Primary prevention is defined as?
Primary prevention is aimed at preventing the health problem is the most cost-effective form of healthcare and includes immunizations, counseling about safety, injury and disease prevention.
Secondary prevention is what?
Screening with a goal to detect disease early, asymptomatic, or preclinical state to minimize its impact, includes BP screenings, mammography and colonoscopy.
Tertiary prevention is defined as?
Treatment that minimizes negative disease outcomes in established diseases. Examples include adjusting therapy to avoid further target organ damage.
Counseling about the risk for sexually transmitted infection is an example of what level of prevention?
Primary
Skin survey for cancerous lesions is an example of what level of prevention?
Secondary
Ordering influenza vaccine for a 68-year-old with DM2 is an example of what level of prevention?
Primary
Adjusting therapy to enhance glycemic control is an example of what level of prevention?
Tertiary
Checking a fasting lipid profile is an example of what level of prevention?
Secondary
Teaching the benefits of participating in a consistent program of moderate intensity physical activity is an example of what level of prevention?
Primary
In a 76-year-old man with COPD ensuring adequate illumination at home is an example of what level of prevention?
Primary
In a 76-year-old man with COPD screening for physical, emotional or financial abuse is an example of what level of prevention?
Secondary
Before we had immunizations how many children were paralyzed annually with polio? how many died annually?
10,000 were paralyzed, 3,000 died annually
Before we had immunizations how many newborns were born with congenital rubella syndrome, including developmental disability, blindness and hearing loss?
20,000
Before we had immunizations how many children were infected with measles annually? how many died?
4 million children infected, 3,000 died
What would be the worldwide death toll each year if the measles vaccine did not exist?
2.7 million measles-related deaths would be expected worldwide.
How many deaths are prevented annually by vaccinating?
9,400 with most deaths occurring in children, elderly and pregnant women
What is the estimated annual death toll related to pneumococcal disease (pne, septicemia, meningitis)?
40,000 of which 50% could be prevented with the pneumococcal vaccine.
What do the new guidelines say in regards to pre- and post vaccines meds?
Don’t give NSAIDs or APAP pre or post vaccine
When do you defer vaccines?
You defer for moderate to severe illness with or without fever only (think hospitalization)
Active immunization via vaccination onset of protection usually occurs?
Within 1 month of vaccine dose
What is active immunity?
Immunity developed in response to vaccine usually characterized by the presence of antibody in the host. Protection is on board in anticipation of possible exposure.
What is passive immunity?
The immunity conferred via immunoglobulin, given post-exposure to select infecting agents.
What is the IG duration of protection? What is IG available for?
6-9 months, Hep A, Hep B, tetanus, and rabies
What is characteristic of tetanus?
Dirty and deep
Joe is a 28-year-old man who presents with a 2-hour history of superficial laceration on the forearm that occurred when he was replacing a window pane and was cut by glass. P/E is consistent with history and record reveals TDAP vaccine given 2 years ago with documentation of primary tetanus series. When considering his immunization needs today, the NP appreciates that Joe should receive? A. A TD booster B. A TDap booster C. A dose of TIG D. No tetanus vaccine
D. No tetanus vaccine
When do you use DTap?
Children under 7 years, use DT if pertussis is contraindicated.
If a patient has a history of anaphylactic (not localized) reaction to Neomycin what vaccines are contraindicated?
IPV, MMR, Varicella
If a patient has a history of anaphylactic (not localized) reaction to Streptomycin, polymyxin B and neomycin (different than Neomycin– WTH) what vaccines are contraindicated?
IPV, Vaccinia (smallpox)
If a patient has a history of anaphylactic (not localized) reaction to Bakers yeast what vaccines are contraindicated?
Hepatitis B
If a patient has a history of anaphylactic (not localized) reaction to Gelatin, neomycin what vaccines are contraindicated?
Varicella Zoster (Zostavax)
If a patient has a history of anaphylactic (not localized) reaction to Gelatin what vaccine is contraindicated?
MMR
What do you need to administer vaccines?
An EPI pen and a phone. All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available.
Define Anaphylaxis?
Acute life-threatening systemic reaction with varied mechanisms, clinical presentations, and severity that results from the sudden systemic release of mediators from mast cells and basophils.
What is the most common presentation of anaphylaxis?
Uritcaria, angioedema, and respiratory compromise.
What is a late sign of anaphylaxis?
BP or end-organ dysfunction ie collapse, syncope or incontinence
Primary anaphylaxis procedure?
ABC, Supine on the floor, EMS, IM Epi, H1/H2 blocker, (IV, O2, monitor)
What are the contraindications for EPI?
NO CONTRAINDICATIONS
Prednisone- does IM or PO matter?
Does not matter, go oral if gut works.
Anaphylaxis reason for admitting?
Can have delayed secondary response
What do you send an anaphylactic patient home with? Referral?
Epi pen (with education), oral antihistamines and 5 days of systemic corticosteroids. Send to allergist
True or False IG is made from pooled donated blood antibodies?
True
T or F TDap should replace a single dose of Td for most adults who have not previously received a dose of Tdap in order to provide pertussis protection?
True
T or F DM2 patients should be vaccinated ASAP for Hep B?
True
Pneumococcal vaccine schedule fpor >65 years?
PCV13 followed by PCV23 one year later (PCV13 always is administered 1st in routine situations)
Infant receives oral rotavirus vaccine- can immunocompromised Grandma change her diapers?
Yes, it does have viral shedding but its deemed harmless. Standard diaper hygiene and hand washing are advisable.
When is Rotavirus contraindicated?
In cases of severe immunodeficiency. SCID
Efficacy of Shingrix vs. Zostavax?
100% VS 50%
Y or N– give Shingrix to 50-year-old starting Humira in 2 weeks?
Yes
Y or N– give Shingrix to a 65-year-old man who received one dose of Zostavax 5 years ago?
Yes
Y or N– give Shingrix to a 55-year-old man who had Shingles 3 months ago and all symptoms have resolved.
Yes
When to receive the flu shot?
Age 6 months and older, the 1st year they get 2 vaccines 4 weeks apart.
What surprising categories are considered high-risk groups for limited supply vaccines?
American indians, alaskan natives, BMI > 40
T or F if you have experienced only hives after a flu shot should you get one?
True Hives following egg exposure is not a contraindication for the flu vaccine.
Rotavirus minimum and maximum age?
1st dose at 6 weeks, max age for final dose is 8 months