Self Care Exam 4 (thorough)

When is hCG excreted in the urine?

as early as 7 days after conception

Define 'Roadblocks' in the 5 R's

barriers to quitting

Define 'Rewards' in the 5 R's

benefits of quitting

Misc. Tests: alcohol test is done so by:

breathalyzer

Misc. Tests: Paternity Testing (IDENTIGENE DNA) is done so by:

cheek swab

Male fertility testing is based on:

sperm concentration, morphology, and motility

Infertility is define as ______

the medical inability to conceive after 1 year of unsuccessful attempts.

Misc. Tests: EarCheck Middle Ear Monitor tests for:

Emits sound waves into ear canal Reflected sound analyzed to determine if middle ear fluid is present

What factors interfere with accuracy of basal thermometry?

Emotions Movements Infections Eating Drinking Talking Smoking

Fecal Immunochemical Test: FIT is what type of test?

FOBT

Toilet Test Product: EZ-Detect™ is what kind of test?

FOBT

How does poor finger stick technique interfere with cholesterol tests?

Falsely low cholesterol result if too small of sample (proper technique would be: 2-3 hanging drops of blood required) Excessive milking/squeezing negatively affects sample quality Must collect sample within 5 minutes or may yield a falsely low result

What are the advantages of selection criteria of home testing?

Fast Convenient/ Accessible Economical Confidential Increases Awareness Early Detection

What factors interfere with hormone fertility test?

Medications affecting hormonal cycle Menotropins to promote ovulation may artificially elevate LH Menopause/perimenopause Polycystic ovarian syndrome (PCOS) Pregnancy Breastfeeding Impaired liver or kidney function Tetracycline antibiotics Recently discontinued oral contraceptives

Other misc tests:

Menopause test Strep A test

What causes false positive pregnancy tests?

Miscarriage or pregnancy within last 8 weeks Fertility Treatments

NOT READY TO QUIT: 5 R'S are used to: (also list 5 R's)

Motivate towards a quit attempt Relevance, risks, rewards, roadblocks, repetition

Check Up America is used to test _______ and is (reusable/not reusable)

full lipid profile; Results by mail, NOT reusable

After fertilization, trophoblastic cells produce __________________.

human chorionic gonadotrophic (hCG) hormone

What is OvuSense or Ava?

Both are basal thermometers that are linked to an app to help plot the temperature on a chart and track ovulation

Primary uses for UTI tests:

Early detection in patients with history of recurrent UTIs or risk factors Confirmation that infection has been cured with antibiotic therapy

Intercourse should happen as soon as ______

a rise in temp is seen

Define 'Relevance' in the 5 R's

why quitting is relevant

What causes false negative pregnancy tests?

Early testing with inadequate level of hCG Collection containers other than provided (e.g., waxed cups, containers with soap residue) If store urine for later testing (refrigerate), must allow to warm to room temp 20-30 minutes before testing

Adverse effects of tobacco use (Respiratory disease)

Lung cancer Asthma COPD Shortness of breath

Directions for Fecal Immunochemical Test: FIT

-After BM, wipe area and retain small amount of stool on toilet paper -Unscrew buffer tube cap/wand -Collect small sample of stool onto grooves of buffer wand -Recap by screwing tightly. -Shake tube for 3 seconds. -Unscrew small clear cap at top of tube and apply 3 drops from tube to sample well. -Read results after 5 minutes but before 10 minutes --Line at "C" = control that test is working --Positive for blood = line at "T"

Key points for Home Testing and Monitoring:

-Appropriateness -->Patient limitations -Product Recommendation -->Cost-effective -->Simple -Counseling -->Directions for proper use -->Disease state education -Interpretation of results -Follow-up recommendation s -->Where -->When Self-testing, NOT selfdiagnosing!

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Approximately ________ _________ ovulation, temp rises (0.4 - 1.0 F) to a level *closer to normal ______

24-48 hours post ovulation = 98.6 F (37 C)

Store brand pregnancy tests have a sensitivity of:

25-50mIU/mL

What is one way HIV home tests are used? (directions and results)

1- HIV antibodies from oral fluid are collected through the swab 2- once the device is inserted in to the test tube, the oral fluid mixes with the liquid and travels up the test stick 3- If C-line turns dark it confirms the test is working properly, if no C-line appears, the test is not working -- if only C-line appears, the test is negative 4- HIV antibodies collecting at the T-line indicates the test is positive

When is hCG detectable?

1-2 weeks after conception

Clearblue Plus has a sensitivity of:

25mIU/mL

What is the optimal conception window?

12-24 hours after ovulation has occurred

There are __ types of UTI tests that test indirectly for bacteria and infection

2

Benefits of quitting smoking on a time scale: (lengthy)

20 min after: your heart rate drops to a normal level 12 hours after: the carbon monoxide level in your blood drops to normal 2 weeks - 3 months after: your risk of having a heart attack begins to drop; your lung function begins to improve 1-9 months after: coughing and SOB decrease 5-15 years after: your risk of having a stroke is reduced to that of a nonsmoker's; your risk of getting cancer of the mouth, throat, or esophagus is half that of a smoker's 10 years: your risk of dying from lung cancer is about half that of a smoker's; your risk of getting bladder cancer is half that of a smoker's; your risk of getting cervical cancer or cancer of the larynx, kidney, or pancreas decreases 15 years after quitting: your risk of coronary heart disease is the same as that of a nonsmoker

hCG declines over following _____________ (post 6 weeks from conception) and stabilizes for remainder of pregnancy.

4-6 weeks

When is the max level of hCG obtained?

6 weeks after conception

UTI Home Test and AZO test strip detect ___% of infections

90%

What is the accuracy of pregnancy tests?

90% at first day of missed period 97% at 1 week after missed period

What is the accuracy is male fertility testing?

Accuracy between 82.4% and 98%

Define 'Advise' in the 5 A's:

Advise to quit Clear, strong, personalized message "I am concerned for your health. I know you have had a heart attack and I don't want to see you have another one because of your smoking habit." "Quitting smoking is the best ting you can do for your overall health." "Use of cessation medications can help you be successful."

What is the selection criteria for home testing?

Appropriateness of testing Ability to accurately conduct the test and interpret the results Potential interferences with test results

Define 'Arrange' in the 5 A's:

Arrange follow up -Contact within 1 week of quit date -Encourage continued abstinence -Check for relapse

What are the 5 A's for smoking cessation?

Ask Advise Assess Assist Arrange

What is the brief intervention of 5 A's for smoking cessation?

Ask Advise Refer

Define 'Ask' in the 5 A's:

Ask about tobacco use "Do you use any tobacco products regularly or socially?" May also consider second hand smoke exposure

Define 'Assess' in the 5 A's:

Assess readiness to quit: -Not ready to quit in next month = 5 Rs -Ready to quit in next month -Recent quitter (last 6 months) -Former tobacco user Can also assess tobacco use: -what? -how much? -tried to quit before?

Define 'Assist' in the 5 A's:

Assist with quitting -Encourage them to decide to quit -Set a quit date -Offer pharmacotherapy -Referral to provider, quitting service

Describe the behavioral aspect and treatment approach for smoking cessation:

Behavioral aspect: the habit of using tobacco treatment: behavior change program

Adverse effects of tobacco use (others; Not all inclusive)

Cancers Infertility SIDS Cataracts Osteoporosis Dental disease Ulcers Poor wound healing

Fact about cigarette smoking:

Cigarette smoking is the "chief, single, avoidable cause of death in our society and the most important public health issue of our time."

What is Basal Thermometry?

Concept of using basal body temperature (BBT) to predict time of ovulation When to measure - each morning before arising Plot temperature reading on graph (app for that) Observe patterns for temperature elevations=> optimal time for intercourse

What are the disadvantages of selection criteria of home testing?

Costly Complicated Timing Interpretation Less Sensitive Avoid appropriate care

Non-pharmacologic self-care options for smoking cessation:

Counseling For all tobacco users: 5 A's For those not interested in quitting: 5 R's Ready to quit Recently quit

What is a fecal occult blood test (FOBT)?

Detection of GI bleeding that may be associated with colon cancer Blue-green color= positive result

The AZO test strips detects:

Detects BOTH nitrites and leukocyte esterase (LE)_, an enzyme unique to WBCs, found in urine when a UTI is present LE is produced by gram-negative and gram-positive bacteria.

Misc. Tests: My Allergy Test detects:

Detects allergy to 10 most common allergens Dust, mites, cat hair, mold.

The UTI Home Test detects:

Detects nitrites -gram negative bacteria reduce nitrate in the urine to nitrite

What is the mechanism of pregnancy detection tests?

Detects the presence of hCG in the urine

How do at home urine drug tests work?

Detects use of drugs 2-3 days before testing to within several hours of testing Reports as positive or negative, not quantity or route Best for detecting casual drug use

What is an essential part of checking blood pressure accurately?

Determining Appropriate Cuff Size (essential)

How does a hair (PDT-90) drug test work?

Drug use over 90 day period can be determined from a 1.5 inch hair sample Reports as low, medium, or high levels of use for all drugs except marijuana which is reported only as positive or negative Mail-in for results Hair tests good for detecting chronic use

Treatment goal and approach for smoking cessation:

Goal: Long-term abstinence from all nicotine-containing products Approach: Best: Counseling + pharmacotherapy

Adverse effects of tobacco use (CV disease)

Heart attacks Strokes, blood clots Circulation problems

Why hepatitis virus is there an at home test for?

Hep C

What are the key counseling points of pregnancy tests?

Hold test stick in urine stream OR dip in collected specimen (not wax cup or soap residue) appropriate length of time First morning urine Urine warmed to room temp if refrigerated Restrict excess fluid Most accurate if at least 1 week after expected period If negative, test again in 1 week if no menstruation

Home Testing

Home testing

Urinary Hormone Fertility Tests is similar to the mechanism of pregnancy tests but differ by: ____________________

LH hormone surge is primarily being detected (E3G is also included in some tests as rises and falls similar to LH)

How would the basal thermometer be used properly?

Measurement of oral, rectal, or vaginal temperatures with a basal thermometer must use same method each time

When should a patient see their PCP after a cholesterol check at home?

If the total cholesterol reading is ≥200 mg/dL, HDL-C is ≤40 mg/dL, or triglycerides are ≥150 mg/dL, see a health care provider for evaluation and further testing.

Interferences and patient counseling of UTI tests:

Improper clean catch midstream urine sample into clean, unwaxed cup Use during menses Strict vegetarian diet (insufficient urinary nitrates) Dyes or certain medications Phenazopyridine (orange color)-dye changes sensor pad to pink Tetracycline- blocks nitrite test reaction= risk of false negative Vitamin C- blocks nitrite test reaction = risk of false negative

What should the patient do before taking a FOBT?

Increase fiber for several days before testing (stimulates bleeding from lesions if present) Do NOT take aspirin and NSAIDs for 2-3 days before or during testing (acetaminophen is OK)

What are some common interferences of checking blood pressure?

Interferences: (Increase blood pressure) -Stress -Smoking -Exercise within 30 minutes of checking BP -Ingestion of caffeine-containing beverages -Medications: (e.g. pseudoephedrine) -Measuring over clothing (should use bare arm) -Full bladder

Describe the withdrawal with nicotine addiction:

Irritability, frustration Difficulty concentrating, poor performance Impatience Cravings (weight gain) Anger, anxiety, depression Insomnia, restlessness Constipation

pharmacologic self-care options for smoking cessation:

Nicotine replacement: patch, gum, lozenge

Describe how nicotine addiction works:

Nicotine triggers dopamine release in brain's nucleus accumbens, the "Reward Center" Inhaled nicotine can reach the brain in seconds

What are two examples of home HIV tests?

OraQuick and myLABBOX HIV I and II tests

Describe the physiological aspect and treatment approach for smoking cessation:

Physiological aspect: addiction to nicotine treatment: medications for cessation

Describe the "reward" with nicotine addiction:

Pleasure Arousal Cognitive, learning & memory enhancement Appetite suppression Mood modulation Feeling of reduced anxiety, tension

Describe withdrawal symptom presentation, peak, etc in regards to time

Present within hours, first 1-2 days Peak at 1-2 weeks Decrease over 2-4 weeks Can persist for months after quitting ~72 hours later average 6 cravings per day the avg crave episode lasts less than 3 min

Directions for Toilet Test Product: EZ-Detect™ (lengthy)

Remove toilet tank cleansers or deodorizers. Flush toilet *2 times* before testing Use 1 test pad to perform a *water quality* check. No blue cross color should appear. Immediately after a bowel movement (BM), float a pad in the toilet bowl, printed side up. After 2 minutes check for the appearance of blue cross on the test pad (positive result) Repeat the test on the next *2 BMs (for a total of 3 BMs)* If negative for all 3 tests, use remaining pad for a *quality control* check using the positive control chemical package provided in the kit. (Flush the toilet and empty positive control contents of the package into the bowl as it refills). Float the pad in the water, printed side up. Presence of blue cross means pads are working properly.

Resting basal body temp is usually between _____ and _____ during the first part of the reproductive cycle.

Resting BBT = 96 F - 97.5 F (35.5 C - 36.4 C)

First Response Early Result has best ________ and ___________

Sensitivity and reliability <6.3mIU/mL

Counseling points for male fertility:

Spermicidal condoms may interfere Collection < 2 days after last ejaculation may decrease count Ideally collect 2-7 days after last ejaculation and test within 3 hours of collection

The patient should test how many times for a FOBT, and for what reason?

Test 3 consecutive BMs to increase chances of detecting bleeding from cancerous lesion

Misc. Tests: TobacAlert tests for:

Tobacco use, tests urine for cotinine

Red meat should be avoided for how many days before a FOBT? and why?

Undigested red meat*- avoid 2-3 days before and during test period as test is not specific for human blood

Describe a cycle of nicotine addiction:

Use tobacco --> nicotine reaches brain --> feel relief, pleasure --> nicotine levels drop --> feel discomfort, withdrawal

How does Vitamin C interfere with cholesterol tests?

Vitamin C > 500mg (artificially low result because slows the development of color reaction)

Presence of LH in hormone fertility test means:

increased chances of conceiving over the next 48 hours

Combining both the UTI Home Test and AZO test strip does what?

increases overall sensitivity and specificity.

Define 'Repetition' in the 5 R's

motivate person to quit or remain abstinent at each encounter

Define 'Risks' in the 5 R's

negative consequences of tobacco use

Treatment for tobacco dependence should address both: _____ and _____ aspects of dependence

physiological and behavioral aspects

CuroL5 is used to test _______ and is (reusable/not reusable)

total cholesterol, LDL, HDL, triglycerides; Reusable, stores results

CholesTrak is used to test _______ and is (reusable/not reusable)

total cholesterol; not reusable

CardioChek is used to test _______ and is (reusable/not reusable)

total, HDL-C, triglycerides, glucose, ketones; Reusable, stores results

Common symptoms of UTIs:

urinary frequency, urgency, dysuria, blood in urine Elderly may present with all, some, or no symptoms

What is the adequate sperm concentration when testing male fertility?

≥20 million cells/mL (M/mL)