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Prevention deck 1 with voice

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  • 1. Adult Health Prevention Nsg 474
  • 2. Primary Care: Definition  The first point of care for the patient  Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long- term care, home care, day care, etc.).  Primary care is performed and managed by a provider often collaborating with other health professionals, and utilizing consultation or referral as appropriate.
  • 3. USPSTF Recommendations  “A” and “B”discuss recommendations with eligible patients and offer them as a priority.  Give lower priority to services with “C” recommendations; they need not be provided unless there are individual considerations in of providing the service.  Discourage the use of services with “D” recommendations unless there are unusual additional considerations.  “I” statements mean the evidence is insufficient to determine net benefit.
  • 4. Age 21-64 Leading causes of death For primary care, consider biggest risks to health & causes of mortality  Malignant neoplasms  Heart disease  Motor vehicle crashes & unintentional injuries  HIV infection  Suicide & homicide
  • 5. Ages 65 and older Leading Causes of Death  Heart diseases  Malignant neoplasms: Lung, colorectal, breast  Cerebrovascular diseases  Chronic Obstructive Pulmonary Disease  Pneumonia and Influenzae
  • 6. The Well Adult Health Exam  Screening recommendations vary by age and underlying risk factors  Some differences between USPSTF and other groups  Can consult AAFP, ACOG, American Cancer Society  USPSTF will heavily influence what is covered under Affordable Care Act of 2010  All visits include current health history and physical exam, lifestyle assessment, screening  Health promotion also includes immunizations and chemoprophylaxis (e.g. folic acid, etc)  These screening recommendations are for individuals with NO known risk factors.  Presence of known risk factors shifts the perspective
  • 7. Screening for all adults USPSTF “A” and “B” Rec.  Behavioral  Alcohol Misuse  Substance abuse  Tobacco  Obesity/ inactivity  Cardiovascular  Aspirin for prevention of heart disease  Hypertension  Lipid Disorders  Sexual  STIs, syphilis, HIV, pap  Endocrine  Diabetes  Cancer  Colorectal  Mental  Depression
  • 8. The Well Adult (21-64 years) Visit  Screening  Blood pressure, pulse rate  Height and weight, waist circumference (calculate BMI)  Lifestyle factors  Obesity assessment, physical activity, stress, sleep, social relationships, spiritual health, safety (home, sports, vehicular, firearms), tobacco/nicotin e, alcohol use, other drug use, domestic violence/abuse, financial (access to food and medicine) – use a questionnaire or interview  Preventive care – immunizations, chemoprophylaxis  Screening – lipid disorders, STIs, diabetes, colorectal cancer, depression, hypertension, breast cancer (female)
  • 9. 21-64 years of age Injury Prevention  Lap/shoulder belts  Motorcycle/bicycle helmets  Smoke detector  Safe storage/removal of firearms
  • 10. Older Adult 65+ Injury Prevention  Lap/shoulder belts  Fall prevention  Safe storage of firearms  Smoke detectors  Set hot water heater to <120-130  CPR training for household members
  • 11. 21-64 years of age Immunizations  Tetanus-diphtheria (Td) boosters (one booster every 10 years)  Rubella (women of childbearing years)  Influenza Vaccine  Gardasil (up to age 26)
  • 12. Screening for Cardiovascular Disease - Lipids  USPSTF recommends  A: Screening all men over age 35, and women>45 if increased risk for CHD  B: Screening men and women 20-34 who are at increased risk for CHD  C: No recommendation for men 20-35 or women >20 without increased risk for coronary heart disease (CHD)
  • 13. At risk for CHD…  The presence of ANY of these factors constitutes “risk”  Diabetes  Previous personal history of CHD (abdominal aortic aneurysm, peripheral artery disease, carotid artery stenosis)  Family history of cardiovascular disease before age 50 in males or age 60 in females  Tobacco use  Hypertension  Obesity (BMI=>30)
  • 14. How to test  Blood test for total cholesterol (TC) and HDL-C. Can be fasting or non-fasting.  Can use TC alone.  To get LDL-C, need a fasting test & is more expensive.  No recommendation on using triglycerides in eval.  Repeat abnormal tests.  Diagnose dyslipidemia on basis of average value of two separate tests.
  • 15. Screening intervals  Every 5 years  Shorter for those with lipid levels near to stage requiring treatment  Longer for those with lower levels  No clear guideline on age to stop screening  If elderly client has never been screened – then test  Most elders have elevated risk for CHD and would benefit from screening
  • 16. Evaluating test results  See National Cholesterol Education Program of the NIH for guidelines  TC - <200 is desirable. If >200, do full lipids test  HDL-C > 60 (F) is desirable. If <60, do full lipids test  Treatment/mgmt of dyslipidemia not part of this course  Remember lifestyle modifications/diet are good for all  But not likely to be sufficient on their own  Dietary modifications unlikely be sufficient intervention
  • 17. 21-64 years of age Counseling  STD Prevention: Avoid high-risk behavior, condoms, female barriers, unintended pregnancy  Dental Health: Regular visits to dental care provider; floss, brush teeth daily
  • 18. Evaluate BP  Remember correct procedures for collecting accurate BP:  Pt seated, back supported, feet on floor  No tobacco, caffeine for 15 -30 minutes  Pt resting in place 5-10 minutes  Arm at heart level  No talking by Pt or provider during test  Check both arms. If more than 10 pts apart, repeat in higher arm. Two readings 5 minutes apart.  Use average of two highest readings
  • 19. Evaluating BP  Formal dx of hypertension is based on two separate readings, more than one week apart.  See JNC7 for full guidelines on management  Dx and mgmt not part of this course
  • 20. Lifestyle Interventions  Weight reduction – ideally BMI <25  DASH type eating plan  Rich in fruits & vegetables  Low-fat diary products  Reduced overall saturated and total fat content  Dietary sodium reduction to <2.4 mg Na or 6g NaCl  Aerobic physical activity – 30 minutes brisk walking almost every day  Moderate alcohol consumption – max 2 drinks/day for men, 1 drink/day for women

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