Vaccinations/Screening/guidelines Flashcards
Tetanus vaccine
Child: *DTaP receive 5 doses at 2 month > 4 month > 6 month 15-18 months 4-6 yrs
Then booster at 11-12 yrs *Tdap
Between ages 11-18: single dose of Tdap recommended
Adult:
Booster for Td every 10 years
For adults who have never received Tdap as an adult, one booster at 10 yrs should be replaced with Tdap
Wound cases~
Only administer TIG w/ vaccination if severe wound and less than 3 doses or vaccination uncertain
Clean minor - tetanus toxoid vaccine if last dose over 10 yrs ago
Dirty severe - tetanus toxoid vaccine if last dose over 5 yrs ago
Give infants and children 5 doses of DTaP. Give one dose at each of these ages: 2 months, 4 months, 6 months, 15 through 18 months, and 4 through 6 years. Use DT for infants and children who should not receive acellular pertussis-containing vaccines.
Give adolescents a single dose of Tdap, preferably at 11 to 12 years of age.
Give pregnant women a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27 through 36. CDC only recommends Tdap in the immediate postpartum period for new mothers who did not receive Tdap during their current pregnancy and did not receive a prior dose of Tdap ever (i.e., during adolescence, adulthood, or a previous pregnancy). If a woman did not receive Tdap during her current pregnancy but did receive a prior dose of Tdap, then she should not receive a dose of Tdap postpartum.
Give adults a single dose of Td every 10 years. For adults who have never received Tdap, a dose of Tdap can replace one of the 10-year Td booster doses. Clinicians can give Tdap regardless of the time since the patient’s most recent Td vaccination
Osteoporosis screening
One time DEXA screening in all women over age of 65
Or…
Women aged 50-64 if they have risk factors equal to or greater than a healthy caucasian 65 y/o woman (WHO FRAX 9.7% or greater)
Or…
A hip fracture after minor trauma would be indicator for bone density screening
if age is considered a risk factor then essentially
ALL women with risk factors should be screened
-age
-smoking, alcohol use, steroid use
-Asian and caucasian
-low calcium intake
Regular management is calcium, vitD, regular weight bearing, muscle strengthening, avoid tobacco and alcohol intake
Low dose chest CT screening for lung cancer
Annually for patients
ages 55 to 80 yrs
with a over 30 pack yr smoking hx who -
-continue to smoke
or quit less than 15 yrs ago
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Colon cancer screening
After the age of 50… until the age of 75
FOBT annually
Flex sig: 5 yrs + FOBT every 3 years
(If either abnormal perform colonoscopy)
Colonoscopy:
Normal: age 50 every 10 yrs
*If patient has single or multiple polyps, personal history of CRC—after initial colonoscopy repeat at 3 years—if normal at 3 years, then colonoscopy every 5 years
IBD: 8 years post diagnosis every 1-3 years
Classic familial adenomatous polyposis: 10-12 yrs old, repeat annually
-until age 75
Pap smear
Women ages 21 to 65 years every 3 yrs
Or ages 30 to 65 years every 5 yrs when combined with HPV testing
Stop at 65 if last 3 pap smears or last 2 HPV cotesting are negative with most recent in past 5 yrs
Can stop before the age of 65 if pt has a hysterectomy with removal of cervix and no hx of cancerous lesions
Postexposure prophylaxis (rabies vaccine+ immunoglobulin)
- High risk wild animal (bat, raccoon, skunk, fox) if animal unavailable
- High risk wild animal-euthanize and test, PEP if positive
- Pet (dog, cat, gerbil) if unavailable for quarantine
- Pet quarantine for 10 days, PEP if animal unhealthy
Indication for HAV vaccine
Chronic liver disease (including HBV HCV) - 2 doses 6 months apart after negative serological testing for immunity
Men who have sex with men
IV drug users
HBV vaccine
All pts w/o documented immunity to HBV w/ diabetes, HIV, other immunocompromising conditions, or liver disease
Chronic liver disease:
3 doses: after initial negative serology for immunity - at 0 months, 1 month, at least 4 months
patients with diabetes are at increased risk for developing hepatitis B, perhaps due to the frequent use of needles for injectable medications and glucometers.
Pneumococcus vaccine
Infants and children - PCV13 once
Ages 19 to 64 (w/ chronic heart, lung, liver disease or Diabetes, smokers, alcoholics) - PPSV23 only
Ages 19-64 (CSF leaks, cochlear implants, asplenia, immunocompromised, CKD = high risk!) - PCV13 followed by PPSV23
Ages over 65 - PCV13 followed by PPSV23
HPV vaccination
For both male and female ages 11-12. (can begin at age 9)
For those who missed initial series as old as 26 for women or 21 for men
Two doses of HPV vaccine are recommended for most persons starting the series before their 15th birthday.
The second dose of HPV vaccine should be given 6 to 12 months after the first dose.
Adolescents who receive 2 doses less than 5 months apart will require a third dose of HPV vaccine.
Three doses of HPV vaccine are recommended for teens and young adults who start the series at ages 15 through 26 years, and for immunocompromised persons.
The recommended 3-dose schedule is 0, 1–2 and 6 months.
Three doses are recommended for immunocompromised persons (including those with HIV infection) aged 9–26 years.
New guidelines: HPV vaccine now approved for men and women up to age 45
Meningococcal vaccination
Ages 11 to 18 years: Quadrivalent- primary vaccination w/ booster at ages 16 to 21 years
Ages over 18 years: Primary vaccination can be given to adults who are at increased risk for invasive meningococcal disease
(asplenia, complement def, college students (age under 21), military, travel to endemic areas)
BP/lipid screening
Blood pressure (over age of 18)
Every two years if normal
Every one year if prehypertension 120-130/ under 80
Fasting lipid screening (total cholesterol plus HDL)
- if total cholesterol under 200, HDL over 35, frequency every 5 years)
- screen more frequently if not
LDL panel
men: over age 35,
women: over 45 AND at high risk of CHD)
Grade A
Men ages 20-35
Women ages 20-45
Both: If at risk for CHD, Grade B
Screen for high cholesterol for all children at least once between ages 9-11
Again between 17-21
Abdominal aortic aneurysm screening
Ages 65-75 abdominal ultrasound if ever smoked
Repair is indicated when the aneurysm becomes greater than 5.5 cm in diameter or grows more than 0.6 to 0.8 cm per year
Diabetes and sequelae screening
Hba1c: normal less than 5.7, DM: over 6.5
Fasting plasma glucose: normal less than 100, DM: over 126
2 hr Oral glucose tolerance: normal less than 140, DM over 200 two hours after 75 g glucose load
Random plasma glucose of 200 and typical symptoms of hyperglycemia (polyuria, polyphagia or polydipsia)
Screening for:
- asymptomatic adults w sustained HTN (>135/80) (grade B) *note no indicates age
- Adults 40 to 70 years who are overweight or obese (grade B)
The American Diabetes Association recommends screening all adults with a BMI
≥25 kg/m2 and at least one risk factor for diabetes every 3 years
In the absence of unequivocal symptomatic hyperglycemia, the diagnosis of diabetes must be confirmed on a subsequent day by repeat measurement, repeating the same test for confirmation. However, if two different tests (eg, FPG and A1C) are available and are concordant for the diagnosis of diabetes, additional testing is not needed. If two different tests are discordant, the test that is diagnostic of diabetes should be repeated to confirm the diagnosis
Screening for nephropathy:
The spot urine albumin-to-creatinine ratio is the screening test for microalbuminuria.
During clinical trials, up to 7% of patients receiving metformin developed asymptomatic subnormal serum vitamin B12 levels. In the setting of neuropathy, too, serum B12 levels would be a very reasonable diagnostic test to order.
Indication for LTOT in COPD
SpO2 less than 88%
SpO2 less than 89% w/ RHF or hematocrit over 55% (erythrocytosis)
*the only COPD intervention that decreases mortality
Indication for ultrasound in pregnancy
Ultrasound is not a mandatory procedure but is indicated for:
Uncertain gestational age, size/date discrepencies, vaginal bleeding, multiple gestations
Breast cancer screening
@perfectly healthy
The USPSTF recommends screening mammography for women, with or without clinical breast examination, every 2 years for women 50-74. Before age of 50 is an individual decision
Clinical screening (I) Recommend against teaching self exam (D)
Bacteriuria screening
The USPSTF recommends screening for asymptomatic bacteriuria with urine culture in pregnant women at 12 to 16 weeks’ gestation or at the first prenatal visit, if later.
*with midstream urine culture, NOT dipstick
BRCA risk assessment
and genetic counseling/testing
screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with one of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.
Breast cancer preventive medications
The USPSTF recommends that clinicians engage in shared, informed decisionmaking with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene.
Chlamydia and Gonorrhea screening: women
The USPSTF recommends screening for chlamydia in sexually active women age 24 years or younger and in older women who are at increased risk for infection.
should be diagnosed by using nucleic acid amplification tests (NAATs) because their sensitivity and specificity are high and they are approved by the U.S. Food and Drug Administration for use on urogenital sites, including male and female urine, as well as clinician-collected endocervical, vaginal, and male urethral specimen
Depression screening adolescents and adults
Screen for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Adults: Screen for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Hey
Falls prevention: older adults
The USPSTF recommends exercise intervention and vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.
Folic acid supplementation
All women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid.
4.0 mg if prior hx of NTD
