Primary and Secondary Prevention Flashcards
Primary Prevention
Preventing the health problem
* Immunizations
* safety counseling
* disease prevention
Secondary Prevention
Detecting disease early, asymptomatic, or in a preclinical state
* Screening tests
* BP check
* mammography
* colonoscopy
Tertiary prevention
minimizing negative disease induced outcomes
* disease is established
* adjusting therapy to avoid further target organ damage
Immunization Principles
- Remove geographic barriers - vaccinate where people are located
- When in doubt re-immunize
- IZ deffered = IZ denied - the presence of a minor illness does not necessate deferring or delay - defer only in presence of mod to severe illness with or without fever (need for hospital)
- Hive alone without annaphylaxis is not a contratindication to vaccinate
Active immunization
response to a vaccine resulting in the creation of antibodies
* protection in aticipation of possible exposure
* onset usually within 1 month
* durration years-lifelong
Passive immunization via adminstration of immune globulin
- anibody produced in another host and conferred to patient
- given post exposure - patient needs to present with risk or report of exposure
- onset within hours
- durration 6-9 months
- limited diseases - varicella, hep A/B, tetanus, rabies
Hx of Anaphylactic reaction to Neomycin
Avoid IPV, MMR, Varicella
Hx of Anaphylactic reaction to Streptomycin, polymixin B, Neomycin
Avoid IPV, Vaccinina (small pox)
Hx of Anaphylactic reaction to
Baker’s yeast
Avoid Hep B vaccine
Hx of Anaphylactic reaction to Gelatin
Avoid MMR
Anaphylaxis
Acute lifethreatenting systemic reaction that results from sudden systemic release of mediators from mast cells and basophils
* rapid onset within minutes-hours of exposure to allergen
Most common Anaphylaxis presentation
- Uticaria
- angioedema
- respiratory compromize (cough/wheeze)
- Sudden reduced BP
- GI symptoms
Anaphylaxis criteria
- Sudden onset with involvemtn of the skin, mucosal tissue or both and sudden resporitory symtoms or sudden reduced BP/symptoms of end organ dysfunction (hypotonia, incontinence) OR
- 2 or more of the following that occur suddenly - sudden skin or mucosal s/s, sudden respiratory s/s, sudden reduced BP, sudden GI symptoms OR
- Reduced BP after exposure to a known allergen (gerater than 30% decrease in systolic BP
Primary care interventions for anaphylaxis
- assess ABC
- Place pt in supine possition
- Activate EMS for ER transfer
- Admin Epi to antiror-lateral thigh - no contraindication for use in anaphylaxis
- Give H1/H2 blocker PO (diphenhydramine/famotadine)
- IV access, O2, onging monitoring
Anaphylaxis after care
- education on the use of EPI pen, potential for bi-phasic reaction, trigger avoidance
- consider Rx for PO antihistamines and systemic corticosteroids
- referral to allergist if unknown cause.
Live attenuated Virus vaccine
MMR
Varicella
intranasal influenza virus vaccine
Rotavirus (PO for infants)
Precautions to live virus
- theoretical risk in pregancy - may pass virus to fetus
- Severe immnicompromise - risk of becomminginfected
- Guidelines if HIV + ( usuallu ok if CD4 >200
- Rotaviris not for infants with severe combined immunodeficiency - recognized early ot Hx of intussusception. Shed in stool practice diaper hand hygeine