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Fall 2020 Primary Care FNP > Young Adult > Flashcards

Young Adult Flashcards

You may prefer our related Brainscape-certified flashcards:
Family Nurse Practitioner (FNP) flashcards
1
Q

Developmental

  • A young adult’s mental health is dependent on the ability to enter a ______. This relationship may be defined as a commitment to another person, c____, or c_____ effort.
  • Erickson’s: ______ vs. _______
  • Problem: _____, Self-_______
A
  • relationship, person, cause, creative effort
  • Intimacy vs. Isolation
  • Isolation, Self-absorption
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2
Q

History

  • Past _____ History
  • D _
  • As____
  • An____
  • M _ _
  • Hypo/hyper_____
A
  • medical
  • DM
  • Asthma
  • Anemia
  • MVP
  • thyroidism
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3
Q

PMH

  • De_______
  • Past M_____ Syndrome
  • U _ _
  • Her____
  • S_ _/ P _ _
  • H _ _
  • Acc_______
A
  • Depression
  • Menstrual
  • UTI
  • Hernia
  • STI/PID (pelvic inflammatory disease)
  • HIV
  • Accidents
  • Recurrent UTIs in men is a RED FLAG!*
  • Hernias in young adults are dt pressure from obesity, weightligters (should be concerned if they are NON-reducable)*
  • Recurrent accidents: always falling? lots of bruises-potential for violence?*
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4
Q

PMH continued

  • If female ask about: G_____ P____ SAB, TAB
  • Ps______ History
  • ______ Abuse - ETOH, IVDU, Nasal
  • _________ Coverage?
A
  • Gravida, Para, Spontaneous, Elective abortion
  • Psychiatric
  • Substance
  • Insurance
  • Be aware of commonly used drugs and slang in the community you work in - Xanax (stix), fentanyl lollipops, IVDU skin popping*
  • REmember most young adults are covered up until 26*
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5
Q

Medication History*

  • Vitamins
    • AAFP, USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.43-0.8mg (400-800 ug) of ____ _____*
  • H______ Supplements
  • _ _ _ Meds
  • I_______ history
  • ____ control/___ sex practices
A
  • Folic Acid
  • Herbal
  • OTC
  • Immunization
  • Birth/safe sex practices
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6
Q

Family History

  • Elevated ______
  • D_____
  • H_____
  • P______ Disease
  • G_____ Abnormalities
  • Ps_____ Disorders
A
  • Cholesterol
  • Diabetes
  • HTN
  • Pulmonary
  • Genetic
  • Psychiatrc (depression, schiz)

FAP: Familial adeno-polyposis - if they have ths genetic anomaly - have to screen early with colonoscopies

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7
Q

Social History

  • S______
  • D____ use
  • A____ use
  • S_____ Activity - How do you obtain sexual history
  • S_____ system
  • Ed_____
  • W____ History
  • H______
A
  • Smoking
  • Drug
  • Alcohol
  • Sexual
  • Support
  • Education
  • Work
  • Housing
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8
Q

STI Screening Gender

What website to find

A

UTD-2020 uptodate.com

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9
Q

Women STI

A
  • gets updated every year
  • who and when should we be screening for STDs
  • <25 yo = increased risk means multiple partners, previous STI
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10
Q

Men STI

A
  • If your in practice taking care of an HIV positive pt, look at updated guidelines bc they have diff recommendations
    • Screening is expensive so just keep in mind that not everyone in this age group can afford it
    • Advocate for them to get screening
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11
Q

Chlamydia and Gonorrhea USPSTF

  • Sexually Active Women
    • The UPPSTF recommends screening for chlamydia and gonorrhea in sexually active women ___ years and younger and in older women who are at increased ____ for infection
  • Sexually Active Men
    • The USPSTF concludes that the current evidence is ______ to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men
    • Screen for (5) if at increased risk
    • Targeted screening venues for chlamydia include ______ clinics, ___ clinics, and _______ facilities
A
  • Women
    • 24, risk
  • Men
    • insufficient
    • Chlamydia, Gonorrhea, Syphilis, HBV, HCV
    • adolescent, STI, correctional

For men- we only really screen when they have increased risk

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12
Q

Health Maintenance-GYN/GU

  • The AAFP recommends screening for chlamydia and gonorrhea in sexually active women ___ years and younger and in older whomen who are at _____ ____ for infection
  • The AAFP concludes that the current evidence is ______ to assess the balance and harms of screening for chlamydia and gonorrhea in ___
A
  • 24 years, increased risk
  • insufficient for men
  • Gonorrhea and chlamydia screen is by cervical swab*
  • For men theres urine tests but there is a swab through the urethra which is painful/complications*
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13
Q

Cervical Cancer

  • Women aged ___ - ___years
  • The USPSTF recommends screening for cervical cancer every ___ years with cervical _____ alone in women aged __-__ years
  • For women ___-___, the USPSTF recommends screening every ___ years with cervical ______ alone, every __ years with high-risk human _______ (hrHPV) testing alone, or every ___ years testing with ____
A
  • 21-65
  • 3y, cytology, 21-29
  • 30-65, 3y cytology, 5y high risk human papillomavirus, or 5y both (cotesting)
  • ​Cervical cytology means liquid pap smear - cells from endo and ecto cervix ar obtained and submerged in formula and sent to lab*
  • Every 3 years for NORMAL WOMEN/previous normal pap smears*
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14
Q

Syphilis

  • What adults do you screen, what adolescents do you screen?
  • THe USPSTF recommends screening for syphilis in persons who are?
A
  • Asymptomatic, nonpregnant adults, Adolescents at increased risk
  • Increased risk persons (multiple partners)
  • Syphilis screening is a blood test based on a number: 1 = negative, higher the number-higher the risk*
  • untreated syphilis can cause neurosyphilis, damages nervou system*
  • We screen all pregnant women*
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15
Q

HIV AAFP 2019

  • Population: Adolescents and adults aged __ - __ yrs and ______ persons
  • Risk Assessment: What are some risk factors? - in which case all ppl should be screened regardless of age when at increased risk
  • Screening Tests (2)
  • Screening intervals =
  • Tx and Interventions =
A
  • 15-65, pregnant
  • male-male, IV drug, no condom use, transactional sex, STIs, those who requests tests
  • Antigen/antibody immunoasay that detects both HIV-1 and HIV2 antibodies and the HIV1 p24 antigen/ supplemental testing with reactive asssay to differentiate btwn HIV1 and 2
  • insufficient evidence to determine time interval
  • No cure or vaccine
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16
Q

USPSTF-PrEP

What is PrEP?

Who do we give it to?

A

Pre-exposure prophylaxis with antiretroviral therapy to persons at high risk for HIV

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17
Q

Breast

  • Mammogram Screening when?
  • SBE =
A
  • Risk Factors -We don’t really do mammograms for those under 40
  • Self Breast Exam –Awareness of breast health and familiarity with one’s own body is typically promoted intead of self-exam

But we educate about being aware of body and self checking (even tho not officially recognized anymore)

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18
Q

CKD

  • The AAFP concludes =
  • Common tests considered for CKD screening include _____-derived estimates of _ _ _ and urine testing for ______
A
  • Insufficient evidence for routine screening
  • creatinine, GFR, albumin
  • We are seeing an increase in CKD bc of increased DM/HTN -> in this case we routinely screen more often (is not technically recommended but may be appropriate now)*
  • Increased risk with taking lots of meds ie motrin*
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19
Q

BMI

AAFP Recommendation =

  • Intensive, multicomponent behavioral interventions include behavioral _____ activities (__ - __ sessions in the first year) such as setting ____ loss goals, improving ___/nutrition and increasing physical ____, addressing barriers to ____, self-______, and strategizing how to maintain ______ changes.
A

Reccomends screening all adults for obesity, BMI > 30 should be refered to intensive, multicomponent behaviorhal interventions

  • 12-26, weight loss, diet, physical activity, barriers to change, monitoring, lifestyle
20
Q

Obesity

  • BMI calculators (2)
    • http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/index.htm
  • Adults
    • Underweight =
    • Normal =
    • Overweight =
    • Obese =
A
  • Adults, Childs and Teens
  • Adults
    • <18.5
    • 18.5-24.9
    • 25-29.9
    • > 30
21
Q

Thyroid Screening

AAFP Recommendations:

A

Insufficient evidence for screening in nonpregnant, asymptomatic adults

  • But usually is a part of blood work or prenatal panel (T4)*
  • Not recommended and not every plan covers it, often need to inke with a reason like obesity or past hx of palpitations*
22
Q

Thyroid USPSTF

Recommendations =

A

Insufficient evidence to balance benefits and harms of screening in nonpregnant, asymptomatic adults

23
Q

Calcium Recommendations 2020

  1. 0-6m* M/F =
  2. 7-12m* M/F =
  3. 1-3y M/F =
  4. 4-8y M/F =
  5. 9-13y M/F =
  6. 14-18y M/F, Pregnant/Lactating =
  7. 19-50y M/F, Pregnant/Lactating =
  8. 51-70y M/F =
  9. 71+y M/F =
A
  1. 200mg
  2. 260mg
  3. 700mg
  4. 1,000mg
  5. 1300mg
  6. 1300mg
  7. 1,000mg
  8. 1,000mg, 1,200mg
  9. 1200mg

Encourage through nutritional intake rather than supplementation as much as possible

24
Q

Vitamin D Screening

AAFP Recommendations

A

Current evident is insufficient to assess balance of benefits and harms of screening for Vitamin D Deficiency.

Not officially recommended but we do it alot anyways, especially with COVID, low D seems to be at higher risk or more sick

25
Q

Vitamin D and Calcium Recommendation for Supplementation

  • The AAFP concludes that the current evidence is ______ to assess the balance of the benefits and harm of _____ Vit D and calcium supplementation for the primary ______ of _____ in ______ women or in men.
  • AAFP concludes that the current evidence is _____ to assess balance of the benefits andharms of daily supplementation of > ____ IU of Vitamin D3 and _____ mg of Ca for the primary prevention of _____ in noninstitutionalized _______ women.
A
  • insufficient, combined, prevention, fractures, premenopausal
  • insufficient, 400, 1,000, fractures, postmenopausal
  • Not recommended above 2,000/day*
  • A lot of Americans are VD deficient bc we work indoors*
26
Q

Vitamin D and Calcium Screening

Consider screening patients who report a current or past medical history of the following

  • Chronic musculoskeletal ____ including f______
  • Osteo_____
  • Rh_____ ______
  • Mal______ syndromes
  • Ob_____, M_____ syndromes, and Type II ______
  • Cardio_______ disease
  • Chronic K_____ disease and _________thyroidism
  • Dep______
  • High risk population such as elderly (over ____ yrs of age) and ____-skinned individuals
  • Chronic use of cortico_____
  • P_____/S_____ hx of inadequate sun exposure (working indoors, homebound, living in higher latitude, wearing excessive clothing, dark skin and use of sun block) insufficient dietary intake of vit D fortified foods
A
  • pain, fibromyalgia
  • porosis
  • Rheumatoid arthritis
  • Malabsorption
  • Obesity, Metabolic, Diabetes
  • Cardiovascular
  • CKD, Hyperparathyroidism
  • Depression
  • >71, dark
  • steroids
  • Personal/Social
27
Q

Recommendations for the diagnosis and management of Vitamin D deficiency in adults

  • _____ exam including general _____, ____ signs, h___ and w____, general s____ assessment, skin _____, and assessment for ___ pain** may provide the examiner with clues to possible vit D deficiency
  • Diagnostic tests indicated (1)
  • In adults, vit D deficiency is defined as a serum 25-hydroxyvitamin D lvl of < ____ ng/mL (50 nmol per L), and insufficiency is defined as lvl of __-__ ng/mL (50-75 nmol/L)
A
  • Physical, appearance, VS, height and weight, skin, color, BONE PAIN**
  • Serum 25-hydroxyvitamin D (25OHD) concentrations
  • <20 ng/mL, 20-30ng/mL
  • Don’t need to memorize this- just know that this may be indicated even tho not recommended (the test is a serum 25)*
  • Supplementation depends on lvl, can have high dose for 3 wks and taper, chronic low dose, etc*
28
Q

7 Warning Signs of Cancer

  • Change in b____ or bl_____
  • A sore that doesn’t ____
  • Unusual bl_____ or dis____
  • Thickening or ___ in breast or elsewhere
  • In_____ or difficulty in sw_____
  • Obvious change in a w___ or m_____
  • Nagging c____ or ____ness
A
  • bowel, bladder
  • heal
  • bleeding, discharge
  • lump
  • Indigestion, swallowing
  • wart, mole
  • cough, hoarseness
29
Q

Cervical Cancer RIsk Factors

  • Sexual _____ before age __
  • More than __ sexual ____ in a lifetime
  • Intercourse with a _____ who has had multiple partners
  • Sm_____ or hx of
  • _ _ _ ….6, 11, 16, 18 viruses with increase risk
  • Intercourse with ___ who has _ _ _
  • REVIEW HPV V_______
    • Age __-__, ____ vaccines*
    • Age __-__, do you give the vaccines?
A
  • intercourse, <20
  • 2, partners
  • male
  • Smoking
  • HPV
  • male with HPV
  • Vaccine
    • 9-26, three
    • 27-45, SHARED DECISION MAKING

  • Still v prevalent, and usually metastatic by the time its diagnosed*
  • HPV vaccine**! encourage to stop smoking*
  • KNOW not just 9-26, 27-45 w shared decision making*
30
Q

HPV Vaccine

  • ____ Vaccines are very effective against HPV types (2), which cause most cervical cancers. So both vaccines prevent cervical cancer and precancer in women.
  • Only ___ of the vaccines (______) also protects against HPV types (2). These HPV types cause most genital ___ in females and males.
A
  • Both, 16 and 18
  • one (Gardasil), 6 and 11, warts

2 vaccines - diff names and diff vaccines all the time, don’t get fixated on name, what you should know - give the vaccine with the most coverage!

31
Q

Skin Cancer

AAFP Recommendations for

  1. Age 10-24
  2. Age > 24
A
  1. RECOMMENDS 10-24yo with fair skin about minimizing exposure to ultraviolet radiation
  2. Current evidence insuficient to assess balance of benefits and harms of counseling adults older than 24 about minizing risks to prevent skin cancer

Again, insufficient evidence, but regardless we still COUNSEL OFTEN esp with increased riks (sun tanning often, tanning beds, etc)

32
Q

Sunscreen

  • The American Academy of Dermatology recommends that, regardless of skin type, a ____-spectrum (protects againts ___ and ___ rays) - ____ resistant sunscreen with SPF at least ___ should be used year round.
  • In addition, ppl need to limit UV exposure by seeking ____, wearing protective ______, h___ and sun____, and avoiding _____ beds.
A
  • broad, UVA and UVB, water, 30
  • shade, clothing, hats, sunglasses, avoid tanning beds
33
Q

Signs and Symptoms of Drug Abuse

  • ____ to work frequently
  • Increased a____teeism
  • Increased ______ for short periods
  • F_____ productivity, poorer _____ of work, disorganized th_____, missed ____lines
  • F____fulness, failure to follow _____
  • P_______ changes, sl_____ on the job
  • Chronic _____ nose
  • _____ proneness
  • What is the number you can call - Community Resources
A
  • Late
  • absenteeism
  • productivity
  • Falling, quality, thinking, deadlines
  • Forgetfulness, instructions
  • Personality, sleeping
  • runny nose
  • Accident
  • 1-800-LIFENET
34
Q

Alcohol Screening

AAFP recommendations

A

Recommends that clnicians screen adults aged > 18 for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.

However, we do screen younger if they have risk

35
Q

IPV Screening

AAFP Recommendations

A

Recommends that clinicians screen women of childbearing age for intimate partner violence (IPV), such as domestic violence, and provide or refer women who screen positive to intervention services. This recommendation applies to women who do not have signs or symptoms of abuse.

36
Q

IPV

Risk Factors

  • Social ______
  • Women with increased ___lessness, g____, is_____ and low ___-____
  • _____ abuse in the home
  • F______ stressors
  • Violence against ____ partners
  • Violence against ____ sex partners
A
  • isolation
  • helplessness, guild, isolation, self-esteem
  • Substance
  • Financial
  • male
  • same sex
37
Q

Intimate Partner Violence

Definition

  • Intimate partner violence is a p_____ of ass_____ and c_____ behaviors that may include inflicted physical injury, ps______ abuse, s____ assault, progressive social _____, sta____, dep_____, int_____ and threats.
  • These behaviors are perpetrated by someon who is, was, or wishes to be involved in an _____ or d_____ relationship with an adult or adolescent, and are aimed at establishing _____ by one partner over the other.
A
  • pattern, assault, coercive, psychological, sexual, isolation, stalking, deprivation, intimidation
  • intimate, dating, control
38
Q

IPV Screening Tests

  • Several screening instruments can be used to screen women for IPV in the past year, such as?
  • USPSTF recommendation for screening tools?
A
  • Humiliation, Afraid, Rape, Kick (HARK)
  • Hurt/Insult/Threaten/Scream (HITS)
  • Extended Hurt/Insutl/Threatens/Scream (E-HITS)
  • Partner Violence Screen (PVS)
  • Women Abuse Screening Tool (WAST)
  • No valid, reliable screening tool in the primary care setting to identify abuse of older or vulnerable adults without recognized S/S of abuse.
  • Don’t focus on this, theres so many tools, just know we do it in every practice/ EPIC has its own tool*
39
Q

Domestic Violence-AAFP

  • Watch for ________ between injury pattern and patient’s story: notice behavioral clues such as _______ to speak in front of partner.
  • Be prepared with non_______ responses to affirmative screening: many domestic violence prevention coalitions provide scripts for screening and responding to pt’s situations
  • Determine whether an abused woman is in _______ danger; if so, implement urgent ______. If she needs info or literature, ensure she can safely hide it – often in the sole of her ___ or in feminine hygiene _____ – so her abuser won’t find it
  • Become familiar with your ____’s family ___. Not all states have mandated reporting laws for HCPs
  • You may need the patient’s _____ to call the ____.
A
  • inconsistencies, reluctance
  • nonjudgmental
  • imminent, intervention, shoe, products
  • states, law
  • permission, police
40
Q

Domestic Violence

  • _____ exam
  • _______ consequences…more passive, less flexible, more apathetic, depressed
  • S_____ complaints
  • Hotline ______
  • NYC: Phone Numbers ADD to BB or SMART PHONE
    • _ _ _
    • _ _ _ - NEW - YORK (Out of City)
    • TTY 212-504-4115 (Hearing Impaired)
  • National #: 1800-79907233
A
  • Physical
  • Emotional
  • Somatic
  • numbers
  • Phone #
    • 311
    • 212 NEW YORK
41
Q

What is super important to do if you find something on a pt who has suffered domestic violence?

A

Documentation

42
Q

When you get home…

  • Develop an “____ plan” in advance for you and your children
    • Know exactly _____ you could go even in the middle of the night - and how to get there
  • Pack an “_____ bag” in case you have to leave home in a hurry. Either hide it yourself or give it to a friend to keep for you
  • Pack t____ articles, m_____, an extra set of ____ to the house and car, an extra set of cl______ for you and your children, and a t___ for each child
  • Have extra ca__, loose _____ for phone calls, check____, or s_____ account book hidden or with a friend.
A
  • “exit plan’
    • where
  • “overnight bag”
  • toilet, meds, keys, clothing, toy
  • cash, loose change, checkbook, savings
43
Q

When you get home…cont…

  • Pack important p_____ and _____ records (the originals or copies), such as ___ ___ cards, b___ certificates, g____ cards, p______, w____ authorization and any other imm_____ docs, v_____ registration cards, m_____ cards and recods, ______ license, r____ receipts, title to the car and proof of in_____, etc.
  • Notify your _____ if you think it is safe
  • Family Violence _____ Fund
A
  • papers, financial, social security, birth, green, passports, work, immigration, voter, medical, drivers, rent, insurance
  • neighbors
  • Prevention
44
Q

Health Maintenance

  • How often PE in this age group? Blood Testing?
  • ___ A/B–remember C prevalence
  • T _ testing?
  • T _/T___
  • H _ _
  • V_____?*
  • F _ _
  • M________ (Know Immunization Schedule)
    • ​(2)
  • AAFP - most common recommendation
A
  • For NORMAL, HEALTHY young adults, PE and blood work every 3y is fine
  • Hep
  • TB
  • Td/Tdap
  • HPV
  • Varicella
  • FLU
  • Meningococcal
    • ​College freshmen living in dorms*
    • Military recruits
  • **if ppl aren’t sure/we don’t know if they’ve gotten varicella (from other countries) - make sure it is safe to administer - a lot of times we just draw TITERS***
  • **COLLEGE FRESHMEN, MILITARY RECRUITS** need meningococcal*
45
Q

Health Maintenance Topics

  • Acc_____
  • V______
  • Discuss ___ factors for illness
  • F______ stressors
  • O_____ Hazards/Stressors
  • C_____ Screenings
  • De_____
  • Chemical Agents
    • D___ Use
    • Al____ Use
    • T____ Use
A
  • Accidents
  • Violence
  • risk
  • Financial
  • Occupational
  • Cancer
  • Depression
  • Chemical
    • Drug
    • Alcohol
    • Tobacco

NPs stand out from MD in PA in our education!

46
Q

Community Agencies

  • DOH/HIV/Immunization and Planned ______
  • Ps___ ER - where are they?
  • PCAP and WIC - what is it?
  • D_____ Screening
  • V_____ Screening
  • _____ Precinct
  • Ph____-TARGET
A
  • Department of Health/HIV/Parenthood
  • Psych
  • Prenatal care assistance program, Women infants and children to get supplemental food and nutrition
  • Dental
  • Vision
  • Police
  • Pharmacy

Fall 2020 Primary Care FNP (11 decks)

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