Prevention deck 1 with voice

• 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 Bdiscuss 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 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, do full lipids test HDL-C > 60 (F) is desirable. If