healthy pop exam 3

Why would an MRI be recommended as a screening tool for breast cancer?

a. If you have an abnormal mammogram - can show extent of abnormality

Haemophilus Influenzae Type B Conjugate Vaccine (HIB)

i. Given as a 3 or 4 dose series in children under 5 years (depending on brand) ii. Prevents the Haemophilus influenzae bacterium that can cause meningitis, pneumonia, epiglottitis, and death

HPV vaccine

i. Given in 2 doses 6-12 months apart at age 11-12 years old - given to boys and girls ii. Protects against HPV std

Measles, Mumps, and Rubella (MMR) vaccine

i. Given in 2 doses for children under 18 years old: 12-15 months and then again at 4-6 years old ii. Protects against measles, mumps, and rubella

What is an alternative to having a colonoscopy to detect colon cancer if a patient does not want to get a colonoscopy?

Occult stool sample and FITT testing

What is PEP? Who should take it? When does it need to be started?

a. Post-exposure prophylaxis --- Taking antiretroviral meds (ART) after a potential exposure to prevent HIV b. If condom broke during sex c. If sexually assaulted d. Healthcare worker exposed at work e. Used in emergency situations à needs to be started within 72 hours

What is PrEP? Who should take it?

a. Pre-exposure prophylaxis --- Daily oral medication to prevent HIV b. Fort those at risk of contracting HIV is who should take this --- Has HIV+ partner --- Has multiple partners and doesn't consistently use condoms --- Injects drugs and shares needles

What is primary prevention?

a. Precedes disease/dysfunction b. Interventions i. Health promotion (e.g., education) ii. Specific protection (e.g., immunization, reducing exposure to carcinogens, occupational hazards) c. Goal: maintain/improve general health of the individual/family/community d. Passive: not personally involved i. Public health efforts - clean water/sewer e. Active: personally involved i. Lifestyle changes

What are the possible prevention approaches for STIs?

a. Primary: education to prevent b. Secondary: Screen and treat early (also treat partners)

Besides the primary objective of health screenings (detecting the disease early), what else can we accomplish with health screenings?

a. Reduced disease progression b. Early disease treatment c. Reduced asymptomatic pathogenesis d. Reduced health care costs e. Not diagnostic or curative i. It is a preliminary step to identify people who need further diagnostic workup

What is secondary prevention?

a. Screening i. Goal: identify individuals in early, detectable stage of disease b. Treating early stages of disease c. Limiting disability because you go to it in time d. Interventions similar to primary prevention but applied to individuals/ populations with disease

Why are health screenings valuable tools?

a. Screening is an important component of clinical preventive services because it is a valuable tool for health care professionals to identify acute and chronic conditions, and risk factors before the condition becomes costly both in financial terms and in quality of life

sensitivity

a. Sensitivity: i. We want all patients with disease to test positive. Don't want to miss anyone ii. A test with good sensitivity = False negatives will decrease iii. the proportion of people who correctively test positive when screened

What does a "D" rating from the USPSTF tell you about the benefit of a particular health screening?

a. The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits i. Discourage the use of this service

What do you know about the claim of a connection between vaccines and autism spectrum disorder (ASD)?

a. There has been concern in the past that autism spectrum disorder might be linked to vaccines i. No link has been found b. Another concern was about ingredients in vaccines, especially thimerosal (a preservative containing mercury) i. Research shows thimerosal does not cause ASD ii. It is no longer present in childhood vaccines except for some multi-dose vials of influenza vaccines

How is AIDS transmitted? PPT

a. Transmitted by exchange of body fluids i. Sexual intercourse, shared needles, infected blood (maternal-fetal transmission)

What is syphilis treated with? If untreated, what may occur in the tertiary stage of syphilis?

a. Treated with Penicillin G. b. It can cause issues for multiple organ systems or death

What happens if both partners are not treated for an STI, like trichomoniasis?

a. Trichomoniasis is considered a ping-pong STI's à the newly treated partner can immediately be re-infected if re-exposed to the organism if both partners are not treated

How can nurses become more culturally competent?

a. Understanding self - having self-awareness - recognizing personal opinions, attitudes, and beliefs b. Managing bias c. Being open-minded d. Experiencing different cultures

What are some possible signs and symptoms of STIs?

a. Unexpected nonbloody vaginal discharge (increased amount, unusual color, or odor) or vaginal bleeding. b. Vulvar itching or swelling. c. Pelvic pain, including painful intercourse, painful urination, and abdominal tenderness. d. Skin eruptions or changes (rashes, ulcers, warts, blisters). e. Flu-like symptoms (fever, swollen or painful lymph glands, loss of appetite, nausea or vomiting). f. Presence of symptoms in a sexual partner, even if symptoms are absent in the client.

At what age should women be screened for cervical cancer?

a. Via Pap test beginning at 21 years old b. Women ages 21-29 - Pap test every 3 years (with HPV testing if Pap is abnormal) c. Women ages 30-65: Pap test + HPV test every 5 years or just a Pap test every 3 years d. Women 65 and older: can stop testing if no history of moderate to severe abnormal cervical cells and cervical testing in the past 10 years was normal

At what age does the US Preventive Services Taskforce (USPSTF) recommend starting colorectal cancer screening?

age 45

specificity

b. Specificity i. We want all patients without disease to test negative. Don't want to tell someone they are positive for the disease when they don't have it. ii. A test with good specificity = false positive decreases iii. A test with poor specificity = false positives increase iv. You want high sensitivity in a test and high specificity

rotavirus

i. Given as a 2-dose series at 2 and 4 months or a 3 dose series at 2,4, and 6 months of age (depending on brand) ii. Given to children to prevent rotavirus - common cold

Hepatitis A Vaccine

i. Given as a 2-dose series separated by at least 6 months 1. Starting at 12 months old ii. Protects against hepatitis A viral infection which causes jaundice, diarrhea, fever, and weakness

pneumococcal vaccine (PCV)

i. Given as a 4-dose series at 2 months, 4 months, 6 months, and 12-15 months ii. Protects against pneumococcal bacterial infection that can cause pneumonia, meningitis, endocarditis, and death

Diphtheria, Tetanus, and Acellular Pertussis Vaccine (DTaP)

i. Given as a 5-dose series: 2 months, 4 months, 6 months, 15-18 months, and again at 4-6 years of age 1. Then booster (Tdap) given at 11-12 years old and again every 10 years (Tdap or Td) ii. Prevents against diphtheria - breathing problems and paralysis iii. Prevents against tetanus - tightening of muscles in jaw (lockjaw) iv. Prevents against pertussis (whooping cough) - coughing spells and pneumonia

hepatitis B vaccine

i. Given as a series of 3 - birth, 1 month, and 6 months ii. Series completed by 6-18 months iii. Prevents against Hepatitis B - viral infection transmitted through blood or body secretions

varicella vaccine

i. Given in 2 doses to children under the age of 13 years 1. Given first at 12-15 months and second dose at 4-6 years ii. A live, attenuated immunization to protect chicken pox virus

Inactivated Polio Vaccine (IPV)

i. Given in 4 doses in infants and children: 2 months, 4 months, 6-18 months, and at 4-6 years old ii. Protects against polio virus which is a highly infectious viral disease that attacks the central nervous system

Meningococcal Conjugate Vaccine

i. MenACWY vaccine given at 11-12 years old with a booster at 16 years old ii. Protects against strains A, C, W, Y of meningitis

active immunity

i. Protected produced by a person's own immune system ii. Usually lasts for many years iii. One way to acquire active immunity is by surviving an infection another way is a vaccination iv. Ex: chickenpox

Meningococcal B Vaccine

i. Recommended for those 10 years and older who are at increased risk for serogroup B meningococcal disease ii. Only protects against serogroup B meningococcal disease

influenza vaccine

i. Routine vaccine for everyone over the age of 6 months ii. To protect against influenza

passive immunity

i. Transfer of antibodies produced by one person or animal to another ii. Provides short immunity, usually 1-6 weeks iii. Ex: Occurs in newborns when antibodies are passed from mom through placenta or in breast milk

HIV screening

o 1.2 million people in US had HIV at end of 2021 § Of those, 13% didn't know they had it o CDC recommends everyone between 13 and 64 get tested at least once o Providers must assess risk factors regularly

breast cancer

o 2nd most common type of cancer among women o Risk increases with age o Nulliparous women: highest risk o Women who had their first child before age 20: lowest risk o Types of Screenings: § Self-Breast Exams § Clinical Breast Exams § Mammograms § MRI (Magnetic Resonance Imaging)

What medication may be used to treat HSV and when is it most effective? PPT

a. Acyclovir (antiviral) for first outbreak --- Early treatment is important! --- Treats symptoms only, not virus - no cure

Know the key organizations that provide guidelines for health screenings.

a. American Cancer Society b. U.S. Preventative Services Task Forces (USPSTF) c. American College of Obstetricians and Gynecologists (ACOG) d. National Cancer Institute (National Institute of Health)

What rating does the USPSTF give the PSA antigen test for screening for prostate cancer? What is another method of checking for prostate cancer during an exam?

a. C (men who are 55-69) - D (men who are over 70) rating b. Digital rectal exam

What are several of the cancers that HPV may cause? PPT

a. Cervical, penile, anal, oropharyngeal

Which STIs are reportable?

a. Chlamydia b. Gonorrhea c. Hepatitis B d. HIV e. Syphilis f. Chancroid

What is tertiary prevention?

a. Defect/disability permanent or irreversible (e.g., stroke) b. Minimizing effect to prevent complications/deterioration c. Goal: focus on rehabilitation to help people attain and retain an optimal level of functioning i. Maximize remaining capacity

What complications or conditions are associated with PID?

a. Ectopic pregnancy b. Infertility (major cause) c. Chronic pelvic pain

How often do patients on PrEP need to see their healthcare provider?

a. Every 3 months

Who should get the flu shot?

a. Everyone 6 months of age and older should get a flu vaccine every season

Who does the CDC recommend receiving the HPV vaccination and at what ages? PPT

a. Girls and Boys receive HPV vaccine (Gardasil) b. At age 11-12 (2 dose series, 6-12 months apart)

Which STIs are bacterial and treated with antibiotics? PPT

a. Gonorrhea b. Syphilis c. Chlamydia d. Trichomoniasis e. Bacterial Vaginosis (BV) f. Vulvovaginal Candidiasi

How infectious is HIV compared to Hepatitis B?

a. HIV doesn't have a vaccine - Hepatitis B has a vaccine (series of 3) b. HIV is an STD that you cannot get rid of, no specific cure for Hepatitis B c. Hepatitis B is 50-100 times more infectious than HIV d. Hepatitis diagnosed by Hepatitis B antibody test e. HIV testing options: blood, oral swab, urine --- Positive result from antibody test requires 2nd confirmation test

Which STIs are viral that may be treated with antivirals? PPT

a. HIV/AIDS b. Hepatitis B c. Genital Herpes (HSV) d. HPV/Genital Warts e. Cytomegalovirus

Who should not get a live vaccine?

a. Immunocompromised b. Pregnant women

Know some disadvantages to health screenings

a. Imperfection and margin of errors i. Anxiety over false positives b. Cost c. Follow-up is not guaranteed d. Difficulty engaging in screening and follow-up

Why is herd immunity so important?

a. It protects those who are not eligible for certain vaccines (i.e., pregnant women, immunocompromised, infants) b. Occurs when majority of the population is protected against disease through immunizations

What should a person's total cholesterol reading be under?

a. Less than 200mg/dL

What is the difference between live/attenuated and inactivated vaccines?

a. Live/attenuated i. Contain a modified living version of microorganism ii. Ex: chickenpox b. Inactivated i. Contain a dead microorganism ii. Ex: flu vaccine

When does seroconversion occur with HIV infections? (meaning when are antibodies formed that can be picked up on a diagnostic test) PPT

a. Occurs within 3-12 weeks for most people

What is PID? Which two STIs are more likely to cause PID

a. Pelvic inflammatory disease --- Infection of upper genital tract in females b. Most cases are caused by untreated gonorrhea and chlamydia infection

prostate cancer

o 2nd most common type of cancer in males in US o Approximately 1 in 8 men will be diagnosed with prostate cancer in his lifetime o Risk factors: § Older age § African Americans o No standard test to screen o Men aged 50 and older: Discuss screening with health care provider § If testing is recommended: PSA blood test with OR without digital rectal exam § PSA blood tests have high false-positive rates o If patient has a family history or is African American, discuss testing with provider beginning at age 45

osteoporosis screening

o Age is the most important non-modifiable risk factor § Women and men over age 50 are at an increased risk for osteoporotic fractures o Risk factors: small, thin frame; Caucasian or Asian descent; smoking/alcohol use; certain meds; poor intake of calcium o Disease of bone loss more common in women 65 years and older § Drop of estrogen in menopause moves calcium into bloodstream = weak, brittle bones

type 2 diabetes screening

o American Diabetes Association (ADA) recommends screening: § All asymptomatic adults who are overweight or obese and have 1+ diabetic risk factors such as · Sedentary lifestyle (physical inactivity) · Hypertension · CVD · Family history § All other patients should start screening at age 45 o If results are WNL, screening should be repeated at least every 3 years

HIV/AIDS

o CDC advocates routine voluntary testing § Options for testing: blood, oral swab, urine § Positive result from antibody test requires 2nd confirmation test § HIV testing in pregnancy § Counseling for HIV testing · Nurses must consider confidentiality and documentation o Treatment with anti-retroviral therapy (ART) § Ex: Retrovir § Often a cocktail of drugs o No cure, but supportive & preventative care to prolong life expectancy

hepatitis B

o Caused by Hepatitis B virus § Affects the liver, often a silent infection § Spread through sexual contact, contaminated blood, body fluids, or maternal-fetal transmission · Can live for 7 days outside the body on inanimate objects § Contaminated needle stick risk= I in 3 contracting Hepatitis B o Diagnosed by Hepatitis B antibody test o No specific treatment available o Vaccination available § Series of 3 given to children (birth, 1 month, 6 months)

genital herpes

o Caused by Herpes Simplex Virus (HSV) § HSV-1: transmitted non-sexually generally § HSV-2: transmitted sexually generally o Initial infection characterized by multiple painful fluid filled lesions, fever, chills, malaise, and severe dysuria o Diagnosed by HSV culture or viral test o Acyclovir (antiviral) for first outbreak § Early treatment important!!!! § Treats symptoms only, not virus - no cure § Prescribed during pregnancy § Wear gloves, can get through small cut in the skin or abrasion

genital warts

o Caused by Human Papillomavirus (HPV) o Symptoms § Small soft papillary swellings § Irritating vaginal discharge with itching § Dyspareunia, postcoital bleeding o Diagnosis § Physical inspection o Treatment § No cure but options to manage symptoms

gonorrhea

o Caused by Neisseria gonorrhoeae o Symptoms: often asymptomatic § Females: dysuria, irregular bleeding § Males: dysuria, discharge o Diagnosed by culture o Treat w/ antibiotics § Drug resistant strains are on the rise § Treat partner(s) o Can lead to PID, infertility, ectopic pregnancy o A reportable communicable disease

syphilis

o Caused by Treponema pallidum o Transmitted through sexual intercourse, kissing, biting or maternal-fetal o Diagnosed through VDRL, RPR blood tests § All pregnant women should be screened · This is a very serious problem § Systemic disease that can lead to death · Primary syphilis · Secondary syphilis · Tertiary syphilis o Treatment available: Penicillin G. o Abstinence during treatment

trichomoniasis

o Caused by Trichomonas vaginalis (protozoa) o Often asymptomatic § Vaginal discharge, inflammation, dysuria may be present o Diagnosed by wet mount culture or rapid test o Treatment with one dose of metronidazole (Flagyl) § Must also treat partner (ping-pong STI's)

chlamydia

o Caused by chlamydia trachomatis § Most frequently reported bacterial STI in U.S. § Often asymptomatic § Diagnosed by culture or antibody test o Treatment available with antibiotics § Must treat patient and partners o Screen pregnant patients as it can lead to neonatal infection o One of leading causes of preventable infertility, urethral scarring, and PID

hypertension screening

o Hypertension is a leading risk factor for heart disease, stroke, and heart attacks o Detecting high BP is a primary prevention strategy for coronary heart disease, cerebrovascular disease, and peripheral vascular disease o Periodic screening for all individuals age 18 and over

cholesterol (lipid screening)

o Major modifiable risk factor for heart disease and stroke o Frequency of screening § Screen once between 9 and 11 y/o (before puberty) § Screen once between 17 and 21 y/o (after puberty) § Screen every 4-6 years in adulthood § If family history of early heart attacks or heart disease, or child is obese or diabetic, may need more frequent screenings

HPV

o Many different types of HPV § Often, HPV goes away on its own without causing problems § But if it doesn't, it can cause genital warts and cancer (cervical, penile, anal, oropharyngeal) o Spread through vaginal, anal, or oral sex o No test to find out HPV "status" other than HPV testing that can be done with Pap o Prevention § HPV Vaccine: protects against several cancer-causing strains and some strains that cause genital warts

COVID-19 vaccine

o Teach our immune system to recognize and fight the virus that causes COVID-19 o Takes several weeks after vaccination for the body to build immunity against virus

cervical cancer

o Used to be a leading cause of cancer death in US o ACOG (2022) recommends: § Cervical Cancer Screening via a Pap test beginning at 21 years old § Women ages 21-29: Pap test q 3 years (with HPV testing if Pap is abnormal) § Women ages 30-65: Pap test + HPV test q 5 years OR just a Pap test every 3 years § Women 65 and older: Can stop testing if no history of moderate to severe abnormal cervical cells AND cervical testing in the past 10 years was normal

advantages of screenings

o Usually simple and inexpensive § Decreased time and cost of healthcare personnel o Individual or group screenings o Ability to provide one-test/ disease-specific screenings (i.e. blood pressure) or multiple test screenings (blood test for glucose and cholesterol level) o Opportunity to provide education

intraobserver reliability

same person able to reproduce the results several times

interobserver reliability

same result when 2 individuals perform the test

Neisseria meningitidis

§ Closely r/t bacteria that causes gonorrhea - symptoms can be similar

mycoplasma genitalium

§ Often no symptoms but if left untreated can lead to infertility § Resistant to many atb but more expensive ones are effective

shigella flexneri

§ Spread through anal sex § Concern about it becoming resistant to antibiotics

Why is cultural competency important?

a. "The adaption of care in a manner that is congruent with the client's culture" b. The ability to work effectively with people, regardless of cultural differences

What should a person's HDL-C reading be over?

a. 40 mg/dL

What age range should women start yearly mammograms?

Women aged 45-54