity, lack of physical activity hx of polyps or adenomas family hx hx of IBS
colorectal cancer: screening
Guaiac
Colonoscopy
cervical cancer: risks
multiple partners
HPV
smoking
cervical cancer: screening
PAP
HPV testing
lung caner: risks
smoking
environmental exposure
radon
lung cancer: screening
CXR
LDCT
lung cancer:
primary prevention
instruction of dangers before beginning smoking
smoking cessation program
lung cancer:
secondary prevention
CXR to detect masses
LDCT for at risk patients
lung cancer:
tertiary prevention
limit impact of disease
STIs: risk
increased number of sexual partners
inappropriate use of barriers
STIs: screening
STD blood, urine, cultures
STIs:
primary prevention
condoms limit partners delay of sexual activity immunizations PEP
STIs:
secondary prevention
GC/Chl screening
HIV, Hep B and C, Syphillis screening
STIs:
tertiary prevention
limit impact of disease (sequelae of PID, chronic pelvic pain, infertility) with some STIs
prevent transmission of disease to others
Depression: risks
isolation chronic diseases loss or grief, life changes female family history substance abuse
Depression: screenings
PHQ
BECK
other validate instruments ≈
Depression: primary prevention
avoid isolation
stay involved
talk w/ people about problems/thoughts/concerns
ETOH/drug avoidance
Depression: secondary prevention
PHQ 2 or 9
BECK
Depression: tertiary prevention
medications
CBT
intervention groups
Intimate Partner Violence: risks
young female pregnancy single, divorced,separated ETOH or drug use in partner smoking poverty
Intimate Partner Violence: screenings
Question Matrix
HITS
recognizing physical or emotional S/S
Intimate Partner Violence: primary prevention
change modifiable risk factors
Intimate Partner Violence: secondary prevention
screenings at visits
counseling for victim to recognize
Intimate Partner Violence: tertiary prevention
counseling to change behavior of perpetrator
social services to assist with legal
permanent plans/solutions to limit contact
assessment of cardiovascular risk AGES
40-79 w/o known cardiovascular disease
when to start statins
10 year atherosclerotic CV risk >10%
20-75 y/o w/ LDL > 190
40-70 y/o w/ LDL 70-190 w/o DM use risk estimator
w/ DM 40-75 y/o
>75 y/o clinical assessment/risk discussion
Framingham rich calculator
used to estimate woman’s 10 year risk of Coronary Heart Disease based on age, smoking, BP, cholesterol
- includes races and DM
how to improve adherence to treatment of HTN, DM, hyperlipidemia
evidence based care plan developed w/ patient (use motivational interviewing)
chose meds easy for adherence (once daily dosing, 1 pill, no SE)
contact w/ patient by clinic: reminders by EHRs, telehealth, emails/texts
HTN: risks
HTN
DM
HLD
Obesity
HTN: screenings
recommended for new onset or uncontrolled HTN
HTN: primary prevention
promote lifestyle modifications to all for healthy lifestyles
diet, exercise, weight loss DASH diet Na reduction dietary K ETOH abstinence or in moderation
HTN: secondary prevention
promote early detection of disease or precursor states
HTN: tertiary prevention
aimed at limiting impact of established disease
Diabetes: risks
HTN
obesity
HLD
Diabetes: screenings
> 45 y/o, overweight/obese, every 3 years
Diabetes: primary prevention
diet
exercise
prediabetes prescribe metformin (not an actual diagnosis)
Diabetes: secondary prevention
metformin
Diabetes: tertiary prevention
limit impact of established disease
Hyperlipidemia: risks
HTN
DM
Obesity
Hyperlipidemia: screenings
?
Hyperlipidemia: primary prevention
risk calculator: BP, cholesterol, DM. smoker
lifestyle interventions
statin treatment
ASA in select patients
Hyperlipidemia: secondary prevention
promote early detection of disease or precursor states
Hyperlipidemia: tertiary prevention
aimed at limiting impact of established disease
Obesity: risks
behavior genetics dietary patterns physical inactivity medication use other exposures
obesity is associated with?
HTN DM HLD cancer gallbladder disease sleep apnea OA CV disease
Obesity: contributing social factors
food and physical activity
education and skills
food marketing and promotion
Obesity: primary prevention
healthy eating: DASH diet smaller plates no second helpings no sugary drinks/desserts
portion control:
tip of index finger = 1 tsp (butter, oil,mayo)
tip of thumb = 1 tbsp (dressing, cream cheese, PB)
fist = 1 cup (fruit, cereal, soup, casserole)
plam = 3 oz (meat)
cupped hand = snacks (ice cream, pretzels, pasta, ships, crackers)
exercise: begin a routine, step up ineffective.inconsistent routine, recognize unplanned exercise
Transtheoretical Model “Stages of Change”
Pre contemplation Contemplation Planning Actions Maintenance Relapse
-may not reach all in 1 visit, may need to start over after visiting success/failures
Transtheoretical Model “Stages of Change”:
Pre-contemplation
(1: I won’t) patient has not thought about or has rejected change
unaware, unwilling, too discouraged
won’t change w/in next 6 months
worst strategy: persuasion
best strategy: listening, empathy, ID barriers
Transtheoretical Model “Stages of Change”:
Contemplation
(2: I might) patient is thinking and talking about change, seeks support
open to info, thinking about trying in next 6 months
good for info, emotional support
Transtheoretical Model “Stages of Change”:
Planning
(3: I will) patient plans what it would take to make change happen
ready to try in next 30 days
best strategies: goal setting, praise readiness, enlist support
Transtheoretical Model “Stages of Change”:
Actions
(4: I am) patient takes positive steps by putting plan into practice
taking steps, needs will power, habituating behaviors
need stimulus control, reinforcement, emotional support
supporting self-efficiency is critical
Transtheoretical Model “Stages of Change”:
Maintenance
(5: I have) patient achieves positive and concrete development with continuing support
has snagged for 6 months
continue to support, relapse prevention/ID
Transtheoretical Model “Stages of Change”:
Relapse
(6) patient falls back into old patterns, actions, behaviors
Motivational Interviewing
person centered
directive
method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence
developed to ID stage of readiness in pt
create a favorable climate for change
use specific skills/strategies to move people forward
addresses ambivalence and resistance
takes 3-5 minutes
5 principles of Motivational Interviewing
(1) roll with resistance
(2) express empathy
(3) avoid argumentation
(4) develop discrepancy
(5) support self-efficacy
when?
dental screening
every 6 months
when? BP screening
begin 18
2 separate readings on 2 occasions
when? ETOH screening
begin 18
ETOH screening
AUDIT tool: quantify ETOH consumption, dependency, related problems
when? BMI screening
begin 18
each visit
when? vision screening
20s - once
30s - once
40s - baseline exam
DM/preDM - annual
>65 - annual
when? domestic violence screening
not pregnant: routine GYN visits
pregnant: 1st visit, every trimester, PP
when? IPV screening
women of childbearing age
when? ASCVD screening
begin 20
20-39: measure RF every 4-5 years
when? blood glucose screening
begin 45, normal every 3 years
A1C >5.7 - annual
GDM - every 3 year
when? colorectal cancer screening
45-75
sigmoidoscopyy q5y or colonoscopy q10y
75-85 if risk factors
>85 no more
when? breast cancer screening
begin 40 annually
>55 every 2 yrs
when? endometrial cancer screening
educate at menopause a/b risk, symptoms
when? prostate cancer screening
begin 50
when? testicular exam screening
begin 15
when? cervical cancer screening
begin 25-65 every 3 yrs
>65 no screenings in normal last 10 years if hx precancerous test for 25 years after dx
PAP q3y
Basal Cell
develop on areas exposed to sun (head / neck)
flat, pale, or pink areas OR raised, red or pink,
translucent, shiny, pearly bumps that may bleed after sx; lower area in the center & blue / brown / black areas; larger
= oozing, crusted areas; grow slowly;
rare for it to spread to other parts of the body; however, left untreated à
invade bone or other tissues beneath the skin;
likely to occur in elderly; men more likely than women
fragile and BLEED EASILY
can progress to
Actinic Keratoses
start as this (pre-cancer) -> squamous cell carcinoma (rare)
usually small, rough or scaly flesh colored patches that begin on sun-exposed areas
Bowens / Actinic Keratoses
squamous cell carcinoma in situ = BOWEN DISEASE
earliest form of SCC
rough patches in sun exposed areas (sometimes in anal/genital area)
larger, redder, scalier than AKs
doctors recommend treating this
Squamous Cell Carcinoma
flat, reddish or brownish patches in the skin; rough, scaly, or crusted surface; grow
slowly & occur on sun-exposed areas (face, neck, ears, lips, back of hands); can develop scares or skin sores; likely
to grow in deeper layers of skin à spread to other parts of the body; almost ALWAYS CAN BE CURED IF
FOUND EARLY!
Normal Mole
most are harmless; evenly colored brown/tan or black spot, can be flat or raised, round or oval; if
there’s an abnormal shape/larger mole/abnormal color à turn into melanoma
Melanoma
less common
most dangerous type
different colors, jagged border
occur anywhere on skin (women: neck. face; men: chest, back)
\may grow quickly and spread to surrounding skin
not common in darker skin
Seborrheic Keratoses
benign tumors/skin growths
tan/brown/black raised spots w/ wavy texture to rough surface
not contagious
Wart
benign growths caused by infection with HPV; lumps / bumps with a rough surface; CAN SPREAD
THROUGH CONTACT; more common in areas of broken skin (fingernails); if on bottom of feet = PLANTAR
WART (hard to treat due to growing inward)
